The Indiana Health Coverage Programs (IHCP) and Indiana Prescription Drug Program (IPDP) require specific information for electronic data submission.  Please provide the requested information to assist with establishing an electronic data interchange (EDI) trading partner relationship with the IHCP/IPDP.

Data will be submitted electronically by one of the following: (Check the appropriate box)
Trading Partner Type
Provider   Clearinghouse / Billing Service Vendor   Managed Care Entity Medicare Intermediary / Carrier VAN