Indiana cardiology billing
Indiana Cardiology Medical Billing Services
Cardiology Billing bills Indiana cardiology practices and ensures every claim meets IHCP, Medicare or commercial requirements before it is submitted.
What we do for cardiology practices
Cardiology billing – from the first visit to the last payment
We do the billing steps that fill a cardiology office’s day: coverage checks, coding review, claims, posting, denials and old balances. We build the work around the tests and procedures you bill and the payers that are behind them.
Eligibility & benefits check:
We monitor active coverage, the IHCP program or insurance product, the plan, network status, referral and authorization regulations and what the patient may owe.
Review of Cardiology Coding:
Coders evaluate CPT, HCPCS and ICD-10-CM codes, modifiers, units and place of service with the physician paperwork and payers’ revisions.
Capture charge:
We go through the visit, test and procedure notes and check them against the charges entered, and then we send a list to the practice of everything that is missing or unclear.
Scrub claim:
We verify subscriber and patient information, NPI and taxonomy, codes, payer selection, authorization numbers and if the IHCP provider record matches the claim before a claim goes out
Claim submission:
We send 837P claims to IHCP fee-for-service, Medicaid health plans, Medicare, Medicare Advantage, commercial carriers and secondary payers, and follow each acknowledgment.
Payment posting:
Each ERA/835 and EOB is matched to payments, contractual write-offs, denials, short payments and any balance the patient can be asked to pay.
Denial work:
We find the reason, we fix or appeal the claim, we see the result, we trace reoccurring problems to their origin. Wrong health plan on file needs a different answer than missing authorization.
A/R follow-up:
First in, first out . Oldest balances and closest filing deadlines. We check status, send records, push for corrections and escalate until each claim is resolved.
Enrollment/Credentialing:
Within the area of work agreed upon we do IHCP and Medicare enrollment, commercial credentialing, CAQH maintenance, revalidation and group changes.
Indiana payer guide
Indiana Medicaid has more than one door.
A single cardiology practice in Indiana may bill a HIP adult, a child on Hoosier Healthwise and an older patient on PathWays in the same afternoon. Each one can send the claim to a different payer.
The state’s FSSA, Indiana Health Coverage Programs, or IHCP, provides Medicaid coverage. First, billing teams differentiate between fee-for-service and managed care. Then they find out who does the service. Some services are not covered at all by health plans for registered members. An active Medicaid ID doesn’t tell you who the claim owner is.
We connect eligibility, benefit checks, provider enrollment, network status and authorization to the claim and its follow-up. Rules are different for each program, plan, provider and service.
| Program | Health plans | A cardiology check |
|---|---|---|
| Healthy Indiana Plan (HIP) | Anthem, CareSource, MHS | Confirm the benefit package and active plan before testing or procedures. |
| Hoosier Healthwise | Anthem, CareSource, MHS | Identify Package A or C and any cost sharing. |
| Hoosier Care Connect | Anthem, MHS, UnitedHealthcare | Check which services are routed elsewhere. |
| Indiana PathWays for Aging | Anthem, Humana, UnitedHealthcare | Verify the Medicaid plan and any Medicare coverage. |
*Scroll the table sideways to compare all columns. →
MD wise no longer participates in HIP or Hoosier Healthwise, so older account history may point to a plan that isn't there anymore. We check each claim against coverage on its own service date.
Our process: verify eligibility, locate program & plan, verify provider network, check benefits & authorization, then submit claim to the payer that owns it. An incorrect payer on a complete claim will result in nonpayment.
Healthy Indiana Plan: (Adults aged 19-64) In that age range, HIP covers qualified adults. Cardiology visits, stress tests and echocardiograms need the right plan and benefit package on file. Not every adult on Medicaid is in HIP, and last visit's plan can be out of date by the next.
Hoosier Healthwise: children and pregnant members:This program covers eligible children and pregnant members and includes CHIP. For a pediatric cardiology practice, Hoosier Healthwise may carry a large share of claims, including echocardiograms for congenital heart conditions. We confirm the package, plan, primary medical provider, referrals and other insurance before billing a family.
