Program of All-Inclusive Care for the Elderly (PACE)

Program of All-Inclusive Care for the Elderly (PACE) is sponsored by Indiana Medicaid. Provides community-based care for qualified members who are 55 and older that live in a PACE service area.

* Indiana Medicaid for Providers * Become an IHCP Provider Become an IHCP Provider Enroll as a provider with the IHCP to bring critical medical care to eligible Hoosier children and adults. * Complete an IHCP Provider Enrollment Application Complete an IHCP Provider Enrollment Application This page includes instructions for completing an IHCP provider enrollment application – either online or by mail.

* IHCP Provider Enrollment and Maintenance Actions IHCP Provider Enrollment and Maintenance Actions Look here for information about a variety of IHCP provider enrollment and profile maintenance activities. Providers are responsible for keeping their enrollment information up to date.

* Family Member/Associate Transportation Providers Family Member/Associate Transportation Providers The IHCP allows a family member or close associate of a Medicaid member to officially enroll as a driver, so the driver's mileage can be reimbursed.

* Ordering, Prescribing or Referring Providers Ordering, Prescribing or Referring Providers IHCP reimbursement for services or medical supplies resulting from a practitioner's order, prescription or referral requires the ordering, prescribing or referring (OPR) provider to be enrolled with the IHCP.

* Enrolling as a Managed Care Program Provider Enrolling as a Managed Care Program Provider IHCP-enrolled providers interested in enrolling as a provider for Healthy Indiana Plan, Hoosier Healthwise, Hoosier Care Connect or Indiana PathWays for Aging members must apply directly to one or more of the managed care organizations (MCOs).

* HCBS Waiver Provider Certification and Enrollment HCBS Waiver Provider Certification and Enrollment This page informs providers on the different HCBS programs available and the certification requirements that are needed for the CIH, FSW, H&W, TBI, and the PathWays waivers before enrolling with the IHCP.

* Bulletins and Reference Modules Bulletins and Reference Modules View and search bulletins and provider reference modules for information and updates on important topics including IHCP policies and procedures.

* Current News Current News View IHCP announcements about upcoming events and other timely news items, and access communications published by IHCP's partnering managed care organizations * Code Sets Code Sets View code tables associated with particular IHCP policies – such as procedure codes allowable for certain provider specialties, diagnosis and service codes covered under a particular benefit plan, and so on.

* Forms Forms Find the forms you need to serve members and transact business with the IHCP. * IHCP Provider Locator IHCP Provider Locator The provider search tool enables you to locate providers enrolled with the IHCP to provide services to Medicaid members.

* OPR Provider Verification OPR Provider Verification IHCP providers should verify enrollment of the ordering, prescribing or referring (OPR) provider before services or supplies are rendered.

* Other Provider Resources Other Provider Resources Visit this page to access additional resources, including code tables, companion guides for electronic transactions, the Indiana State Plan, and answers to frequently asked questions about the IHCP.

* Provider Education Opportunities Provider Education Opportunities The IHCP offers provider training opportunities including instructor-led workshops, seminars, webinars, and self-directed web-based training modules. Current offerings are posted here. * 2026 IHCP Works 2026 IHCP Works The Indiana Health Coverage Programs (IHCP) invites providers to attend the IHCP Works seminar October 6–8, 2026.

* IHCP Live IHCP Live IHCP Live webinars offer providers an opportunity to learn about new policy initiatives and billing guidance. Visit this page for information about upcoming webinars and recordings of past presentations. * IHCP Quick Hits IHCP Quick Hits View short, informational videos on topics of special interest to IHCP providers.

* Program Integrity Provider Trainings Program Integrity Provider Trainings These provider education training links cover topics such as documentation requirements, billing guidelines, and other program integrity- and audit-related issues.

* IHCP Provider Healthcare Portal Training IHCP Provider Healthcare Portal Training Providers and their delegates can learn how to make the most of the IHCP Provider Healthcare Portal through web-based training sessions.

* Presumptive Eligibility Qualified Provider Training Presumptive Eligibility Qualified Provider Training Providers interested in becoming qualified providers (QPs) for presumptive eligibility (PE) must complete an application through the IHCP Portal and contact IHCP Provider Relations to arrange training.

