Indiana FSSA Medicaid · October 24, 2026 · Primary source
BT2024181: IHCP reminds providers not to bill Medicaid members, with some exceptions
Summary
Indiana IHCP Bulletin BT2024181, issued November 14, 2024, reminds participating providers that federal and state regulations prohibit billing Medicaid members for covered services beyond the IHCP payment determination, with limited exceptions. Under Indiana Administrative Code 405 IAC 1-1-3, providers must accept IHCP payment as payment in full, and violations constitute grounds for provider agreement termination and decertification. The bulletin details permissible exceptions for noncovered services, services lacking prior authorization, services exceeding benefit limits, and situations where a hospital utilization review committee finds continued stay is not medically necessary under 42 CFR 482.30.
What this may mean
Indiana Medicaid providers that improperly balance-bill Medicaid members for covered services face termination of their provider agreements and decertification from IHCP. Hospitals invoking the utilization review exception under 42 CFR 482.30 must follow specific procedural steps, including written notice to the patient no later than two business days after the determination, before billing the member. Providers are also prohibited from charging members for missed appointments or medical record copies.
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.
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