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.

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 Provider Enrollment Packet on this website.

Enrolling as an OPR Provider

  1. 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.
    • OPR providers are not required to pay application fees.
  2. Submit the packet using the mailing instructions at the bottom of this page.

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.

  1. Complete the IHCP Ordering, Prescribing, or Referring Provider Enrollment and Profile Maintenance Packet. Detailed instructions are included in the packet. Complete only the following:
    • Fields 1 through 3 in Section II - Provider Information
    • Any other fields with information that needs to be updated
    • Section VII - Provider Signature/Attestation
  2. Submit the packet using the mailing instructions at the bottom of this page.

Recertifying your OPR Provider Enrollment

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

Disenrolling as an OPR Provider

  1. OPR providers may voluntarily disenroll from the IHCP at any time. Complete the IHCP Ordering, Prescribing, or Referring Provider Enrollment and Profile Maintenance Packet. Detailed instructions are included in the packet. Complete only the following:
    • Fields 1 through 3 and 14 in Section II - Provider Information
    • Section VII - Provider Signature/Attestation
  2. 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 by submitting the appropriate enrollment application packet. For more information about enrolling as another provider type, see Complete an IHCP Provider Packet.

Mailing and Processing OPR Provider Transactions

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

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

  • If the packet 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 an application is rejected for missing or incomplete information, the entire packet will be returned to the provider with a letter indicating what needs to be corrected or attached. Providers MUST return the entire packet, as well as a copy of the provider letter, when submitting the correction or missing information.
  • If the packet 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.