Provider Enrollment Application Fee

Certain enrolling providers are subject to an application fee. The IHCP Provider Enrollment Risk Category and Application Fee Matrix provides a full list of provider types and indicates which types are subject to application fees. Generally, the application fee applies to "institutional" providers, as defined by the Centers for Medicare & Medicaid Services (CMS), and not to individual professionals, such as physicians.

If providers are subject to an application fee, it is assessed in full for each service location at initial enrollment, revalidation, or with a change of ownership. The application fee is NOT an annual assessment.

Note

  • The application fee does not apply to practitioners enrolling only as ordering, prescribing, or referring (OPR) providers.
  • If a provider's service location is enrolled in Medicare or the provider pays an application fee to another state's Medicaid agency for a specific service location, the provider is not required to pay an application fee for that service location to the Indiana Health Coverage Programs (IHCP).

CMS sets the application fee amount, which may be adjusted annually. The application fee for enrollments received in 2016 is set at $554. The application fee for enrollments received in 2017 is set at $560.

Payment Options

The application fee can be paid only using one of the following electronic methods. Paper forms of payment are not accepted.

  • Online - Go to the IHCP Bill Pay site and follow the on-screen instructions. You can pay online using a credit card, debit card, or electronic funds transfer from your checking account. When the transaction is complete, you will receive a confirmation number to enter in the appropriate section of your IHCP provider packet.
  • By telephone - Contact IHCP Customer Assistance toll-free at 1-800-457-4584 and select the appropriate option. Please have your credit card, debit card, or checking account information ready. When the transaction is complete, you will receive a confirmation number to enter in the appropriate section of your IHCP provider packet.

Providers can download a Federal W-9 form for reporting payments on the provider's tax forms.