The Indiana Family and Social Services Administration (FSSA) in collaboration with Anthem Blue Cross and Blue Shield (Anthem) manages the Indiana PathWays for Aging program and other Indiana Health Coverage Programs (IHCP) member benefits. Indiana PathWays for Aging is a statewide coordinated care program for Indiana’s Medicaid enrollees who are 60 years of age or older, and eligible for Medicaid on the basis of age, blindness, or disability and have limited income and resources. Eligibility is determined by the state of Indiana’s FSSA Division of Family Resources (DFR).
Anthem is here to support members enrolled in Indiana PathWays for Aging by implementing strategies to address complex and chronic health conditions. Enrollees include members who have Medicaid, full Medicare benefits, those residing in a nursing facility, and those who are receiving managed long-term services and support (MLTSS) in a home or community-based setting.
Note: Providers must be approved or certified through the Division of Aging/Office of Medicaid Policy and Planning and Indiana Medicaid.
Anthem’s MLTSS Care and Support Coordination teams work to support member choice and independence by providing access to and coordination of services and supports. This allows members to live with dignity in their community or long-term care facility, improving their quality of life and achieving their self-identified goals.
To ensure members’ needs are being met, MLTSS staff work closely with our Case Management and Behavioral Health teams, Primary Medical Provider (PMPs), and Indiana PathWays for Aging MLTSS providers to identify and connect with members who could benefit from MLTSS services. For more information on MLTSS requirements and covered benefits, please refer to your provider manual or access the FSSA page for Indiana PathWays for Aging covered benefits.
Indiana PathWays for Aging is a statewide managed care program for Indiana’s Medicaid enrollees. For enrollment into Indiana PathWays for Aging, a member must:
In addition to this criteria, individuals are also eligible if they:
All individuals who are 60 years of age or older in the target eligibility categories will be included unless they meet one of the following exclusions:
Eligible Medicaid enrollees that are age 59 and under, who are on the Aged and Disabled Waiver, will receive waiver services by Department of Disability and Rehabilitative Services (DDRS) in conjunction with Fee for Service (FFS). Individuals who are hospice recipients prior to age 60 will remain in FFS unless they choose to opt-in to Indiana PathWays for Aging.
Individuals who are in the American Indian/Alaskan Native population and in an Indiana PathWays for Aging eligible category may voluntarily enroll in Indiana PathWays for Aging. If they do not choose to opt-in, these enrollees will remain in FFS.
For information on the Department of Disability and Rehabilitative Services (DDRS), please visit the Family and Social Services Administration’s (FSSA) page dedicated to DDRS .
Care and Service Coordinators are part of the care planning team for individuals in the Indiana PathWays for Aging program. These coordinators work with individuals enrolled in the program to create person centered service plans that reflect the physical, behavioral, and LTSS needs and goals of each person enrolled in the program. The care planning team will partner with members to identify a LTSS provider of their choosing and send referrals to ensure services continue to align with the member’s needs.
Our providers will receive referrals digitally through our Care Central platform in accordance with the counties and services they are contracted for. Then:
Please reach out via phone or email to verify eligibility or refer a member for LTSS or LTC services.
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Hours: 8 a.m. to 5 p.m. EST
Providers do not have to request authorizations. Service needs are determined through the person-centered planning process. Upon accepting referrals, Anthem will document and create an authorization for providers.
Anthem will authorize services in accordance with the person-centered service plan. Providers can view authorization details and check real-time authorization status through our Care Central platform at any time.
Care Central is designed as our one-stop shop to reduce provider administrative effort by streamlining member referral management, claims submission, billing processes, and giving providers actionable insight into the information important to their day-to-day operations.
Note: Specialty referrals to in-network HCBS providers do not require prior authorization.
Anthem uses Availity as its exclusive partner for managing all electronic data interchange (EDI) transactions. Electronic data interchange (EDI), including electronic remittance advice (835), allows for a faster, more efficient, and cost-effective way for providers to do business. For more information on using Availity, please visit our Learn about Availity page.
Providers can also access:
To initiate billing for the approved reimbursement, a claim must be submitted based on the specified service type you have provided. Claims can be submitted through our Care Central platform within Availity, tailored to LTSS providers where you can save claims settings, review claims prior to submission, receive confirmation once your claim is submitted, check status of your claim and confirmation of payment.
Anthem accepts electronic and paper claim submissions but encourages providers to submit electronic claims.
There are several nuances specific to LTSS that should be taken into consideration when navigating the LTC billing and payment process. This includes:
Note: Anthem will not cover bed-hold days in a nursing facility as a member benefit unless the member is in hospice care.
Anthem covers hospice care to members meeting the criteria established in the IHCP Hospice Provider Module and applies to hospice in all settings, including:
LTSS services are authorized as part of the person-centered planning process and development of the Integrated Care Plan and service plan. Care and Service Coordinators complete assessments and discuss needs with the member/family to determine the type, amount, duration and frequency of LTSS services.
Requests for authorizations for non-LTSS Home- and community-based services (HCBS) such as skilled nursing facility and nursing facility services (long-term), long-term acute care hospitalization and home health services may be made through Availity or via fax. Prior authorization requests may be faxed via the Anthem provider helpline.
Note: Facilities who have multiple members needing authorization for LTSS services should submit each request separately.
For more information about Indiana PathWays for Aging, please visit the Indiana FSSA site.
Hours: 8 a.m. to 5 p.m. EST