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Provider Enrollment and Credentialing During the COVID-19 Emergency

Date: 05/06/20

Managed Health Services (MHS) would like to outline modified processes during the COVID-19 emergency to address changes made by FSSA in BT202029 and BT202039.

Per FSSA guidance, MHS will still require providers and practitioners to be enrolled with IHCP in order to bill for reimbursement for Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect. However, the following changes are being implemented:

Enrollment

  • MHS will be relaxing the enrollment requirement that requires the NPI of the rendering practitioner to be linked to the Group Billing NPI on the IHCP enrollment file.
    • Enrollment requests that do not meet the linkage requirement in place prior to the COVID-19 emergency will be flagged in the system and termed 90 days after the emergency is declared over, unless the provider notifies MHS that the linkage has been updated at IHCP.
    • Requests for enrolling a PCP holding a panel must still have the group linkage established with IHCP, as MHS is required to register panel-holding PCPs with the state at a linked location. If a request is received that the linkage is not established at IHCP, MHS will reach out to the group to get clarification and direction on finalizing enrollment.
  • Effective May 15, 2020, MHS will be removing the claim reject B2, Not enrolled with MHS with rendering NPI/TIN on DOS. Enroll with MHS and resubmit claim. This will allow claims to enter the MHS system even if the practitioner or provider is not yet enrolled with MHS. MHS will then enroll the practitioner as a non-contracted provider based on the information submitted on the claim unless the practitioner is not enrolled with IHCP at all. If a claim rejects B2 prior to May 15, 2020, please resubmit after the 15th.
  • Effective, May 15, 2020, MHS will remove the claim reject B1 Rendering and Billing NPI are not tied on state file. If a claim rejects B1 prior to May 15, 2020 please resubmit after the 15th.

Credentialing

MHS has established minimum standards for participation in the MHS network. The minimum standards are available in the MHS Provider manual at mhsindiana.com/providers/resources/guides-and-manuals. During the COVID-19 emergency, credentialing applications that do not meet minimum standards, but do meet the following criteria will be processed as provisional applications:

  • Current and signed application with attestation (CAQH)
  • A valid license to practice in the state in which the practitioner is located.

Additionally, MHS will review the National Practitioner Data Base report for quality assurance.

If a provider is missing documentation for full credentialing and must be provisionally credentialed, a notice will be sent to the practitioner indicating the provisional status with instructions on what must be provided in the credentialing file to ensure full credentialing. Per NCQA guidelines for provisional credentialing during the COVID-19 emergency, provisional status can last no longer than 180 days.  Practitioners who do not complete full credentialing requirements within the 180 days will be automatically changed to a non-contracted status.



Last Updated: 05/06/2020