Ready or not, MCEs are here.
With Indiana's transition to the PathWays for Aging program, home care agencies are navigating a new landscape of challenges. Previously considered 'clean' claims are now at risk. Paradigm ensures that all your bases are covered, comparing and correcting your EVV and claim data on your behalf so that every client feels like a private pay client.
MedicaidinIndiana.
Electronic Visit Verification
EVV and home care Medicaid billing in Indiana can be confusing; here’s what you need to know.
EVV Requirements
The hybrid model in IN allows agencies can choose between Sandata or their preferred EVV software.
EVV Aggregator
Sandata is Indiana’s official EVV aggregator. Providers using different EVV systems must ensure compatibility with Sandata.
Billing Process
Billing in Indiana requires separate processing from EVV data. Providers must submit claims either through a clearinghouse or individually to the Indiana Health Coverage Programs (IHCP) portal.
Rates
Indiana stands out as one of the top-paying states for Home Care Medicaid, offering attractive rates such as $34.36 per hour for Attendant Care and $36.92 per hour for Respite services.
It's crucial to note that as Indiana transitions to a pure Managed Care Entity (MCE) model in July 2024, these MCEs may negotiate different rates with agencies. Therefore, it's vital for agencies to meticulously review every payer contract to maintaining financial stability and optimal reimbursement rates.
Payers
Until July 2024, home care agencies in Indiana have the flexibility to receive referrals and payments from the Indiana Health Coverage Programs (IHCP) as well as a variety of Managed Care Entities (MCEs). However, starting from July 2024, the system will undergo a significant transition, with MCEs becoming the exclusive entities for managing payments and referrals. These include:
- Anthem
- Humana
- United
How Paradigm can Help.
Billing
Enrollments
Eligibility
EVV Management
Training
