Indiana Medicaid: New prior authorization requirements for incontinence products

To comply with state requirements, starting Jan. 1, 2026, we’ll require prior authorizations for most incontinence products when the service provided exceeds the monthly monetary benefit limit for UnitedHealthcare Community Plan of Indiana members. This requirement also applies to both the Indiana PathWays for Aging and Hoosier Care Connect plans.

This change applies to most incontinence products; however, we’ve identified certain incontinence product service codes (table 10) that are authorized for supplies above the monthly monetary limit.

Prior authorization guidelines

Prior authorization for benefits above the monthly benefit limit will be granted based on medical necessity. Please submit the following documentation with your request: 

• Nursing assessment requirements: Members are required to participate in a nursing assessment to determine the appropriate products, brands and quantities of incontinence products needed. All nursing assessments must be performed by a licensed nurse who is employed by the supplying provider.
• Clinical documentation supporting the need for additional products
• The actual quantity of supplies needed per month and any factors affecting frequency of use and length of use

How to submit new or updated requests

You can fax your request to 844-897-6514 with the universal provider authorization fax form and any medical necessity documentation.

Questions? We’re here to help.

If you have questions, call Provider Customer Service at 877-610-9785 from 8 a.m.–8 p.m. ET, Monday– Friday.