405 Ind. Admin. Code 10-9-1 : OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES — HEALTHY INDIANA PLAN —9 - Providers —9-1 - Provider enrollment

Authority: IC 12-15-44.5-9

Affected: IC 12-15-44.5

Sec. 1.

(a) With the exception of emergency services providers, a provider rendering covered services to a member shall be enrolled in the Indiana Medicaid program at the time of service in order to receive reimbursement. An emergency services provider who is not enrolled in the Indiana Medicaid program at the time of service shall enroll in the Indiana Medicaid program retroactive to the date of service in order to receive reimbursement.
(b) In order to enroll as a provider as required under subsection (a), the provider shall comply with the procedures set forth in 405 IAC 5-4-1.
(c) A provider providing covered services to members shall provide the services under a contract with a managed care organization except in the following circumstances:
(1) If the service provided is listed in 405 IAC 10-7-10.
(2) If the managed care organization:
(A) has designed an out-of-network benefit for its members; or
(B) otherwise approves the out-of-network service.

405 IAC 10-9-1

Filed 5/18/2015, 12:34 p.m.: 20150617-IR-405140339FRA
Filed 1/19/2018, 8:42 a.m.: 20180214-IR-405170484FRA