IHCP Provider Enrollment Options

To become compliant with the Affordable Care Act (ACA) requirements, the Indiana Health Coverage Programs (IHCP) has made significant changes to provider enrollment policies and procedures effective January 1, 2012. Provider enrollment forms and instructions have been updated to reflect ACA compliance. Please familiarize yourself with the information on these web pages before beginning the enrollment process. Additional policy information can be found in the Provider Manual, Chapter 4, Provider Enrollment, Eligibility, and Responsibility.

What do you want to do?

Complete an IHCP provider application, which includes the following:
- Enroll for the first time
- Add a service location
- Report a change of ownership
Update Your Provider Profile, which includes the following:
- Update Claim Certification Statement for Signature on File
- Update CLIA certification information
- Add or change a delegated administrator
- Start or change direct deposit (electronic funds transfer)
- Update Medicare number information
- Update name and address information
- Submit an IHCP Provider Agreement
- Disenroll from IHCP or a service location
- Change your IHCP specialty
- Change your taxpayer identification information
- Submit an IHCP Psychiatric Hospital Bed Addendum
- Submit an IHCP PRTF Attestation Letter
- Recertify your enrollment
Enroll as a provider with a managed care entity:
- MCE Provider Enrollment Form
- MCE Provider Credentialing Form

Appeals Process

If a provider's enrollment is involuntarily terminated or the IHCP denies enrollment to a new provider, the provider has the right to appeal the decision. See Chapter 4 of the IHCP Provider Manual for details about the appeals process.

Additional Information

The following links provide useful information you may need after you have enrolled.

Subscribe to email notifications - The Email Notification System is used to send notices to subscribers on behalf of the IHCP. Notices are sent when new documents, such as bulletins or chapters of the IHCP Provider Manual, are published to the website. You may change your subscription profile or unsubscribe at any time. Email addresses are never sold or used for any purpose other than IHCP business.
Set up additional users to access Web interChange - Web interChange is a secure website that enables you to submit claims, check member eligibility, update your provider profile, and much more. The person listed on the enrollment application will be set up to access Web interChange. See the Web interChange site for information about setting up additional users to access Web interChange.