BT2026185

The Indiana Health Coverage Programs (IHCP) issued Bulletin BT2026185 on October 29, 2026, updating billing requirements for Emergency Services Only (ESO) coverage applicable to qualifying non-U.S. citizens enrolled in ESO Coverage with Pregnancy Coverage (Package B) or Emergency Services Only (Package E). Effective November 30, 2026, fee-for-service professional claims submitted on a CMS-1500 claim form or its electronic equivalent must include two elements: an approved diagnosis in the primary position for emergency or labor and delivery services, and the emergency indicator field marked on the claim for each service detail line. The bulletin defines emergency services as unscheduled episodic services provided to individuals requiring immediate medical attention following the sudden onset of an emergency medical condition. The definition of emergency medical condition tracks both Indiana Administrative Code 405 IAC 5-2-9 and 42 U.S.C. § 1395dd(e)(1): a condition manifesting acute symptoms of sufficient severity, including severe pain, such that a prudent layperson with average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to place the individual's health in serious jeopardy, cause serious impairment to bodily functions, or cause serious dysfunction of any bodily organ or part. The pregnancy-specific provision extends this standard to the health of an unborn child.