Family Planning Billing Procedures
When submitting charges for family planning services to any of the Medicaid Programs (Traditional or Managed Care), if the member is enrolled in Hoosier Healthwise Package B, Pregnancy Only, YOU MUST include a pregnancy diagnosis as the primary diagnosis on the claim form, even though the patient is no longer pregnant.
At this time, if you do not include the pregnancy diagnosis the claim will be denied as a non-covered for the member’s benefit package. The Medicaid system is not set up to recognize the family planning diagnosis codes as covered services for the Package B members. Refer to Chapter 8 of the Indiana Health Coverage Programs Provider Manual for source documentation with respect to this policy.
My office has recently begun working with the Office of Medicaid Policy and Planning (OMPP) to modify this requirement and allow claims to process when only a family planning diagnosis code is present. Medicaid will notify providers via an Indiana Health Coverage Programs Provider Bulletin, Banner Page, or Newsletter article if/when this coding policy is modified.
