IHCP allows providers until September 1, 2017, to update rendering provider linkages

The Indiana Health Coverage Programs (IHCP) has received a number of inquiries from providers about claim denials for explanation of benefits (EOB) 1010 - Rendering provider is not an eligible member of billing group or the group provider number is reported as rendering provider. Please verify provider and resubmit. As announced in previous IHCP publications, claims billed for services performed by a rendering provider not linked to the specific service location on the claim will deny for EOB 1010. IHCP policy requires rendering providers to be linked to the specific locations where they render services for a group practice. Further, a rendering provider's services may not be billed for a service location to which he or she is not linked. Group providers must ensure that the provider profile for each group location has the correct rendering providers linked with accurate effective and end dates. To provide financial relief to providers impacted by EOB 1010 denials, the IHCP will temporarily convert EOB 1010 to a "post-and-pay" status, meaning that the system will allow claims and claim details with this issue to pay, but the EOB 1010 message will continue to post on the RA, so providers are aware the problem exists. This temporary workaround will be in place through August 31, 2017, allowing providers ample time to link rendering providers to the appropriate group locations to support proper claims adjudication. Effective September 1, 2017, the EOB 1010 will revert to a denial status.

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INDUSTRY NEWS TAGS: Medicaid Indiana

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