Complete an IHCP Enrollment Application

Don't miss important information! Sign up to receive email alerts when new information is posted to the IHCP website. Click here to sign up now!

Providers are encouraged to use the Provider Healthcare Portal (Portal) to enroll, add a service location, report a change of ownership, revalidate, or update provider profile information. Providers will find the online process much quicker and easier than using paper forms. Online help guides users through the process from start to finish, and provides immediate confirmation of submissions.

If a provider chooses to submit paper forms, he or she must complete an Indiana Health Coverage Programs Enrollment and Profile Maintenance Packet (IHCP provider packet) to enroll, add a service location, report a change of ownership, revalidate, or update provider profile information.

Note: If you are enrolling as an ordering, prescribing, or referring (OPR) provider or updating an OPR enrollment, this section does not apply. See Participating as an OPR Provider on this website 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 enroll online through the Portal or 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 enroll the service location through the Portal or 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 the IHCP, the change is treated as a new enrollment. The new owner will need to enroll online through the Portal or complete and submit the appropriate IHCP provider packet in its entirety, including new ownership information and signatures. If the CHOW is for a nursing facility, the new owner must use the paper IHCP provider packet - the online Portal is not an option for this transaction.
  • Revalidate enrollment as an IHCP provider - When it is time to revalidate your enrollment as an IHCP provider, you will receive notice on your Portal account, as well as written notification of the revalidation deadline. Revalidation is similar to a new enrollment. You will need to revalidate through the Portal or complete and submit the appropriate IHCP provider packet in its entirety, with all current information. See the Provider Enrollment Revalidation page on this website for more details.
  • Update Provider Profile information for 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. See Update Your Provider Profile on this website for more details.

Provider Classification, type, and specialty

The Portal will guide you through enrollment transactions based on your provider classification, as well as your provider type and specialty. Your provider classification, type, and specialty will also determine the appropriate paper IHCP provider packet to use and the specific instructions for completing it.

All providers fall into one of the following three classifications for claims submission and reimbursement purposes. See the Member Eligibility and Benefit Coverage provider reference module for more information about determining the appropriate provider classification for your circumstances.

  • Billing provider - A practitioner or facility operating at a distinct service location and billing as a sole practitioner or a business entity with no rendering providers linked to the practice or entity
  • Group provider - A practice operating at a distinct service location and with one or more practitioners or rendering providers linked to a common taxpayer identification number (TIN) for billing
  • Rendering provider - A practitioner or other provider rendering services for a group practice and linked to a common taxpayer identification number (TIN). A provider 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.

Use the IHCP Provider Enrollment Type and Specialty Matrix to determine your provider type and specialty and to identify the proper IHCP provider packet and documents you must submit to enroll or revalidate as an IHCP provider. Choose your provider type from the following list.