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FSSA update

Clarification on when a PE can be backdated when it comes to arrival time.

As stated in Indiana Health Coverage Programs (IHCP) Bulletin BT202256, the IHCP established new rules allowing for the additional reason for backdating Presumptive Eligibility (PE) start dates and allowing an advocate to help complete a PE application.

The current backdating rules are as follows:  

• When a qualified provider (QP) located in the Central time zone submits a PE application between 11 p.m. and 11:59 p.m. Central Time and is given a PE start date based on Eastern Time, which pushes the eligibility date to one day after the date of service – In this instance, the QP can submit a request to have the PE effective date changed to the date of service, which is the date the PE application was submitted from the perspective of the provider.  

• When a system outage of the IHCP Provider Healthcare Portal makes the web-based application unavailable on the date of service – In this instance, the PE application must be submitted within one day of the date of service. After the PE application is submitted and PE is established, a QP can submit a request to have the established PE effective date changed to the date of service. IHCP banner page BR202242 OCTOBER 18, 2022

IHCP is clarifying the instructions from BT202256 regarding the arrival time of the PE applicant in this scenario:

• An applicant arrives at the provider one hour before midnight, and an application cannot be filed until after midnight. To clarify, when an applicant arrives at the provider one hour before midnight and the application cannot be filed until after midnight, the PE application must be filed by close of business (5:30 p.m.) the following day in order to update the PE effective date of service.

To submit a backdate request, send the Member ID of the PE member, the date to backdate to, and reason for the request to [email protected]. This request must be sent to the mailbox within 24 hours of the first date of service. Please note, restrictions around the timely submission of the PE application do not apply to incarcerated individuals. If there are any questions regarding this rule or to confirm if someone can act as an advocate, email [email protected].

To view the FSSA Banner click this link http://provider.indianamedicaid.com/ihcp/Banners/BR202242.pdf

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