Indiana PathWays for Aging - Managed Long-term services and supports (MLTSS)

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.

Don't have an Availity* Essentials account?

Register free now

Need help with Availity Essentials?

Indiana PathWays for Aging program benefits

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 eligibility

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:

  • Be 60 years of age or older
  • Be eligible for Medicaid based on age, blindness, or disability
  • Have limited income or resources

In addition to this criteria, individuals are also eligible if they:

  • Are receiving full Medicare benefits (dually eligible)
  • Reside in a nursing facility
  • Receive hospice services
  • Are receiving long-term services and supports (LTSS) in a home or community-based setting-including those on the Aged and Disabled Waiver
 

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:

  • Individuals who are only partial benefit dually eligible (Qualified Medicare beneficiary (QMB)-only, specified low-income Medicare beneficiary (SLMB)-only, Qualifying Individual (QI), or Qualified disabled working individual (QDWI)
  • Individuals who are Department of Disability and Rehabilitative Services (DDRS) waiver recipients 
  • Program of All Inclusive Care for the Elderly (PACE) members
  • Resident care assisted program (RCAP) members
  • End stage renal disease (ESRD) 1115 members
  • Breast and cervical cancer (MA-12) eligible members
  • Individuals who are Traumatic brain injury (TBI) waiver recipients
  • TBI out-of-state placements
  • Intellectual or developmental disability (IDD) residents of intermediate care facilities (ICF) (in other words, group homes)
  • Emergency services only (ESO) members
  • Family planning only members
  • Members with modified adjusted gross income (MAGI) eligibility in Healthy Indiana Plan (HIP) or Hoosier Healthwise
  • Individuals who are registered members of a federally recognized tribe that are eligible for HIP but have opted out into non-HIP, Fee for Service (FFS) coverage; in other words, Medicaid for Native Americans (MANA)
  • Anyone 59 years of age or younger (including those on the Aged and Disabled Waiver)

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 .

Indiana PathWays for Aging referral process

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:

  • Providers will review the documentation provided in the referral when accepting referrals for Home and Community Based Services (HCBS) and determine the capacity to meet the member’s individual needs.
  • Anthem team members will work collaboratively with referring practitioners to support individuals seeking Nursing Facility services.

Indiana PathWays for Aging Provider Services Helpline

Please reach out via phone or email to verify eligibility or refer a member for LTSS or LTC services.

Phone

833-569-4739
Hours: 8 a.m. to 5 p.m. EST

LTSS Provider Relations Email

INMLTSSProviderRelations@anthem.com

Indiana PathWays for Aging Provider resources and forms

Authorizations

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 on Availity

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.

Utilizing Availity for web-based submission using direct data entry

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:

LTSS claims and reimbursement

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:

  • Retroactive eligibility
  • Member share of cost
  • Relationship between LTSS and hospice
  • Nursing facility bed holds

Note: Anthem will not cover bed-hold days in a nursing facility as a member benefit unless the member is in hospice care.

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:

  • Routine home hospice care
  • Continuous home hospice care
  • Inpatient respite hospice care
  • General inpatient hospice care

Service plan authorization

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.

Provider Helpline

833-569-4739

Hours: 8 a.m. to 5 p.m. EST

Email

INMLTSSProviderRelations@anthem.com

Joining our Provider Network

LTSS providers, including atypical providers who do not have a National Provider Identifier (NPI), wishing to participate in the Indiana Pathways for Aging Program with Anthem Blue Cross Blue Shield can apply digitally by utilizing our automated Digital Provider Enrollment tool hosted on the Availity* Portal. To begin the process, navigate to the Join Our Network page to access the Digital Provider Enrollment tool. If you are not currently registered as a provider in Availity Essentials,* you will be prompted to register at Availity.com prior to completing the application process.

Required network participation documentation

To apply and participate in our network, providers must be able to supply the following materials when submitting their enrollment application through the portal:

  • A copy of certification documents verifying that the provider is approved/certified through the Division of Aging and Indiana Medicaid
  • Their primary email address and signatory name (if Anthem Blue Cross and Blue Shield does not already have this on file)
  • Copy of Secretary of State letter authorizing provider to do business in the state of Indiana
  • Copy of current Certificate of Insurance (COI)
  • Copy of current W-9 form

Please note: All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete. If any of these materials are not included in the request, it will be deemed incomplete.

Post-enrollment application submittal process

Providers may view their application status following successful completion of the provider enrollment application within the portal dashboard. Then:

  • Providers will be notified within 24 hours in the event the application is determined to be incomplete
  • Anthem will process all applications within 30 calendar days of receipt of the completed application 
  • Anthem will be notified upon receipt of the application and will reach out to the provider directly to review and confirm documents received
  • Provider will receive a welcome letter, including their effective date once application is approved and loaded

Providers—new or part of an existing contract—will be effective with Anthem the first of the month following the receipt of a complete network participation request.

Please note:

  • The effective date will be no sooner than the IHCP effective date.
  • The network participation receipt date is the date Anthem receives the provider’s complete network participation request electronically via an online portal, email, postal mail, or fax.
  • If you would prefer to submit your network participation application to us by email or postal mail, please download the form, complete the necessary application information, attach all necessary documentation and send the completed form to either:

If you have questions about the application or application process, you may contact Anthem via phone or email:

Phone

833-569-4739

Hours: 8 a.m. to 5 p.m. Eastern time

Email

INMLTSSProviderRelations@anthem.com

Do HCBS providers have to receive NCQA credentialing?

HCBS providers are excluded from the National Committee for Quality Assurance (NCQA) guidelines and therefore are not required to go through a traditional credentialing process. Instead, Anthem reviews the providers’ compliance with contractual requirements and ensures their eligibility to participate in the program—resulting in a deemed credentialed or “certified” status.

Provider contracting terminology

Enrollment – The process of loading a contracted and credentialed provider to all MCE internal systems, loading for claims payment, and loading to the provider directory (if applicable).

Credentialing – The process of reviewing the qualifications and appropriateness of a provider to join the health plan's network. Credentialing requirements and processes will follow NCQA guidelines.

Contracting/Negotiating – The process of the provider and MCE formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scope of services, etc.

Related information

Provider News

Provider News is your source for important news and announcements, including policy updates, prior authorization changes, new product and program offerings, and more.

Stay up to date on any information or announcements surrounding MLTSS or Indiana PathWays to Aging by visiting the Indiana Provider News page.

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.

Page Last Updated: 12/20/2023

Provider tools & resources

Interested in becoming a provider in our network?

We look forward to working with you to provide quality services to our members.