Participating as an OPR Provider

Participating in the Indiana Health Coverage Programs (IHCP) as an ordering, prescribing, or referring (OPR) provider allows Medicaid reimbursement for the covered services and supplies you order, prescribe, or refer for your patients who are IHCP members. A simplified application process requires minimal information and time, and makes participation easy. Before enrolling, please note the following:

  • If you are already enrolled in the IHCP as another type of provider, you do not need to enroll as an OPR provider.
  • You must have a National Provider Identifier (NPI).
    • The NPI is the standard, unique health identifier for healthcare providers and is assigned by the National Plan and Provider Enumeration System (NPPES).
    • Applying for the NPI is a process separate from IHCP enrollment.
    • To obtain an NPI, apply online at NPPES.cms.hhs.gov.
  • OPR providers are not required to pay application fees.
  • Opioid treatment centers that do not intend to submit claims for reimbursement should enroll as OPR providers.
  • OPR providers are required to revalidate their IHCP enrollment at intervals not to exceed every five years.

Note: OPR providers cannot submit claims to the IHCP for payment for services rendered. If you wish to be able to submit claims, you must enroll as another IHCP provider type. To enroll as a billing, group, or rendering provider, see Complete an IHCP Enrollment Application on this website.

Enrolling as an OPR Provider

Providers are encouraged to enroll as OPR providers using the IHCP Provider Healthcare Portal (Portal). The Portal guides users through the process, and supporting documentation can be attached and submitted online.

If you choose to use paper, you must complete the IHCP Ordering, Prescribing, or Referring Provider Enrollment and Profile Maintenance Packet. Detailed instructions are included in the packet. The 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.

Once enrolled, OPR providers are encouraged to register a Provider Account on the IHCP Portal. The Portal offers a quick and easy way to keep the OPR enrollment information up-to-date. For more information about registering on the Portal, see the Provider Healthcare Portal provider reference module.

Updating Your OPR Provider Profile

The information that identifies and describes a specific provider is called a Provider Profile. When your information changes (for example, changes to license information, contact information, name or address, or the disclosed individuals for organizations), you are required to submit a profile update to the IHCP within 10 business days.

Recertifying your OPR Provider Enrollment

OPR providers must maintain an active license and/or certification to remain enrolled in the IHCP. Providers are not required to submit documentation to recertify their enrollment; the IHCP verifies licensing information periodically.

Revalidating your OPR Provider Enrollment

The Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to revalidate OPR provider enrollments at intervals not to exceed every five years. For more information, see Provider Enrollment Revalidation.

OPR providers must revalidate using the IHCP Ordering, Prescribing, or Referring Provider Enrollment and Profile Maintenance Packet. (The option to use the IHCP Portal is coming soon - watch IHCP publications.) Detailed instructions are included in the packet. The 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.

Disenrolling as an OPR Provider

OPR providers may voluntarily disenroll from the IHCP at any time. Providers can disenroll using the IHCP Provider Portal, or they can complete the IHCP Ordering, Prescribing, or Referring Provider Enrollment and Profile Maintenance Packet. Detailed instructions are included in the packet. Complete only the necessary fields and submit the packet using the mailing instructions at the bottom of this page.

After disenrolling as an OPR provider, you may enroll as another provider type. For more information about enrolling as another provider type, see Complete an IHCP Enrollment Application.

Mailing paper OPR Provider Transactions

  1. Before mailing, make a copy of the completed provider packet.
  2. Mail the packet to the IHCP at the following address:
    Provider Enrollment Unit
    P.O. Box 7263
    Indianapolis, IN 46207-7263

Processing OPR Provider Transactions

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 your submission is complete, your transaction will be processed.
  • If the IHCP confirms your enrollment, you will receive a verification letter from the Provider Enrollment Unit.
  • If the IHCP denies enrollment, you will receive a notification letter explaining the denial reason. If you believe your enrollment was denied in error, you may appeal. See the Provider Enrollment provider reference module for information about the appeal process.