Ind. IHCP Hospice Services Provider Reference Module, Section 6, Dually Eligible Hospice Member Residing in a Nursing Facility

For a dually eligible (Medicare and Medicaid) hospice member residing in a nursing facility, the hospice

provider must bill Medicare for the hospice services and the IHCP for the nursing facility room-and-board

services.

If the dually eligible hospice member has private insurance, Medicare and the IHCP require the hospice

provider bill the private insurance company first for the hospice services and the room-and-board services.

If the private insurance company denies payment, in whole or in part, for the hospice services, the hospice

provider must bill Medicare for the outstanding balance according to the billing guidelines established by

the Medicare program.

If the private insurance company denies payment in whole or in part for the nursing facility room-and-board services, the hospice provider must bill the IHCP for the outstanding balance. The hospice provider

must attach to the UB-04 claim form or electronic equivalent a copy of the notice from the private

insurance company that outlines denial of payment for these dates of service. (For claims submitted via the

IHCP Portal, attachments may be uploaded electronically; for 837 transactions, attachments must be

submitted separately by mail, as described in the Claim Submission and Processing module.)