BT 2022120

IHCP bulletin
INDIANA HEALTH COVERAGE PROGRAMS BT2022120 DECEMBER 29, 2022
Changes made to outlier reimbursement for eligible

out-of-state children’s hospitals
In accordance with House Bill 1112 (HB 1112), effective for inpatient hospital services with discharge dates on or after
June 1, 2022, the Indiana Health Coverage Programs (IHCP)
reimburses inpatient hospitals, including crossover claims provided
by eligible out-of-state children’s hospitals, at 130% of the
calculated Medicaid inpatient hospital outlier payment.
This increase in reimbursement applies to both fee-for-service

(FFS) and managed care claims and applies to claims for members
younger than 19 years of age.
Eligible out-of-state children’s hospitals are children’s hospitals

located in a state bordering Indiana. In addition, the out-of-state
children’s hospital must be a freestanding general acute care hospital, or a facility located within a freestanding
general acute care hospital that meets one of the following criteria:
◼ Designated by the Medicare program as a children’s hospital

◼ Furnishes inpatient healthcare services to patients who are predominantly individuals
younger than 19 years of age
The IHCP identified the children’s hospitals listed in Table 1 that are eligible to receive increased outlier
reimbursement.
Explanation of benefits (EOB) code 9046 – Out of State Children's Hospital additional payment is used to identify FFS
claim details that are reimbursed at 130% of the calculated Medicaid inpatient hospital outlier payment.
Table 1 – Hospitals eligible to receive increased outlier reimbursement

IHCP Provider ID National Provider Identifier (NPI) Hospital name
300011814 1508315516 Advocate Children’s Hospital
300012683 1235234535 Ann & Robert Lurie Children’s Hospital
300042834 1538471800 Children’s Hospital of Michigan
100069650A 1548212988 Cincinnati Children’s Hospital Medical Center
300020322 1457379448 Dayton Children’s Hospital
300037420
100275950A 1427146430 La Rabida Children’s Hospital
100069780A 1134152986 Nationwide Children’s Hospital
100069740A 1982609442 Norton Children’s Hospital
100034170A 1831195908 Norton Women's & Children’s Hospital
201076690A 1376656538 Shriners Hospitals for Children (Chicago, IL))
201065990B 1659590644 Shriners Hospitals for Children (Dayton, OH)
300030841 1093894990 University of Chicago – Comer’s Children’s Hospital
Page 1 of 2
IHCP bulletin BT2022120 DECEMBER 29, 2022
If a hospital meets the requirements of HB 1112 and has not been contacted by the IHCP, please contact Myers and
Stauffer LC at [email protected]. If a hospital does not meet the requirements of HB 1112, the hospital is not
eligible for this payment program.
Managed care and FFS claims will be mass adjusted.
Inpatient FFS claims with discharge dates on or after

June 1, 2022, through Dec. 28, 2022, will be mass adjusted
to apply the increased reimbursement. Mass adjusted claims
will appear on Remittance Advices (RAs) beginning on or
after Feb. 8, 2023, and will be identified with internal control
numbers (ICNs)/Claim IDs that begin with 52 (mass
replacements non-check related).
Managed care claims following the same DOS criteria as

FFS claims will be mass adjusted. The timing of the mass adjustment will vary by each managed care entity (MCE).
Reimbursement for inpatient claims for members enrolled in the Healthy Indiana Plan (HIP) will remain unchanged.
The reimbursement change applies to managed care claims for members enrolled in Hoosier Care Connect and
Hoosier Healthwise.
The following information applies to the MCEs processing affected Hoosier Care Connect and Hoosier Healthwise
claims:
◼ Mass adjustments were reprocessed on the dates listed:
− CareSource – Aug. 5, 2022
− MHS – Oct. 15, 2022
◼ Providers will see the mass adjustment on RAs no later than the following dates:
− MDwise – 45 days after the bulletin is published
− Anthem – 60 days after the bulletin is published
◼ No claims were impacted at UnitedHealthcare.
QUESTIONS?
If you have questions about this publication, please contact Customer Assistance at 800-457-4584.
COPIES OF THIS PUBLICATION SIGN UP FOR IHCP EMAIL NOTIFICATIONS

If you need additional copies of this publication, To receive email notices of IHCP publications, subscribe
please download them from the IHCP Bulletins by clicking the blue subscription envelope
page of the IHCP provider website at or sign up from the IHCP provider website
in.gov/medicaid/providers. at in.gov/medicaid/providers.
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IHCP bulletin

INDIANA HEALTH COVERAGE PROGRAMS BT2022120 DECEMBER 29, 2022

Changes made to outlier reimbursement for eligible

This increase in reimbursement applies to both fee-for-service

Eligible out-of-state children’s hospitals are children’s hospitals

◼ Designated by the Medicare program as a children’s hospital

Table 1 – Hospitals eligible to receive increased outlier reimbursement

Managed care and FFS claims will be mass adjusted.

Inpatient FFS claims with discharge dates on or after

Managed care claims following the same DOS criteria as

◼ Mass adjustments were reprocessed on the dates listed:

− CareSource – Aug. 5, 2022

− MHS – Oct. 15, 2022

− MDwise – 45 days after the bulletin is published

− Anthem – 60 days after the bulletin is published

◼ No claims were impacted at UnitedHealthcare.

COPIES OF THIS PUBLICATION SIGN UP FOR IHCP EMAIL NOTIFICATIONS

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