* Electronic Visit Verification Training Electronic Visit Verification Training Check this page for training opportunities around electronic visit verification (EVV) for personal care and home health services. * Archived Workshop Presentations Archived Workshop Presentations Find presentations from the most recent IHCP workshops and seminars are archived here.

* Portal Links for Providers Portal Links for Providers This page offers quick access to the most commonly used provider portals for IHCP transactions, such as prior authorization, claim submissions and enrollment updates.

* IHCP Provider Healthcare Portal IHCP Provider Healthcare Portal The IHCP Provider Healthcare Portal is an internet-based solution that offers enhanced reliability, speed, ease of use, and security to providers and other partners doing business with the IHCP. * Eligibility Verification Eligibility Verification It is important that you verify member eligibility on the date of service every time you provide services.

* Presumptive Eligibility Presumptive Eligibility The Presumptive Eligibility process allows qualified providers to make PE determinations for certain eligibility groups to receive temporary health coverage until official eligibility is determined.

* Electronic Visit Verification Electronic Visit Verification The IHCP will implement an electronic visit verification (EVV) system for federally required provider documentation of designated personal care and home health services.

* Electronic Data Interchange (EDI) Solutions Electronic Data Interchange (EDI) Solutions Find important information for providers, software developers, and trading partners that communicate via electronic data interchange format and direct data entry. * Billing and Remittance Billing and Remittance Whether you're new to Medicaid or have been a provider for years, this section is designed to help answer your billing questions.

Find links to provider code sets, fee schedules and more. * Program Integrity Program Integrity The mission of the Program Integrity Unit is to guard against fraud, abuse, and waste of Medicaid program benefits and resources.

* Health Insurance Portability and Accountability Act (HIPAA) Health Insurance Portability and Accountability Act (HIPAA) The Health Insurance Portability and Accountability Act (HIPAA) contains the provisions for portability, Medicaid integrity, and administrative simplification. * Medical Review Team (MRT) Medical Review Team (MRT) The Medical Review Team determines an applicant's eligibility based on a disability.

Providers must be enrolled as MRT providers to be reimbursed for MRT services. * Prior Authorization Prior Authorization Prior authorization is required for certain covered services to document the medical necessity for those services before services are rendered.

* Preadmission Screening and Resident Review (PASRR) Preadmission Screening and Resident Review (PASRR) The Preadmission Screening and Resident Review process is a requirement in all IHCP-certified nursing facilities, prior to admission or when there is a significant change in the physical or mental condition of a resident.

* Long-Term Care Long-Term Care The IHCP reimburses for long-term care services for members meeting level-of-care requirements. * Hospice Hospice The IHCP reimburses for hospice services in a hospice facility, in a nursing facility, and in a private home.

* Medicaid Rehabilitation Option (MRO) Medicaid Rehabilitation Option (MRO) IHCP Medicaid Rehabilitation Option services include community-based mental health care for individuals with serious mental illness, youth with serious emotional disturbance, and/or individuals with substance use disorders.

* Substance Use Disorder (SUD)/Serious Mental Illness (SMI) Treatment Substance Use Disorder (SUD)/Serious Mental Illness (SMI) Treatment Learn more about the IHCP implementation of Section 1115 SUD and SMI demonstration waivers to expand treatment of substance use disorder (SUD) and serious mental illness (SMI).

* Nonemergency Medical Transportation Nonemergency Medical Transportation Nonemergency medical transportation services for most members served through the fee-for-service delivery system are brokered through Southeastrans Inc. * Incontinence, Ostomy and Urological Supplies for FFS Members Incontinence, Ostomy and Urological Supplies for FFS Members The IHCP contracts with a single vendor to be the sole provider of incontinence, ostomy and urological supplies for fee-for-service (FFS) Medicaid members.

* Notification of Pregnancy (NOP) Notification of Pregnancy (NOP) A Notification of Pregnancy transaction helps identify risk factors in the earliest stages of pregnancy and thereby improve birth outcomes. * Pharmacy Benefits Pharmacy Benefits Providers can find pharmacy benefit information for the program/health plan with which the member is enrolled.

* Preferred Diabetes Supply List (PDSL) Preferred Diabetes Supply List (PDSL) The Preferred Diabetes Supply List helps ensure that IHCP members receive the highest quality products at the lowest cost. * Right Choices Program (RCP) Right Choices Program (RCP) The Right Choices Program monitors member utilization and, when appropriate, implements restrictions for members who would benefit from increased case coordination.

