Provider Blog: Transition of Care
Date: 06/15/26
Transitions in healthcare can be challenging, especially when a member is moving from one Managed Care Entity (MCE) to another. As providers contracted with IHCP, understanding and following transition of care policies is essential for maintaining continuity and quality of care.
Transition of Care – Key Responsibilities
To help you manage member MCE transitions, here are the most important provider responsibilities that ensure a smooth and effective transfer of care:
Stay up to date about changes to enrollment and reimbursement processes. This will help you prepare for upcoming adjustments to member care and coverage.
Coordinate a warm handoff when necessary. This step is crucial for transferring knowledge and maintaining uninterrupted care for members as they move between MCEs. Ideally, both the transferring and receiving entities will collaborate prior to the transition. No action will be required by providers for members to be authorized for previously approved services during the 90-day transition of care period. As Prior Authorization Approvals expire or the 90-day transition of care period ends, providers must request new authorizations from the member’s new MCE or MCE benefit management vendor.
Initiate proactive communication. Open dialogue supports the seamless transfer of care responsibilities and prevents potential gaps in information about the member or the care you’re responsible for delivering as their provider. Whether MHS is the transferring or receiving MCE, MHS will remain in close partnership with you during the transition.
Establish a follow-up protocol with the transferring or receiving MCE after the member’s transition. Confirming receipt of transferred information and addressing any issues ensures no detail is overlooked.
Meet all other requirements as outlined in the MHS Provider Manual Ch:7 Medical Management: Continuity of Care section to maintain compliance and quality standards throughout the transition process.
Change of Provider Requirements
When a provider leaves the MHS network due to Indiana Medicaid, MHS, or provider choice, it’s important to be aware of the MHS policies and procedures in place:
Members receive a 90-day continuity of care period in the case of the abovementioned scenario. During this period, if you are the member’s Primary Care Provider we appreciate your help referring them to a new specialist or doctor.
If you leave the MHS network and a member is receiving ongoing treatment or has a special condition, they must be allowed to continue seeing you as their provider during the 90-day continuity of care period — even if you are no longer in the MHS network.
By following these guidelines, you as the provider and we as the MCE help guarantee that members experience a smooth, safe, and supportive transition of care. Staying informed and proactive is key to making these transitions successful for everyone involved.
As always thank you for being our partner in care. If you have any questions or require assistance, please contact MHS Provider Services.
Resources & Support
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🌐 MHS Provider Manual: https://www.mhsindiana.com/providers/resources/guides-and-manuals.html
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