Podiatry HHWHIPP 0552318 Providing health coverage to Indiana

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Podiatry HHW-HIPP 0552(3/18) Providing health coverage to Indiana families since 1994

Podiatry HHW-HIPP 0552(3/18) Providing health coverage to Indiana families since 1994

Agenda • Provider Requirements • Program Coverage • Hoosier Healthwise Package A • Hoosier

Agenda • Provider Requirements • Program Coverage • Hoosier Healthwise Package A • Hoosier Healthwise Package C • Healthy Indiana Plan • Code Sets • Claim Requirements • Reimbursement 2

Provider Requirements Podiatry is a self-referral specialty To provide services to members, providers must

Provider Requirements Podiatry is a self-referral specialty To provide services to members, providers must be: • An IHCP provider • Qualified to render podiatry services o Enrolled with a specialty 140 (podiatrist) o Practicing within the scope of his or her medical license 3

Program Coverage Hoosier Healthwise Package A Hoosier Healthwise Coverage • Podiatry is a self-referral

Program Coverage Hoosier Healthwise Package A Hoosier Healthwise Coverage • Podiatry is a self-referral service, however, for routine foot care services, all IHCP members are subject to the restrictions described in the Routine Foot Care section of the IHCP Podiatry Module. Hoosier Healthwise Package A covers: • Surgical procedures involving the foot • Laboratory or X-ray services • Hospital stays when medically necessary • No more than six routine foot care visits per year • Out-of-State podiatric services o Limitations are the same as instate services 4

Program Coverage Hoosier Healthwise Package C covers: • Surgical procedures involving the foot •

Program Coverage Hoosier Healthwise Package C covers: • Surgical procedures involving the foot • Laboratory or X-ray services • Hospital stays when medically necessary • Out-of-State podiatric services o Coverage is subject to any limitations included in the CHIP benefit package • Routine foot care services are not covered 5

Program Coverage Healthy Indiana Plan Coverage • Self-referral within the MDwise network HIP Podiatry

Program Coverage Healthy Indiana Plan Coverage • Self-referral within the MDwise network HIP Podiatry services are available for: o HIP State Basic o HIP State Plus • HIP coverage only available for individuals with lower extremity circulatory disorders including diabetes 6

Code Sets Podiatry services are reimbursed based on the Podiatry Service Codes provided by

Code Sets Podiatry services are reimbursed based on the Podiatry Service Codes provided by IHCP Code Sets: http: //provider. indianamedicaid. com/generalprovider-services/billing-and-remittance/codesets. aspx • Table 1 – Covered Procedure Codes for Podiatrists (Specialty 140) • Table 2 – Procedure Codes for Routine Foot Care • Table 3 – ICD-10 Diagnosis Codes for Routine Foot Care Coverage • Table 4 – Procedure Codes for Therapeutic Shoes for Severe Diabetic Foot Disease 7

Claim Requirements Submission Guidelines: • Claim submission within 90 days of date of service

Claim Requirements Submission Guidelines: • Claim submission within 90 days of date of service for in-network providers • Claim submission within 365 days of date of service for out-of-network providers • MDwise Quick Contact Guide • Claims will be adjudicated within: o 21 calendar days for clean electric claim submissions o 30 calendar days for clean paper claim submissions 8

Reimbursement Hoosier Healthwise • Claims are reimbursed based on Medicaid rates • Indiana. Medicaid.

Reimbursement Hoosier Healthwise • Claims are reimbursed based on Medicaid rates • Indiana. Medicaid. com Healthy Indiana Plan • Claims are reimbursed based on Medicare rates o If a Medicare rate is not available, services will be reimbursed at 130% of the Medicaid rate • CMS. gov 9

Resources IHCP Provider Modules • Indianamedicaid. com • Code Sets MDwise Provider Manual •

Resources IHCP Provider Modules • Indianamedicaid. com • Code Sets MDwise Provider Manual • http: //www. mdwise. org/for-providers/manual-andoverview MDwise Prior Authorization • http: //www. mdwise. org/for-providers/forms/priorauthorization 10

Questions 11

Questions 11