* IHCP Programs and Services IHCP Programs and Services Indiana Medicaid provides a healthcare safety net to Hoosier children, aged, disabled, pregnant women, and other eligible populations under the umbrella of Indiana Health Coverage Programs (IHCP). * Traditional Medicaid Traditional Medicaid Traditional Medicaid is a program created to provide health care coverage to individuals who are not enrolled in managed care.

Members normally served in Traditional Medicaid include individuals eligible for both Medicare and Medicaid, individuals who... * Healthy Indiana Plan Healthy Indiana Plan The Healthy Indiana Plan is a health-insurance program for qualified adults ages 19-64.

* Hoosier Care Connect Hoosier Care Connect Hoosier Care Connect is a healthcare program for individuals age 59 years and younger who are blind or disabled, not institutionalized or receiving waiver services, and not eligible for Medicare. * Hoosier Healthwise Hoosier Healthwise Hoosier Healthwise is a health care program for children up to age 19 and pregnant women.

The program covers medical care like doctor visits, prescription medicine, mental health care, dental care, hospitalizations, and surgeries at little or no cost... * Indiana PathWays for Aging Indiana PathWays for Aging Indiana PathWays for Aging is a new managed care health program for eligible Hoosiers age 60 and older. This program begins July 1, 2024.

* Program of All-Inclusive Care for the Elderly (PACE) Program of All-Inclusive Care for the Elderly (PACE) PACE provides community-based care for qualified members who are 55 and older that live in a PACE service area.

* Medicaid Rehabilitation Option (MRO) Medicaid Rehabilitation Option (MRO) IHCP Medicaid Rehabilitation Option services include community-based mental health care for individuals with serious mental illness, youth with serious emotional disturbance, and/or individuals with substance use disorders.

* Home- and Community-Based Services (HCBS) Home- and Community-Based Services (HCBS) HCBS programs are intended to assist a person to be as independent as possible and live in the least restrictive environment possible while maintaining safety in the home.

* Family Planning Eligibility Program Family Planning Eligibility Program Low-income individuals who don't qualify under another eligibility category may qualify for family planning services under the Family Planning Eligibility Program. * 590 Program 590 Program The 590 Program provides coverage for certain healthcare services provided to members who are residents of state-owned facilities.

* Medicare Savings Programs Medicare Savings Programs Medicare Savings Programs pay Medicare coinsurance, deductibles, and/or premiums for qualified elderly and disabled individuals. * Contact Us Contact Us The IHCP is interested in hearing from you if you have input or need assistance. * IHCP Quick Reference Guide IHCP Quick Reference Guide The IHCP Quick Reference Guide lists phone numbers and other information for vendors.

* Portal Links for Providers Portal Links for Providers This page offers quick access to the most commonly used provider portals for IHCP transactions, such as prior authorization, claim submissions and enrollment updates.

* Policy Consideration Requests Policy Consideration Requests The Indiana Health Coverage Programs (IHCP) has a specific process for members, providers, or other interested parties who would like to submit requests for policy consideration. * Provider Relations Consultants Provider Relations Consultants Provider Relations regions are organized to minimize provider wait times when providers need assistance.

