Indiana FSSA Medicaid · November 4, 2026 · Primary source
BT2026186
Summary
Indiana's Medicaid agency (IHCP) issued bulletin BT2026186 on November 3, 2026, correcting a claim-processing error that caused QMB-Only crossover claim payment logic intended only for FQHCs and RHCs to be applied to all provider types. The expanded logic, which allowed Medicare deductible and coinsurance amounts to bypass EOB code 4095, has been reversed so that only FQHC and RHC providers benefit from it. Claims for non-FQHC and non-RHC providers with dates of service on or after January 9, 2024 that were incorrectly paid will be adjusted downward, while previously denied FQHC and RHC claims from that same period will be reprocessed for payment.
What this may mean
Non-FQHC and non-RHC Indiana Medicaid providers that received crossover claim payments under the erroneously expanded logic from January 9, 2024 forward will see claim adjustments (recoupments) on remittance advices with ICN prefixes of 52 or 80. FQHCs and RHCs with previously denied QMB-Only crossover claims from the same period will receive retroactive payment upon reprocessing. The correction restores the payment policy to FQHC and RHC crossover claims only, with no prospective rule change beyond realigning system logic to original policy intent.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
Related items
- Indiana FSSA Medicaid · October 24, 2026BT2026174Score 85
- Indiana FSSA Medicaid · October 24, 2026BT202627: IHCP announces changes to applied behavior analysis (ABA) therapy servicesScore 85
- Indiana FSSA Medicaid · October 27, 2026BT2026180Score 83
- Indiana FSSA Medicaid · October 24, 2026BT202646: IHCP to require ABA agencies to be accreditedScore 83
- Indiana FSSA Medicaid · October 29, 2026BT2026182Score 80
- Indiana FSSA Medicaid · October 27, 2026BT2026151: IHCP clarifies billing guidance for providers enrolled as a CCBHC or CMHCScore 80