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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. After providers are enrolled as IHCP providers, they may apply to participate as providers under the managed care program. Visit the Enrolling as a Managed Care Program Provider page to learn more about how to apply with one or more of the managed care plans.
  6. 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 requirements.
  7. 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 Provider Enrollment Revalidation page to learn more about revalidation requirements.
  8. 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 information.
  9. 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 Enrollments

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 process.

Additional Information

For training sessions about completing provider enrollment paperwork, visit the Archived Workshop Presentations page or contact your Provider Relations field consultant.

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.