## Indiana MedicaidProviders Home * Provider Enrollment - Click to ExpandToggle * Become an IHCP Provider - Click to Expand * Provider Classification, Type and Specialty * Complete an IHCP Provider Enrollment Application - Click to Expand * IHCP Provider Enrollment and Maintenance Actions - Click to Expand * Family Member/Associate Transportation Providers - Click to Expand * Ordering, Prescribing or Referring Providers - Click to Expand * Enrolling as a Managed Care Program Provider - Click to Expand * HCBS Waiver Provider Certification and Enrollment * Provider References - Click to ExpandToggle * Bulletins and Reference Modules - Click to Expand * Current News - Click to Expand * Email Notifications - Click to Expand * Forms - Click to Expand * IHCP Provider Locator - Click to Expand * OPR Provider Verification - Click to Expand * Other Provider Resources - Click to Expand * Provider Education - Click to ExpandToggle * Provider Education Opportunities - Click to Expand * 2026 IHCP Works - Click to Expand * IHCP Live - Click to Expand * IHCP Quick Hits - Click to Expand * Program Integrity Provider Trainings - Click to Expand * IHCP Provider Healthcare Portal Training - Click to Expand * Presumptive Eligibility Qualified Provider Training - Click to Expand * Electronic Visit Verification Training - Click to Expand * Archived Workshop Presentations - Click to Expand * Business Transactions - Click to ExpandToggle * Portal Links for Providers * IHCP Provider Healthcare Portal - Click to Expand * Eligibility Verification - Click to Expand * Presumptive Eligibility - Click to Expand * Electronic Visit Verification - Click to Expand * Electronic Data Interchange (EDI) Solutions - Click to Expand * Billing and Remittance - Click to Expand * Program Integrity - Click to Expand * Health Insurance Portability and Accountability Act (HIPAA) - Click to Expand * Clinical Services - Click to ExpandToggle * Medical Review Team (MRT) - Click to Expand * Prior Authorization - Click to Expand * Preadmission Screening and Resident Review (PASRR) - Click to Expand * Long-Term Care - Click to Expand * Hospice - Click to Expand * Medicaid Rehabilitation Option (MRO) - Click to Expand * Substance Use Disorder (SUD)/Serious Mental Illness (SMI) Treatment - Click to Expand * Nonemergency Medical Transportation - Click to Expand * Incontinence, Ostomy and Urological Supplies for FFS Members * Notification of Pregnancy (NOP) - Click to Expand * Pharmacy Benefits - Click to Expand * Preferred Diabetes Supply List (PDSL) - Click to Expand * Right Choices Program (RCP) - Click to Expand * About IHCP Programs - Click to ExpandToggle * IHCP Programs and Services - Click to Expand * Indiana PathWays for Aging * Program of All-Inclusive Care for the Elderly (PACE) - Click to Expand * Medicaid Rehabilitation Option (MRO) * Home- and Community-Based Services (HCBS) - Click to Expand * Family Planning Eligibility Program - Click to Expand * 590 Program - Click to Expand * Medicare Savings Programs - Click to Expand * Contact Information - Click to ExpandToggle * Contact Us - Click to Expand * IHCP Quick Reference Guide - Click to Expand * Portal Links for Providers - Click to Expand * Policy Consideration Requests - Click to Expand * Provider Relations Consultants - Click to Expand # Program of All-Inclusive Care for the Elderly (PACE) * Indiana Medicaid for Providers * Current: Program of All-Inclusive Care for the Elderly (PACE) The Program of All-Inclusive Care for the Elderly (PACE) was implemented by the state of Indiana to provide quality community-based care for Indiana Health Coverage Programs (IHCP) members who: * Are 55 years old or older * Are certified by the state to qualify for nursing facility level of care * Are able to live safely in the community at the time of enrollment * Live in a PACE service area * Primary care (doctor and nursing services) * Medical specialty services * Physical, occupational and recreational therapy * Laboratory/X-ray services ## Managed Care Delivery System The PACE program is operated within the managed care delivery system, and PACE organizations are considered managed care organizations (MCOs).

In this delivery system, contracted MCOs are paid a capitated monthly premium for each IHCP member enrolled with the MCOs. The capitated premium covers the cost of the services allowable under the program as provided to IHCP members enrolled with the MCO. The MCO assumes financial risk for services rendered to its members.

PACE participants are required to sign an enrollment agreement indicating they understand the PACE organization must be their sole service provider. Services must be preapproved and obtained from specified doctors, hospitals, pharmacies and other healthcare providers that contract with the PACE organization.

Before rendering services, IHCP providers must always verify member eligibility as described in the _Member Eligibility and Benefit Coverage")_ provider reference module. The Eligibility Verification System (EVS) options (IHCP Provider Healthcare Portal, phone-based interactive virtual assistant [GABBY] and 270/271 electronic transaction) will indicate if the member has current coverage under the PACE program.

Providers can also check the member's Medicare and Medicaid (IHCP) cards for a sticker indicating that the member is a PACE participant. The IHCP will deny payment of fee-for-service claims submitted by non-PACE providers for PACE members.

## Additional Information Additional information about PACE, including qualifying service areas, is available on the Program of All-Inclusive Care for the Elderly") page on the Indiana Family and Social Services (FSSA) Division of Aging website. ### Get Important News & Updates ### Provider News & Events * 09-02-2026 IHCP will host monthly IHCP Live webinar September 2 There are no past calendar entries at this time.

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