On November the 15th from December the 15th the IHCP announced that they would be turning on edits for Indiana. These edits will check EVV for non-compliant claims. This means that you may have some claims that were previously approved that will now come back denied. This will mainly happen with claims that have EVV data not matching.
The IHCP edits are intended to ensure that all providers follow the EVV requirements. This is an effort to prevent fraud and abuse in the healthcare system. With these edits, any discrepancies between the EVV data and the claim will be flagged for review and will come back in a denied status. Providers must make sure that their EVV data matches with their claims to avoid potential denial of payment. Furthermore, providers should be aware that non-compliant claims may lead to recoupment of payments previously made by the IHCP
You can read more about the bulletin announcement here.
The bulletin above states:
“Beginning Nov. 15, 2023, and continuing through Dec. 15, 2023, the IHCP will temporarily turn on EVV system edits that activate claim denials for noncompliant EVV personal care services. For noncompliant EVV claim submissions, claims will be denied between Nov. 15, 2023, through Dec. 15, 2023.”
“The IHCP will temporarily turn on EVV system edits
that activate claim denials for noncompliant EVV personal care services.”
What does this mean?
When a non-compliant EVV claim is subject to a hard edit, it means that even if it was previously approved, it’s no longer going to be eligible. Instead, it’ll come back to you denied. This will happen when EVV data is not matching on a claim.
What does my agency need to do?
- Make sure that the Sandata Aggregator is receiving recently verified EVV records.
- Check your recent claim activity and make sure it is appropriately linked to verified EVV records.
- Again, check to see if any EVV data does not match.
Billing with GEOH
We understand that claims coming back denied can be stressful. Here at GEOH we have a service that can do your billing for you. This can help you to get paid on time, and make sure your agency is in compliance. If you are interested in taking the stress out of billing set up a time below to speak to an expert that can help!
Are billing services only for large agencies?
No! GEOH can help any agency, any size with their billing and it is affordable.
