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 the Participating as an OPR
Provider page 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 the Update Your Provider
Profile page 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.
See Chapter 4 of
the IHCP Provider Manual for more information about
determining the appropriate provider classification for your
- 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
Provider Type and Specialty
Use the 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.