IHCP Provider Enrollment Transactions
The Indiana Health Coverage Programs (IHCP) provider enrollment
forms, instructions, and processes are outlined on the
provider enrollment web pages. Before proceeding with any
enrollment-related transaction, please see Chapter 4 -
Provider Enrollment, Eligibility, and Responsibilities of the
IHCP Provider Manual for additional information.
Provider Enrollment Information
- A National Provider Identifier (NPI) is required for almost all
providers who want to enroll in the IHCP. Visit the National Provider
Identifier page to learn more about the NPI.
- If you are interested in participating as an IHCP provider so
you are eligible to order, prescribe, or refer covered services and
medical supplies for your patients who are eligible for IHCP
coverage, go directly to the Ordering,
Prescribing or Referring Providers page.
- When enrolling as an IHCP provider, certain provider types are
subject to an initial application fee. The fee amount is set by the
Centers for Medicare & Medicaid Services (CMS). Generally, the
application fee applies to "institutional" providers, as defined by
CMS, and not to individual professionals, such as physicians. Visit
the Provider Enrollment
Application Fee page to learn more about which providers
are subject to fee payment.
- Each provider is subject to a pre-enrollment risk assessment
screening to determine the potential level of risk for fraud,
waste, and abuse. Providers are categorized by risk level - high,
moderate, or limited - using the CMS guidelines for risk
determination. Visit the Provider Enrollment
Risk Levels and Screening page to learn more about
the risk levels and the related screening activities.
- After providers are enrolled as IHCP providers, they may apply
to participate as providers under the managed care program. Visit
as a Managed Care Program Provider page to learn more
about how to apply with one or more of the managed care plans.
- Recertification of expiring licenses and other certifications
is necessary for a provider to continue to be eligible as an IHCP
provider. Visit the
Recertify Provider Enrollment Licenses and Other
Certifications page to learn more about recertification
- Revalidation of provider enrollment occurs on a regular
schedule. Most providers are required to revalidate at intervals
not to exceed every five years; however, a more frequent three-year
revalidation requirement applies to some provider types. Visit the
Revalidation page to learn more about revalidation
- The information obtained from a provider during the provider
enrollment process is compiled into a provider profile. All
enrolled providers are required to keep their provider profiles
up-to-date with current information about their business. Visit the
Update Your Provider
Profile page to learn more about updating your profile
- Providers may voluntarily disenroll from the IHCP. See the
Disenroll from the IHCP
page to learn more about this process.
Select the Transaction That Applies
Appeals Process for Involuntary Terminations and Denied
If a provider's enrollment is involuntarily terminated or the
IHCP denies a provider's enrollment or revalidation, the provider
has the right to appeal the decision. See Chapter 4 of the
IHCP Provider Manual for details about the appeals
For training sessions about completing provider enrollment
paperwork, visit the Archived Workshop
Presentations page or contact your Provider Relations
The following links provide useful information you may need
after you have enrolled.
- Subscribe to email notifications - Email notifications alert
subscribers to important changes on the IHCP website. Notices are
sent when new documents, such as bulletins, banners, or chapters of
the IHCP Provider Manual, are published. You may change your
subscription at any time. Email addresses are never sold or used
for any purpose other than IHCP business.
- Set up additional users with access to 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 IHCP Provider Packet will be set up
to access Web interChange. See the Web interChange site for information
about setting up additional users of Web interChange.