03 - Extended Care Facility

Initiating Your Enrollment Transaction

  1. See the IHCP Provider Enrollment Type and Specialty Matrix on this website for a list of the documentation you must submit to be enrolled or revalidated as an Indiana Health Coverage Programs (IHCP) provider. Possible specialties under this provider type are:
    • 030 - Nursing Facility
    • 031 - Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
    • 032 - Pediatric Nursing Facility
    • 033 - Residential Care Facility
    • 034 - Psychiatric Residential Treatment Facility (PRTF)
  2. See the IHCP Provider Enrollment Risk Category and Application Fee Matrix on this website to determine your risk level and whether you are required to pay an application fee. The enrollment and revalidation screening process is determined by the risk level that applies to your provider type. At its discretion, the State may assign a provider a higher risk level that supersedes the risk level assigned by the Centers for Medicare & Medicaid Services (CMS) and noted on the matrix.
    • Generally, an extended care facility provider enrollment or revalidation is considered "limited" risk and is not subject to additional screening measures.
    • An extended care facility provider enrollment, revalidation, or change of ownership requires the payment of an application fee for each service location. Submit confirmation of your electronic payment of the fee to the IHCP or document in your enrollment submission that you have paid the fee to Medicare or another state Medicaid program.
  3. Providers are encouraged to use the IHCP 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 enrollment submissions. For more information about enrolling through the Portal, see the Provider Enrollment provider reference module.
  4. If you choose to enroll or update via paper, complete the IHCP Hospital and Facility Provider Enrollment and Profile Maintenance Packet. Detailed instructions are included in the packet. See the Provider Enrollment provider reference module for more information.
    • To enroll, add a service location, report a change of ownership, or revalidate a current IHCP enrollment, you must complete and submit the entire packet.
    • To update an existing Provider Profile, submit the appropriate Provider Profile maintenance form or complete the relevant sections and submit the IHCP provider packet, following the instructions provided. See Update Your Provider Profile on this website.
    • The paper IHCP provider packet is an interactive PDF file, allowing you to type information into the fields electronically, save the completed file to your computer, and print the file for mailing.
      • Before mailing, make a copy of the completed IHCP provider packet and required documentation for your records.
      • Mail the packet and other required documentation to the IHCP at the following address:
        Provider Enrollment Unit
        P.O. Box 7263
        Indianapolis, IN 46207-7263
  5. After you are enrolled as an IHCP provider, if you are interested in enrolling as a provider with the IHCP's managed care program, you must apply directly to one or more of the managed care entities (MCEs). Please see the Enrolling as a Managed Care Program Provider page for information about the programs and the MCEs with which the State contracts for each. Links to the MCE enrollment forms follow - use the form appropriate for your provider type:

Processing Your Enrollment Transaction

Please allow at least 15 business days for processing before checking the status of your submission. After your transaction is processed, the IHCP Provider Enrollment Unit will notify you of the results.

  • If the submission needs correcting or is missing required documentation, the Provider Enrollment Unit will contact you by telephone, email, fax, or mail. This contact is intended to communicate what needs to be corrected, completed, and submitted before the IHCP can process your enrollment transaction. If you are enrolling via the Portal and your submission is rejected for missing or incomplete information, the submission must be corrected in the Portal. If you are enrolling via paper, a letter will be sent indicating what needs to be corrected or attached. When submitting the correction or missing information, providers MUST return the entire packet, along with a copy of the letter explaining the errors or omissions as a cover sheet.
  • If the submission is complete, the Provider Enrollment Unit will process your transaction and conduct the appropriate screening associated with your assigned risk level.
  • If the IHCP confirms your enrollment or revalidation, you will receive a verification letter from the Provider Enrollment Unit.
  • If the IHCP denies enrollment or revalidation, you will receive a notification letter explaining the reason for denial. If you believe your enrollment or revalidation was denied in error, you may appeal. See the Provider Enrollment provider reference module for information about the appeal process.

 

  1. See the Provider Type Application Fee and Risk Assignment Matrix for Non-Waiver Providers on this website to determine your risk level and whether you are required to pay an application fee. The enrollment and revalidation screening process is determined by the risk level that applies to your provider type. At its discretion, the State may assign a provider a higher risk level that supersedes the risk level assigned by the Centers for Medicare & Medicaid Services (CMS) and noted on the matrix.
    • Generally, an Extended Care Facility provider enrollment or revalidation is considered "limited" risk and is not subject to additional screening measures.
    • An Extended Care Facility provider enrollment or change of ownership requires the payment of an application fee for each service location. Submit confirmation of your electronic payment of the fee to the IHCP or document that you have paid the fee to Medicare or another state Medicaid program on the IHCP Provider Affordable Care Act Application Fee Addendum included in the IHCP Provider Packet.
  1. The IHCP Provider Packet is an interactive PDF file, allowing you to type information into the fields from your computer screen, save the completed file to your computer, and to print the file for mailing.
  2. Before mailing, make a copy of the IHCP Provider Packet and required documentation for your records.
  3. Place all forms and required documentation in an envelope.
  4. Mail the packet and other required documentation to the following address:
    HP Provider Enrollment
    P.O. Box 7263
    Indianapolis, IN 46207-7263
  5. Once you are enrolled as an IHCP provider, if you are interested in enrolling as a provider with the IHCP's managed care program, you must apply directly to one or more of the managed care entities (MCEs). More information is available from the MCEs. See the Hoosier Healthwise and Healthy Indiana Plan contact information on the IHCP Quick Reference Guide on this website. Links to the MCE enrollment forms follow:

Processing Your Enrollment Transaction

Please allow at least 20 business days for mailing and processing before checking the status of your submission. After your transaction is processed, the HP Provider Enrollment Unit will notify you of the results.

  • If the packet needs correcting or is missing required documentation, the HP Provider Enrollment Unit will contact you by telephone, email, fax, or mail. This contact is intended to communicate what needs to be corrected, completed, and submitted before the IHCP can process your enrollment transaction.
  • If the packet is complete, HP will process your transaction and conduct the appropriate screening associated with your assigned risk level.
  • If the IHCP confirms your enrollment or revalidation, you will receive a verification letter from the HP Provider Enrollment Unit.
  • If the IHCP denies enrollment or revalidation, you will receive a notification letter explaining the denial reason. If you believe your enrollment or revalidation was denied in error, you may appeal. See Chapter 4 of the IHCP Provider Manual for information about the appeal process.