Complete an IHCP Provider Packet
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Providers 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
complete and submit the appropriate IHCP provider packet in its
- 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 the 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. 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.
The appropriate IHCP provider packet and the instructions for
completing it depend on your provider classification and your
provider type and specialty.
All providers fall into one of the following three
classifications for claims submission and reimbursement purposes.
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
Provider Type and Specialty
IHCP Provider Enrollment Type and Specialty Matrix to
determine your provider type and specialty and identify the
documents you must submit to enroll or revalidate as an IHCP
provider. Choose your provider type from the following list.