Indiana Medicaid entered 2026 with one of the most significant structural changes in its recent history — the exit of MDwise from the Indiana Health Coverage Programs (IHCP) network effective December 31, 2025. The FSSA determined MDwise no longer met program standards and terminated its participation. Its former members were auto-assigned to the three remaining MCEs — Anthem, CareSource, and Managed Health Services — at the start of 2026.

Beyond the MDwise transition, 2026 brought a meaningful fee schedule increase — Indiana Medicaid now reimburses physician services, DME, and transportation at 100% of prior-year Medicare rates. And the PathWays for Aging program, launched July 1, 2024, is now fully operational in 2026 with its own separate MCO network for Indiana’s Medicaid population age 60 and older.

Part 1: Indiana’s Four Medicaid Programs

Indiana operates four distinct Medicaid programs through the Indiana Health Coverage Programs (IHCP), administered by FSSA OMPP, with claims processed through CoreMMIS (Gainwell Technologies). Indiana Medicaid covers approximately 1.8–2.2 million Hoosiers as of 2026.

1. Healthy Indiana Plan (HIP)

Adults 19–64 who are not disabled and not on Medicare. Indiana’s Section 1115 Medicaid expansion. Requires monthly POWER Account contributions.

HIP Plus (non-tobacco users who pay POWER Account contributions): lower cost-sharing, full benefits. HIP Basic (tobacco users or those who miss POWER Account payments): higher cost-sharing, limited benefits.

Billing implication: Verify HIP tier (Plus vs. Basic) at every visit — tier changes mid-year when POWER Account contributions lapse, changing patient cost-sharing obligations.

HIP MCOs: Anthem, CareSource, MHS

2. Hoosier Healthwise (HHW)

Children under age 19 and pregnant women. Package C is Indiana’s CHIP program for children above the standard Medicaid income threshold with small monthly premiums and copays.

HHW MCOs: Anthem, CareSource, MHS, UnitedHealthcare

3. Hoosier Care Connect (HCC)

Disabled adults under age 60 who are NOT Medicare eligible, NOT institutionalized, and NOT receiving HCBS waiver services. When HCC members turn 60 or become Medicare eligible, they transition to PathWays for Aging or a dual-eligible arrangement.

HCC MCOs: Anthem, CareSource, MHS, UnitedHealthcare

4. Indiana PathWays for Aging

Launched July 1, 2024. Covers Hoosiers age 60+ on Medicaid, including dual-eligible members and those needing LTSS. Covers both physical health AND long-term services and supports through the same MCE.

PathWays MCOs (SEPARATE from HIP/HHW/HCC):

• Anthem Blue Cross Blue Shield of Indiana
• Humana Healthy Horizons in Indiana (PathWays only — NOT in HIP/HHW/HCC)
• UnitedHealthcare Community Plan of Indiana

Critical rule: CareSource and MHS are NOT PathWays MCOs. Routing a patient age 60+ to CareSource or MHS will result in denial if they are enrolled in PathWays.

Traditional Medicaid (Fee-for-Service)

Members not in managed care — institutionalized, receiving HCBS waiver services, or in specific limited-benefit categories. Bill directly to IHCP/CoreMMIS.

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Part 2: 2026 MCO Landscape — Post-MDwise Indiana

MCO	HIP	Hoosier Healthwise	Hoosier Care Connect	PathWays for Aging	Phone
Anthem Blue Cross Blue Shield	Yes	Yes	Yes	Yes	866-902-1690 option 1
CareSource Indiana	Yes	Yes	Yes	No	844-607-2829
Managed Health Services (MHS/Centene)	Yes	Yes	Yes	No	877-647-4848
UnitedHealthcare Community Plan	Yes	Yes	Yes	Yes	Via Availity
Humana Healthy Horizons	No	No	No	Yes	833-410-2496
MDwise	TERMINATED Dec 31, 2025	TERMINATED	TERMINATED	N/A	N/A

Always verify payer IDs with your clearinghouse before submitting to any Indiana MCO.