Hoosier Care Connect: It’s for young individuals who are blind or disabled and not eligible for Medicare. It’s not included in HIP or Hoosier Healthwise. We verify enrollment in the plan, network and care coordination rules and authorization. Some services are split individually, such as the Medicaid Rehabilitation Option, so each service is routed based on its own worth.
PathWays for Aging: check enrollment, not age: PathWays offers complete Medicaid for the old, blind or disabled senior citizens. PathWays does not accept patients because they are 60. We verify the Medicaid plan and any Medicare coverage, latest network status, and who is authorizing the payment and who is paying for each service.
Enrollment and provider readiness
Provider records decide whether claims pay.
IHCP enrollment and plan network status are two separate approvals.
A provider may be actively enrolled in IHCP, yet not be in a health plan’s network.
Registering as an IHCP Provider
Enrollment prep comprises reconciliations of NPI, taxonomy, provider type, specialization, service locations, billing providers, rendering providers and group affiliations. However, rather than a general packet, the IHCP has distinct criteria for each provider because the licenses, ownership disclosures, agreements, EFT information and supporting documentation are all different for each enrollment category.
A practice, once enrolled in IHCP, will apply individually to each health plan it wishes to contract with.
Maintaining and revalidating records
Revalidation periods are specified by IHCP at no more than five years. Each service location revalidates independently. We don’t guess a delivery date, we follow the notice issued to the provider. We update addresses, licenses, NPI and taxonomy information, group connections and ownership information.
IHCP Provider Healthcare Portal - Working
The portal supports enrollment, eligibility verification, provider management, secure messaging and fee-for-service non-pharmacy claims, status, adjustments and remittances. Health plan claims follow each plan's own systems. Fee-for-service prior authorization goes through separate contractor workflows. We work through delegate access set up for the practice's locations.
Before the claim
Eligibility Confirmation and Approval Matching.
The coverage, the network status and the approved services all need to be in agreement with the claim for the service date.
Eligibility and Benefits
An old card might show a plan the patient left months ago, and an electronic check might show another. IHCP asks providers to verify eligibility on every date of service, so we do. We look at primary and secondary coverage, benefits, network, referrals, authorization and what the patient can be asked to pay, then recheck whenever something doesn't match.
An insurance card alone doesn't show active coverage.
Prior authorization:
The standard cardiology triggers are imaging, nuclear tests, ablations and device operations, and the restrictions vary by payer, product and setting. We determine the payer of record, review their needs, confirm ordering and servicing providers, collect the data, submit and track the request, and then match the approved services, units and dates to the claim.
Acentra Health manages IHCP fee-for-service nonpharmacy authorization. Health plans approve services they cover. An approval is not a payment, coverage, medical necessity, coding and enrollment still apply.
Medicare and commercial coverage
Each payer type gets its own review.
Original Medicare, commercial plans and dual-eligible coverage follow different rules, so we don't treat them alike.
Original Medicare
Medicare billing for Indiana cardiology
WPS Government Health Administrators is the Part A and B Medicare Administrative Contractor for Jurisdiction 8, which includes Indiana.
For Original Medicare claims, we review national coverage regulations, applicable local coverage determinations, and the coding and documentation. Modifiers . Added focus on the technical and professional elements of echocardiograms and stress testing . The follow-up function differentiates between amendments, reopens and appeals, and watches over requests for records. Medicare Advantage claims follow the member's plan.
Commercial insurance
One carrier, several products
A carrier's name can sit on many products with different networks, referrals, authorization lists, medical policies and appeal steps. Being credentialed for one product doesn't make a practice in-network for the rest.
Anthem in Indiana
Anthem publishes separate precertification references for Indiana commercial products and national accounts. Staff identify the member's product before choosing a list. Anthem also supports digital authorization tracking through Availity Essentials. We use the matching commercial, Medicare Advantage or Medicaid guidance depending on the patient's plan.
Dual-eligible patients
PathWays Dual Care links Medicare and Medicaid for certain dual-eligible individuals through fully integrated dual-eligible special needs plans (FIDE SNPs). We check actual enrollment because not all dual-eligible patients are in one.
