Ind. IHCP Hospice Services Provider Reference Module, Section 6, Medicaid-Only Hospice Member Residing in a Nursing Facility

If a Medicaid-only hospice member residing in a nursing facility has private insurance, the hospice

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

services. When the private insurance company denies or partially pays the claim, the hospice provider can

bill the IHCP for the remaining balance for the hospice services and the room-and-board services.

If the private insurance company has denied payment for hospice services or room and board, in whole or

in part, 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 describes denial of payment for those dates of service. (For claims submitted via the IHCP

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

separately by mail, as described in the Claim Submission and Processing module.) Upon receipt of all

documentation, the IHCP processes the claim for payment.

If the member has private insurance, the hospice provider must bill the private insurance company first, and

then bill Medicare for the outstanding balance, according to the guidelines established by Medicare.