PLP Review Notice

Date: 01/22/20

Managed Health Services (MHS) provides health coverage for members enrolled in Hoosier Healthwise, the Healthy Indiana Plan (HIP), Hoosier Care Connect, Ambetter from MHS, and Allwell from MHS. Beginning immediately with this notice, all contracted providers may request Prudent Lay Person (PLP) review for Emergency Room (ER) claims billed with revenue code 450. This is applicable for all MHS plans, including Ambetter (Marketplace) and Allwell (Medicare).

A request for PLP review must be submitted with appropriate documentation to MHS, P.O. Box 3000, Farmington, MO 63640-3800. If, after review, it is determined that it would be reasonable to assume that the ER visit would be considered emergent to a lay person, the payment will be adjusted to pay at the emergent rate. Request for PLP review must be made within 120 days of the initial reimbursement date.

Please contact MHS Provider Services at 1-877-647-4848 with any questions. Thank you for being our partner in care.