We find out the major payer, the Medicare arrangement, the Medicaid coverage, the networks and the authorizations. Original Medicare crossover and integrated plans bill differently. Before we resubmit we check if a secondary payment has been received Routing checks for services that only Medicaid pays for.
A Qualified Medicare Beneficiary shall not be charged for cost sharing for Medicare Part A or B.
How the work flows
There are four distinct stages between the initiation and the final balance.
Each stage finishes with a “something” the next stage needs: a confirmed coverage, a clean claim, a posted payment, a declared next action.
- Registration: demographic and insurance information.
- Eligibility & Benefits: Check coverage on date service provision.
- Program and Payer: IHCP Fee-for-Service, Health Plans, Medicare and Commercial Coverage.
- Network & authorization: participation, recommendations & approvals.
- Documentation & coding: Complete the record.
- Charge entry: match note with billable services.
- Scrubbing the claims: correct errors before sending.
- Submission: route the claim and confirm acceptance.
- Payment posting: reconcile remittances.
- Denials: correct or appeal.
- A/R: work unpaid balances.
- Reporting: review payer and IHCP program trends, then assign fixes.
Reporting feeds back into intake: trends by payer and program become specific changes in the next cycle.
Final review
Six things we confirm before a claim goes out.
- Patient and subscriber details are accurate and coverage is active on the service date.
- IHCP program, health plan, primary and secondary payer and payer ID are correct.
- Provider enrollment and network status match the NPI, taxonomy, location and the billing, rendering, ordering or referring providers.
- Matching services, dates and units to authorizations and referrals.
- Units, site of service and documents match CPT/HCPCS codes, ICD-10-CM codes, modifiers.
- The filing deadline is known and proof of filing is retained.
Read the reason, then the balance.
Denied money says little on its own. We sort claims into wrong plan, enrollment mismatch, authorization failure, coding edit, duplicate and coordination-of-benefits problems, and we age balances by payer and next step. Repeating the same assertion doesn’t make a poor plan or missing record right. We track them separately because initial filings, revised claims and appeals all have their own deadline.
Note: 3 deadlines, 3 clocks: initial filing, corrected claims & appeals.
Cardiology service lines
Review that follows the care you document.
Our checks follow what the record supports. Your codes and payer rules scope the related outpatient and procedure workflows.
01. Cardiología general y preventiva
Office visits, risk assessment, chronic care follow-up and the documentation to support it all.
02. Diagnosis and Imaging
Echocardiograms, stress tests, radioactive investigations, modifiers, authorization and technical/professional components.
03. Cardiologie interventionnelle
Cath lab procedures, stents and supplies. Place of service review.
04. EP and Devices
Pacemaker and ICD implantation, device checkups with remote monitoring, Ablations
05. Pediatric cardiology and congenital heart diseases
Echocardiograms and follow-ups for youngsters, with Hoosier Healthwise package, referrals and plan checks.
Where we work
Practices throughout Indiana.
A single billing team may work with independent cardiologists, multi-specialty groups, suburban clinics and rural offices across the state of Indiana including Indianapolis, Fort Wayne, Bloomington and Lafayette. We divide down the work by provider location and payer rules, so you know who does what on your side and our side.
More hands to help in the revenue cycle. .
Many offices have one person covering front desk questions, IHCP changes, enrollment forms and aging claims. A billing partner takes the denial and A/R work off that person's plate so staff can spend more time with patients. Our reports list open balances, who owns each and the next step. Payment still depends on coverage, documentation, contracts and what each payer decides.
Common questions
Indiana cardiology billing FAQs.
Plain answers on eligibility, enrollment, claims and follow-up.
Talk to a billing specialistNo. After IHCP enrollment, a provider applies to each health plan separately.
HIP covers qualifying adults. Hoosier Healthwise covers eligible children and pregnant members. We confirm the actual benefit package for each patient.
No. Check electronic eligibility for the service date.
No. The portal handles fee-for-service nonpharmacy claims. Health plan members' claims go through the plan.
No. Coverage, coding, documentation and enrollment still decide the result.
We can review the denials, the supporting records and the correction or appeal options. We can't promise recovery.
Next step
Bring your Indiana cardiology billing under one roof.
We begin with a look at your payer mix, unpaid claims and administrative needs.