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Part 3: Eligibility Verification

IHCP Provider Portal: provider.indianamedicaid.com Indiana Medicaid provider line: 866-725-9991 HIP Helpline: 877-438-4479 Hoosier Healthwise: 800-889-9949

All five active Indiana MCOs accept eligibility verification through Availity Essentials.

Verify at every visit: program (HIP/HHW/HCC/PathWays/FFS), MCE assignment, and HIP tier (Plus vs. Basic). Former MDwise patients must be re-verified for new MCE assignment. Build an age-60 flag to catch HCC to PathWays transitions mid-year.

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Part 4: 2026 Key Updates

1. MDwise Exit — January 1, 2026

MDwise terminated December 31, 2025. Former MDwise prior authorizations honored by new MCE for minimum 90 days. Verify every former MDwise patient’s new MCE. Do not submit to MDwise payer IDs.

2. Fee Schedule Increase — 100% of 2025 Medicare Rates

Effective January 1, 2026, Indiana Medicaid reimburses physician services, DME, and transportation at 100% of 2025 Medicare rates (Bulletin BT2025156). Anesthesia conversion factor increased to $19.37. Reimbursement questions: FSSA.IHCPReimbursement@fssa.in.gov

3. IHCP Provider Enrollment Matrix Version 11 — March 20, 2026

The IHCP Provider Enrollment Type and Specialty Matrix updated to Version 11 on March 20, 2026. All new enrollments and revalidations after this date must reference Version 11. Confirm pending applications align with the updated matrix.

4. Home Health Agencies — Medicare Enrollment Required by July 1, 2026

Per Bulletin BT202595, all home health agencies providing Indiana Medicaid services must be enrolled in Medicare effective July 1, 2026. Agencies not yet Medicare-enrolled must begin PECOS enrollment immediately — processing takes 60–90 days.

5. PathWays for Aging — Fully Operational

Launched July 1, 2024, PathWays is now fully established. Providers serving patients age 60+ who are not yet contracted with PathWays MCOs (Anthem, Humana Healthy Horizons, UnitedHealthcare) should initiate contracting now.

6. Federal Medicaid Legislation Impact

Federal legislation effective January 1, 2026 eliminated a 2-year temporary financial incentive for ACA Medicaid expansion states including Indiana. Projected cuts over 10 years — immediate 2026 impact is limited to this specific incentive. Monitor FSSA communications for subsequent changes.

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Part 5: Claim Filing Limits

Payer	Timely Filing Limit	Notes
IHCP Traditional FFS	12 months	FFS members not in managed care
Anthem BCBS Indiana (Medicaid)	12 months	Per Anthem Indiana Provider Manual
CareSource Indiana	90–180 days	Verify with contract
MHS (Centene)	90–180 days	Verify with contract
UnitedHealthcare Community Plan	90–180 days	Verify with contract
Humana Healthy Horizons (PathWays)	90–180 days	Verify with contract
Medicare Part A/B (WPS Jurisdiction 8)	12 months	WPS Health Solutions is Indiana’s MAC
Medicare Advantage	90–120 days	MA plans set own deadlines
Anthem BCBS (commercial)	180 days	Dominant commercial carrier
UnitedHealthcare (commercial)	90–180 days	Varies by employer contract
Aetna (commercial)	120 days	Verify with contract
Cigna (commercial)	90–180 days	Varies by plan
Humana	90 days	Shortest window — prompt submission required

Indiana’s Medicare Administrative Contractor is WPS Health Solutions (Wisconsin Physicians Service), Jurisdiction 8, covering Indiana and Michigan. Use WPS resources at wpsgha.com for Medicare billing guidance — not Palmetto GBA or CGS.

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Part 6: Commercial Payer Landscape

Anthem Blue Cross Blue Shield of Indiana is the dominant commercial carrier and also the largest Medicaid MCO — making it uniquely important for Indiana providers across both commercial and Medicaid billing.

