Policy UpdatesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMay 14, 2025

Announcement: Temporary Emergency Financial Assistance Payment Reconciliation

As required under Senate Enrolled Act (SEA) 132 (2024), the Office of Medicaid Policy and Planning (OMPP) established a Temporary Emergency Financial Assistance program (TEFAP) for Indiana PathWays for Aging providers that experience a financial emergency as defined in law due to claim payment issues (see Indiana Health Coverage Programs Bulletin BT2024110). SEA 132 allowed the OMPP to administer this program during the first 210 days after the Indiana PathWays for Aging program was implemented, with an end date of January 31, 2025 as confirmed in BT202514.

Beginning May 1, 2025, Managed Care Entities (MCEs) will begin the process to reconcile payments made to providers through this program. Providers who received funding under TEFAP will receive a letter of notification from each MCE who provided financial assistance that includes detailed instructions for the reconciliation process. Although each MCE letter will outline in detail the steps of their recoupment process, the letters will include the following information:

  • The total dollar amount owed to the applicable MCE.
  • An outline of Provider Repayment Options, such a staggered recoupment process or an option for providers to repay in a lump sum to the MCE.
  • Applicable reconciliation dates.

The MCEs will continue to work with providers experiencing challenges with claims.

Please contact your designated provider relationship management representative if you have further questions or email INMLTSSProviderRelations@anthem.com.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-084301-25