Ind. Code § 12-15-13.5-1 "Office"
Sec. 1. As used in this chapter, "office" refers to the office of the secretary of family and social services.
As added by P.L.134-2019, SEC.2.
Ind. Code ch. 12-15-13.5
Ind. Code ch. 12-15-13.5
in effectInd. Code § 12-15-13.5-2 Recovery audit; contract; performance
Sec. 2. (a) The office and a managed care organization that has contracted with the office under this article shall perform a recovery audit to ensure the integrity of the Medicaid program.
(b) The office shall contract with a recovery auditing entity to perform the recovery audit. A contract with a recovery auditing entity must include the following services:
(1) Review of claims submitted by providers or other individuals furnishing items and services for payment by the Medicaid program to determine whether overpayment or underpayment occurred.
(2) Recovery of identified overpayments and payment to providers of identified underpayments.
(c) A managed care organization may either perform the recovery audit internally or contract with a recovery auditing entity to perform the recovery audit. A recovery audit by a managed care organization, whether performed internally or through a contract with a recovery auditing entity, must meet the requirements of subsection (b) and section 3 of this chapter.
As added by P.L.134-2019, SEC.2.
Ind. Code § 12-15-13.5-3 Audit period
Sec. 3. A recovery audit under this chapter must include the following:
(1) Subject to subdivision (2), for audits initiated after June 30, 2019, the audit look back period must be three (3) years and one hundred-eighty (180) days.
(2) If the office or a managed care organization discovers information that may indicate a credible allegation of fraud, abusive billing practices, or a claims process error rate greater than thirty percent (30%), the office or the managed care organization may increase the audit look back period to a total of seven (7) years.
As added by P.L.134-2019, SEC.2.
Ind. Code § 12-15-13.5-4 Annual provider education
Sec. 4. The managed care organization or the auditing entity, in conjunction with the office, shall perform educational and training programs annually for providers that include the following:
(1) A summary of the managed care organization's auditing entity's past or previous audit findings that provide guidance to Medicaid providers.
(2) The most common errors or issues and how a provider can avoid these errors and issues.
(3) Recommended practices for providers on improving claim submissions.
As added by P.L.134-2019, SEC.2.
Ind. Code § 12-15-13.5-5 Expired
As added by P.L.134-2019, SEC.2. Expired 12-31-2019 by P.L.134-2019, SEC.2.
Ind. Code § 12-15-13.5-6 Recovery audits; development, review, and certification of plans of treatment
Sec. 6. (a) Subject to subsection (b), a recovery audit shall not require documentation, at the time of service, for services provided by a community mental health center (as defined in IC 12-7-2.1-78) when the documentation is part of an ongoing plan of treatment or a documentation of specific treatment methods.
(b) The direct service provider shall complete documentation described in subsection (a) within a reasonable time frame, but not later than thirty (30) days from the date of service, prior to Medicaid billing.
(c) Any supervising provider in a community mental health center is eligible to review documentation in order to certify a plan of treatment or review specific treatment methods at intervals not greater than ninety (90) days.
(d) A supervising provider described in subsection (c) may review the documentation described in subsection (c) regardless of:
(1) whether the supervising provider is providing direct supervision; and
(2) the location where the service was provided.
A review described under this subsection must be documented by the signature of the supervising provider.
(e) In developing a plan of treatment, the following must be completed to demonstrate active treatment with a client:
(1) A signed client consent form.
(2) The completion of a list of requirements concerning audit compliance, as determined by the division in collaboration with community mental health centers, that verifies active participation in the development of the client's plan of treatment.
(3) Either:
(A) the signature of the client on the client's plan of treatment; or
(B) if the direct care provider, after a good faith effort, is unable to obtain the client's signature on the client's plan of treatment:
(i) the provision of documentation by the provider of the reasons the provider was unable to obtain the signature;
(ii) the continuation of attempting to obtain the client's signature on the client's plan of treatment; and
(iii) a determination by the division, based on the documentation in item (i), that the direct care provider has made a good faith effort to obtain the signature.
As added by P.L.127-2020, SEC.3. Amended by P.L.145-2026, SEC.74.
Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026