Presumptive Eligibility and Notification of Pregnancy

OMPP implemented two programs in July 2009 aimed at improving birth outcomes in the Hoosier Healthwise program.
 
  1. Presumptive Eligibility (PE) for pregnant women
  2. Notification of Pregnancy (NOP)
      
The goal of the PE program is to offer ambulatory prenatal healthcare to women early in their pregnancies, so they stay healthy and have healthy babies. PE is a limited period of time during which a pregnant woman, who has been determined to be “presumptively eligible” by a Qualified Provider (QP), may receive ambulatory prenatal services while her Hoosier Healthwise application is being processed.
 
Providers will be reimbursed for ambulatory services during the presumptive eligibility period, regardless of whether or not the member ultimately qualifies for the Hoosier Healthwise program.
      

NOP Quick Reference Guide

View frequently asked questions regarding reimbursement, billing, CPT codes, benefits and other information.

Guide to completing the NOP
Step-by-step guide on how to complete the NOP through the Indiana Medicaid Provider Portal.


What Is a Qualified Provider?

View Indiana Medicaid Provider FAQs
Find a Qualified Provider
 
A QP is a provider who meets the following criteria:
  • Enrolled as a provider in the Indiana Health Coverage Programs (IHCP).
  • Capable of verifying pregnancy via a professionally administered pregnancy test (home administered tests do not meet this requirement).
  • Attended a Qualified Provider training session provided by the Family and Social Services Administration (FSSA) or designee.
  • Currently providing outpatient hospital, rural health clinic or clinic services as defined in BT200910.
  • Able to access Web interChange, a printer and a fax machine.
  • Allows PE applicants to use an office phone to facilitate the PE and Hoosier Healthwise enrollment process.