Medical Billing in Indiana | Hoosier Healthwise, HIP & Timely Filing

Medical Billing in Indiana: The Short Version

Indiana Medicaid is delivered through fully managed care across four programs: Hoosier Healthwise (families and children), the Healthy Indiana Plan (low-income adults via Section 1115 waiver), Hoosier Care Connect (aged, blind, disabled), and Indiana PathWays for Aging (seniors). All MCE claims carry a 180-day timely filing limit. MDwise exited the program January 1, 2026 — its members were redistributed to remaining MCEs. Elevance Health (Anthem) controls approximately 68% of Indiana's commercial insurance market and is also the largest Medicaid MCE, creating a unique environment where billing teams must strictly separate Anthem commercial workflows from Anthem Indiana Medicaid workflows. Indiana SB 480 (effective July 1, 2025) significantly reduced prior authorization burdens for fully-insured commercial plans.

Payer Landscape

Major Payers in Indiana

Payer	Type	What Billing Teams Should Know
Anthem Blue Cross and Blue Shield (Indiana)	Commercial / Blues Plan / MA	Elevance Health's Indiana subsidiary — controls ~68% of commercial market. Also Indiana's largest Medicaid MCE. Critical: Anthem commercial and Anthem Indiana Medicaid are completely separate entities with different payer IDs, fee schedules, and authorization systems. Never mix them
UnitedHealthcare	Commercial PPO/HMO / MA	Second largest commercial carrier in Indiana. Significant employer-sponsored market. UHC Community Plan also participates as Indiana Medicaid MCE — separate from commercial UHC
Cigna / Evernorth	Commercial PPO	Employer-sponsored market, particularly large Indiana employers. Standard 90-day in-network timely filing
Aetna (CVS Health)	Commercial PPO/HMO / MA	Growing commercial and Medicare Advantage presence in Indiana. Standard 90-day in-network timely filing
Humana	Medicare Advantage / Medicaid MCE	Exited employer commercial group market in 2024. Active as Medicare Advantage carrier and as an Indiana Medicaid MCE (HIP, Hoosier Care Connect, PathWays)
Indiana Medicaid (FSSA/OMPP)	Medicaid (via MCEs)	180-day timely filing applies to all programs (Hoosier Healthwise, HIP, Hoosier Care Connect, PathWays). Bill the patient's MCE directly

Medicaid Structure

Indiana Medicaid: Managed Care Entities (2026)

Administered by the Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP). MDwise exited all Indiana Medicaid programs effective January 1, 2026 — members were redistributed to the remaining five MCEs.

Plan	Programs Served	Notes
Anthem Blue Cross and Blue Shield Indiana	Hoosier Healthwise, HIP, Hoosier Care Connect	Elevance Health subsidiary. Largest MCE by membership in Indiana
CareSource Indiana	Hoosier Healthwise, HIP	Medicaid-focused nonprofit MCO. Absorbed MDwise members in January 2026
Humana	HIP, Hoosier Care Connect, PathWays	National carrier with Indiana Medicaid MCE operations
Managed Health Services (MHS)	Hoosier Healthwise, HIP, Hoosier Care Connect	Centene Corporation subsidiary. Statewide participation
UnitedHealthcare Community Plan	HIP, Hoosier Care Connect, PathWays	National MCO, Indiana Medicaid operations. Separate from commercial UHC

Filing Deadlines

Timely Filing Limits for Indiana Claims

Indiana Medicaid's 180-day window applies uniformly across all MCEs and programs. Commercial limits are contract-specific — always confirm against your provider agreement.

Payer	Timely Filing Limit	Notes
Indiana Medicaid (All MCEs)	180 days from date of service	Applies uniformly to Hoosier Healthwise, HIP, Hoosier Care Connect, and PathWays managed care claims across all five MCEs
Medicare (Original)	12 months from date of service	Federal standard (42 CFR §424.44); no contract variation
UnitedHealthcare (Commercial)	90 days from date of service	Standard commercial; some contracts allow 180 days. Verify provider agreement
Aetna (Commercial)	90 days in-network; 12 months out-of-network	Verify current contract terms
Cigna (Commercial)	90 days in-network; 180 days out-of-network	Standard commercial Cigna policy
Humana (Medicare Advantage)	365 days from date of service	Medicare Advantage plans. Humana exited employer group commercial market in 2024
Anthem BCBS Indiana (Commercial)	180 days (commercial, typical)	Verify specific product and contract. Anthem Indiana Medicaid MCE claims: 180 days (separate payer ID)

Verified against payer publications (July 2026). Filing limits change by contract and plan year — treat this table as a starting point, not a substitute for the payer manual.

