IHCP will remove age restrictions on certain diagnosis codes and mass reprocess claims that denied inappropriately

The Indiana Health Coverage Programs (IHCP) will remove the age restriction limits in CoreMMIS for specific ICD-10 diagnosis codes. According to information published by the AMA, there are no age restrictions for the diagnosis codes presented. The diagnosis codes in Table 1 may apply regardless of the patient’s age. As noted by the AMA, “These disorders generally have onset within the childhood or adolescent years, but may continue throughout life or not be diagnosed until adulthood.”1 The removal of age restrictions will apply retroactively to dates of service (DOS) on or after October 1, 2016. Claims billed with the ICD-10 diagnosis codes in Table 1 may have denied inappropriately for explanation of benefits (EOB) 4030 – The diagnosis given is not compatible with the member’s age. Effective December 7, 2017, claims that denied for EOB 4030 for the affected DOS will be mass reprocessed. Providers should see the reprocessed claims on Remittance Advice (RA) statements beginning December 12, 2017, with internal control numbers (ICNs)/Claim IDs that begin with 80 (reprocessed denied claims).