2018 IHCP Workgroups Podiatry HHW-HIPP0552(3/18)

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

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

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 Limitations are the same as instate services

Program Coverage Hoosier Healthwise Package C 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 Coverage is subject to any limitations included in the CHIP benefit package Routine foot care services are not covered

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

Code Sets Podiatry services are reimbursed based on the Podiatry Service Codes provided by IHCP Code Sets: http://provider.indianamedicaid.com/general-provider- services/billing-and-remittance/code-sets.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

Submission Guidelines: 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: 21 calendar days for clean electric claim submissions 30 calendar days for clean paper claim submissions

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

IHCP Provider Modules Resources Indianamedicaid.com Code Sets MDwise Provider Manual http://www.mdwise.org/for-providers/manual-and-overview MDwise Prior Authorization http://www.mdwise.org/for-providers/forms/prior-authorization

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