Complete an IHCP Provider Packet

Providers complete an Indiana Health Coverage Programs Enrollment and Profile Maintenance Packet (IHCP Provider Packet) to do any of the options below.

Note: If you are enrolling as an OPR provider or updating an OPR enrollment, this section does not apply. Go directly to the Participating as an OPR Provider page for more information.

Enroll as an IHCP provider for the first time - When you enroll as a provider with the IHCP you will need to complete and submit the appropriate IHCP Provider Packet, in its entirety.
Add a service location to an existing IHCP provider - When you add a service location to an existing IHCP provider, that service location is treated as a new enrollment. You will need to complete and submit the appropriate IHCP Provider Packet, in its entirety.
Report a change of ownership (CHOW) for an existing IHCP provider - When you report a change of ownership for an entity that is already enrolled with IHCP, the change is treated as a new enrollment. You will need to complete and submit the appropriate IHCP Provider Packet in its entirety, including new ownership information and signatures.
Revalidate enrollment as an IHCP provider - When it is time to revalidate your enrollment as an IHCP provider, you will receive notice of the revalidation deadline. Revalidation is similar to a new enrollment. You will need to complete and submit the appropriate IHCP Provider Packet in its entirety, with all current information.
Update provider profile information of an existing IHCP provider - Although many provider updates can be made online or with the submission of separate update forms, some updates may require you to complete and submit the relevant sections of the IHCP Provider Packet. Refer to the Update Your Provider Profile page on this website for more details.

The appropriate IHCP Provider Packet and the instructions for completing it depend upon your provider classification and your provider type and specialty.

Provider Classification

All providers fall into one of the following three classifications for claims submission and reimbursement purposes. Refer to Chapter 4 of the IHCP Provider Manual for more information on determining the appropriate provider classification for your circumstances

Billing Provider - A practitioner or facility operating and billing under a unique Taxpayer Identification Number (TIN) - either a sole practitioner's Social Security Number (SSN) or a business entity's Federal Employer Identification Number (FEIN); AND that has no rendering providers linked to the business TIN or, if a sole proprietor, the TIN is not shared or used by any other practitioner, group, or facility
Group Provider - A practice with one or more practitioners, or rendering providers, linked to a common Taxpayer Identification Number (TIN)
Rendering Provider - A practitioner or other provider rendering services for a group practice and linked to a common Taxpayer Identification Number (TIN). Providers enrolled as "rendering" under one or more groups at one or more service locations, may also enroll as a Billing Provider at a different service location.

Provider Type and Specialty

Use the IHCP Provider Type and Specialty Matrix on this web site to determine your provider type and specialty and identify the documents you must submit to enroll/revalidate as an IHCP provider. Proceed by choosing your provider type from the list below.