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Also, if other insurance and the IHCP reimbursed the provider for hospice care services, the provider was overpaid and must refund the overpayment to the IHCP.
State Form 48731/OMPP 0011 - This form is for reporting a hospice member's terminal illness and related conditions.
Federal regulations require hospice revocation to be in writing.
The effective date of the hospice revocation must be equal to or greater (future) than the date the document is signed.
The hospice interdisciplinary team and the curative care team complete this form together, describing both the hospice and curative services to be rendered.
The IHCP expects providers from both teams to interact and coordinate all services.
Processing the paperwork from the original/current provider first ensures that CMCS can authorize the paperwork of the new hospice provider with minimal interruption.
The Indiana Health Coverage Programs (IHCP) requires hospice providers to use IHCP hospice forms for IHCP-only hospice members.
The IHCP hospice forms contain the necessary information to enroll an individual in the IHCP hospice program and provide the standardization to facilitate workflow for the Medicaid prior authorization contractor.
This practice is consistent with the timeliness requirement that all forms have the required signatures within 10 business days from the start of a hospice benefit period.
State Form 54896 - For reporting on the terminal illness and related conditions of members 20 years of age and younger, when concurrent hospice services and curative treatment are elected.