Major commercial payers:

• Anthem BCBS Indiana — dominant statewide, commercial + Medicare Advantage + all four Medicaid programs
• UnitedHealthcare — significant employer-sponsored presence; active in Medicaid and commercial
• Aetna — large employer groups in Indianapolis and Fort Wayne
• Cigna — metropolitan areas: Indianapolis, Fort Wayne, South Bend, Evansville
• Humana — Medicare Advantage + PathWays for Aging Medicaid

Regional notes:

• Indianapolis: Anthem dominant, all Medicaid MCOs active, strong HIP population
• Fort Wayne: Anthem dominant commercial, Parkview Health system influence
• South Bend: Anthem dominant, UnitedHealthcare significant for employer groups
• Rural Indiana: Anthem statewide coverage, Humana/UnitedHealthcare Medicare Advantage significant

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Part 7: Credentialing in Indiana

Step 1 — IHCP CoreMMIS Enrollment

IHCP Provider Portal: provider.indianamedicaid.com Provider Enrollment Helpline: 1-877-707-5750

Requirements: Active NPI, valid Indiana state license, provider type/specialty aligned with Version 11 matrix, $750 enrollment fee per service location for institutional providers (CY 2026), Medicare enrollment for home health agencies by July 1, 2026.

Processing time: 30–60 days for clean applications.

Step 2 — Separate MCO Contracting

IHCP approval does NOT automatically credential you with any MCO. After approval:

1. Maintain current CAQH ProView profile (all five MCOs require it)
2. Submit network participation request via each MCO’s portal
3. Complete MCO credentialing review (45–75 days per plan)
4. Sign participating provider agreement
5. Confirm activation date before submitting first claim

For PathWays for Aging patients: must contract separately with Anthem, Humana Healthy Horizons, and UnitedHealthcare — CareSource and MHS credentialing does not cover PathWays patients.

Most Indiana MCOs use Availity as primary portal.

Indiana State Licensing

Indiana Medical Licensing Board (MD/DO/PA): in.gov/pla Indiana State Board of Nursing (NP): in.gov/pla Indiana Professional Licensing Agency (all others): in.gov/pla

Physician licenses renew on 2-year cycle. Build renewal reminders 90 days before expiration.

Credentialing Timeline

Payer / Enrollment	Typical Timeline
IHCP CoreMMIS	30–60 days
MCO credentialing (each)	45–75 days after IHCP approval
Anthem BCBS (commercial)	60–90 days
UnitedHealthcare (commercial)	60–90 days
Aetna / Cigna / Humana	90–120 days
Medicare PECOS (WPS Jurisdiction 8)	60–90 days

Start 120–150 days before intended first date of patient care for full network participation.

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What Indiana Providers Should Do Right Now

For the MDwise transition:

• Audit patient panel for all former MDwise members — confirm new MCE in your system
• Check whether MDwise 90-day transition authorizations have expired and require re-auth
• Update payer routing for all former MDwise patients

For Medicaid billing:

• Confirm eligibility workflow captures both program and MCE at every visit
• Verify HIP tier (Plus vs. Basic) at each HIP patient visit
• Build age-60 flag for HCC to PathWays transitions

For 2026 updates:

• Confirm billing system reflects updated fee schedule (100% of 2025 Medicare rates)
• Verify pending enrollments align with Version 11 IHCP matrix (March 20, 2026)
• Home health agencies: begin Medicare PECOS enrollment if not already enrolled

For credentialing:

• Confirm CAQH ProView profile is current — all Indiana MCOs require it
• Verify PathWays contracting with Anthem, Humana Healthy Horizons, UnitedHealthcare for practices treating patients 60+
• Prioritize Anthem BCBS Indiana credentialing for commercial

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Final Thoughts

Indiana Medicaid in 2026 is defined by the post-MDwise landscape. Understanding the four programs, the correct MCO for each patient, and the PathWays for Aging separation are the foundational requirements for billing correctly. The fee schedule increase to 100% of Medicare rates and the fully operational PathWays program create new revenue opportunities for practices that are correctly enrolled and contracted.

At ClaimsXperts, we work with Indiana providers on IHCP enrollment, MCO credentialing, PathWays contracting, Medicaid claim routing, and full-cycle revenue cycle management.

Contact us today at https://www.rcmmasters.com/#contactus to learn how ClaimsXperts can support your Indiana practice.

ClaimsXperts is a Revenue Cycle Management company based in Frisco, TX, serving medical practices across the United States.