info@mdrevenuegroup.com9:00 AM - 5:00 PM | Mon - Fri
Headquartered in Indianapolis, Anthem BCBS of Indiana is the bedrock of commercial employer group and individual insurance in the state. Mastering Anthem’s Availity portal workflows, specialty fee schedules, and stringent pre-service certification edits is vital to practice financial performance.
HIP 2.0 features a unique consumer-directed structure where enrollees make monthly POWER account contributions to maintain HIP Plus (which includes comprehensive dental, vision, and lower copays). If contributions lapse, non-exempt members drop to HIP Basic, altering practice copay collection protocols.
Indiana Health Coverage Programs (IHCP) contract with Anthem, CareSource, and MHS to administer HIP, Hoosier Healthwise, and Hoosier Care Connect. Practices must maintain synchronized credentialing across all three MCOs to protect patient access and capture pay-for-performance incentives.
WPS GHA administers Medicare Part A and B in Indiana under Jurisdiction 8 (shared with Michigan). WPS J8 enforces strict Local Coverage Determinations (LCDs) on outpatient diagnostics, ophthalmology, cardiology, and physical therapy caps.
Specialized claims processing engineered for Anthem BCBS Indiana, HIP 2.0 MCOs, and WPS J8 Medicare guidelines.
Learn MoreFull-cycle RCM managing prior authorizations, POWER account tier validations, and secondary crossover reconciliations.
Learn MoreProvider enrollment across Anthem, CareSource, MHS, Indiana Medicaid, and regional hospital network directories.
Learn MoreTargeted audit evaluating Anthem fee schedule accuracy, HIP 2.0 copay leakage, and WPS J8 documentation compliance.
Learn MoreFront-desk intake and prior-authorization support designed for busy clinical practices in Indianapolis, Fort Wayne, and across Indiana.
Learn MoreBenchmark collection speed against Indiana commercial and Medicaid payer denial patterns and fee schedules.
Learn MoreTargeted visibility for independent practices competing with IU Health and Franciscan physician networks.
Learn More| Indiana Payer Reality | The Generic Billing Trap | The MD Revenue Group Approach |
|---|---|---|
| HIP 2.0 POWER Accounts | Failing to verify monthly member POWER account status, missing point-of-service copay collections on HIP Basic. | We build automated real-time eligibility verifications to flag HIP Plus vs. Basic tier status before every visit. |
| Anthem BCBS Dominance | Treating Anthem Indiana like an out-of-state Blue plan, missing headquarters Availity portal edits and fee rules. | We configure direct Availity clearinghouse connections and optimize commercial fee schedules to maximize yield. |
| WPS J8 Medicare LCDs | Billing modifier 25 on complex office visits without distinct documentation, leading to WPS J8 claim reductions. | We enforce stand-alone clinical notes that substantiate separate medical decision-making under WPS J8 rules. |
| Indiana MCO Rosters | Allowing provider credentialing to lapse with Anthem, CareSource, or MHS, blocking Medicaid patient volume. | We run synchronized enrollment audits across all three primary Indiana Health Coverage Program MCOs. |
We audit 90 days of claims for Anthem fee schedule compliance and WPS J8 LCD alignment.
We connect clearinghouse and EDI gateways with WPS J8, Anthem, and Medicaid MCOs without interruption.
Real-time visibility into clean claims rate (targeting 98%+), A/R days under 32, and recovered revenue.
Our Indiana billing specialists recovered uncollected HIP Basic copays, resolved Anthem pre-authorization denials, and streamlined WPS J8 Medicare secondary crossover reconciliations.
See What We Can Recover For YouFSSA has reinforced mandatory point-of-service verification of member POWER account contribution status (HIP Plus vs Basic) to ensure accurate copayment collection.
Anthem has expanded automated prior authorization requirements across commercial and Medicare Advantage plans for advanced imaging and surgical procedures.
WPS J8 continues active probe audits on high-level E/M coding (99214/99215) and minor surgical modifiers 25/59 across Indiana medical groups.
We audit specifically for HIP 2.0 POWER account leaks, Anthem pre-authorizations, and WPS Jurisdiction 8 local schedules.