IN-Specific Rules

Indiana Billing Realities to Know

SB 480 PA Reform — Effective July 1, 2025

Indiana SB 480 restricts prior authorization for fully-insured commercial plans: no PA for the first 12 PT/chiropractic visits per episode of care; PA cannot cover more than 1% of unique services or 1% of providers annually; all PA reviews require a clinical peer; step therapy restricted for qualifying low-cost FDA-approved drugs. Does not apply to self-funded ERISA plans, Medicaid MCEs, or Medicare Advantage.

Anthem Controls ~68% of Commercial Market

Elevance Health (Anthem) controls approximately 68% of Indiana's commercial market — one of the most concentrated in the country. Anthem also operates Indiana's largest Medicaid MCE. Anthem commercial policies, fee schedules, and portals are entirely separate from Anthem Indiana Medicaid. Credentialing and authorization workflows must be maintained independently for each.

MDwise Exit — Claims Runout in Progress

MDwise exited all Indiana Medicaid programs January 1, 2026. Outstanding 2025 DOS claims must be submitted to MDwise before their runout deadline. Patients previously on MDwise now have a new MCE (Anthem, CareSource, or MHS) — identify the new plan via IHCP eligibility verification. New authorizations must be obtained from the new MCE; MDwise authorizations do not transfer.

HIP Is a Unique Section 1115 Waiver Program

The Healthy Indiana Plan (HIP) operates under a federal waiver with member POWER Account premium contributions. HIP Plus (with contributions) and HIP Basic (without, reduced benefits) have different coverage provisions. Prior authorization through HIP MCEs has historically been among the more complex in the state. Always verify the specific HIP tier when providing services to HIP members.

Frequently Asked Questions

Indiana Medicaid managed care claims (Hoosier Healthwise, HIP, Hoosier Care Connect, PathWays) must be submitted within 180 days from the date of service. This applies uniformly across all MCEs (Anthem, CareSource, Humana, MHS, UHC). There is no 365-day window for Indiana managed care Medicaid. Claims approaching the 150-day mark should be prioritized for immediate resolution.

SB 480 (Public Law 144, effective July 1, 2025) restricts PA requirements for fully-insured commercial plans: no PA for the first 12 PT/chiropractic visits per episode of care; PA cannot be required for more than 1% of unique services or 1% of providers annually; all PA reviews must involve a clinical peer; and step therapy is restricted for qualifying low-cost FDA-approved drugs. This law does not apply to self-funded ERISA plans, Medicaid MCE programs, or Medicare Advantage. Verify which plan type the patient has before assuming SB 480 applies.

MDwise exited the Indiana Medicaid program effective January 1, 2026. Claims with dates of service in 2025 should be submitted to MDwise before their claims runout deadline — typically 90–180 days from the plan's exit date. For patients previously on MDwise who now have 2026 dates of service, identify their new MCE (Anthem, CareSource, or MHS) through IHCP eligibility verification and submit to the new plan. New authorizations must be obtained from the new MCE for ongoing care.

Hoosier Healthwise serves children, pregnant women, and low-income families at or below 200% FPL. The Healthy Indiana Plan (HIP) serves non-disabled adults ages 19–64 who are not eligible for traditional Medicaid, primarily under Indiana's Section 1115 partial Medicaid expansion. HIP requires member premium contributions (POWER Accounts) for HIP Plus, with HIP Basic as the fallback tier. Billing is MCE-based for both programs, but HIP's waiver structure means certain services may have different coverage provisions. Always verify the specific program when working Indiana Medicaid claims.

Medical Billing in Indiana: Hoosier Healthwise, HIP & Timely Filing