Disenroll from the IHCP

Providers may voluntarily disenroll from the Indiana Health Coverage Programs (IHCP) using the IHCP Provider Healthcare Portal (Portal) or via paper by using the IHCP Provider Disenrollment Form on the Update Your Provider Profile page of this website. The Portal or this form may be used to disenroll:

• An entire group or billing provider enrollment
• A specific service location
• Rendering provider linkages from a provider group or from one or more service locations
• Waiver rendering provider linkages from a waiver provider group or from one or more service locations

Note

Providers that want to disenroll from the IHCP should keep the following in mind:

• Providers enrolled as primary medical providers (PMPs) with a managed care entity (MCE) must contact the MCE to begin the disenrollment process before disenrolling from the IHCP.
• Waiver providers must contact the waiver divisions at the State before disenrolling from the IHCP.
• Ordering, prescribing or referring (OPR) providers who want to disenroll should see Ordering, Prescribing, or Referring Providers on this website.

Basic Steps to Disenroll

1. Disenroll online using the Provider Healthcare Portal OR
2. Complete the IHCP Provider Disenrollment Form.
   • Detailed instructions are included in the form.
   • Be sure to get appropriate signatures.
   • The disenrollment form is an interactive PDF file, allowing you to type information into the fields from your computer, save the completed file to your computer, and print the file for mailing.
   • Make a copy of the form for your records.
   • Mail the form to the IHCP at the following address:
     Provider Enrollment Unit
     P.O. Box 7263
     Indianapolis, IN 46207-7263

Processing Your Disenrollment

Please allow at least 15 business days for processing before checking the status of your disenrollment. You will be notified after the Provider Enrollment Unit processes your disenrollment.

• 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 your disenrollment is submitted via the Portal, and your submission is rejected for missing or incomplete information, the disenrollment must be corrected via the Portal. If your disenrollment is submitted via paper, the entire submission will be returned to you. Providers MUST return the entire submission to make corrections or to provide the missing information.
• If the update request is complete, it will be processed, and you will receive a notification.