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Family Member/Associate Transportation Providers

The Indiana Health Coverage Programs (IHCP) allows a family member or close associate of a Medicaid member to officially enroll as a driver, so the driver's mileage can be reimbursed. This is appropriate for members who must make frequent trips for medical services, and who have a person willing and able to transport them, but doing so presents a financial burden.

Enrollment Process for Family Member or Associate Drivers

The following processes and guidelines apply to family member or associate drivers enrolling with the IHCP:

  • Individuals enroll with the IHCP as provider type 26 - Transportation; provider specialty 266 - Family Member.
  • If you have a transportation business or are already enrolled with the IHCP as another type of transportation provider, you should not enroll under this specialty.
  • The Medicaid member you are transporting must request your enrollment by completing the Medicaid Family Member or Associate Transportation Services Form. Reimbursement is restricted to transportation for the specific member completing the form. If you drive more than one family member, you need to enroll only once, but your enrollment must include a separate request form from each Medicaid member you will be driving.
  • You must submit the following documents for enrollment:
    1. An IHCP Family Member or Associate Transportation Provider Enrollment and Profile Maintenance Packet - completed and signed by the enrolling driver
    2. A copy of the Medicaid Family Member or Associate Transportation Services Form - completed and signed by the requesting Medicaid member
    3. A copy of your current driver's license
    4. A copy of your current auto insurance for the vehicle being used
    5. A copy of your current auto registration for the vehicle being used
    6. A W-9 tax form
  • The forms in #1 and #2 above can be completed online by clicking the links provided and filling in the information. The completed forms can then be printed for mailing.
  • Before mailing, it would be helpful to keep a copy of all documents for your records.
  • You must mail the packet and other required documentation to the IHCP at the following address:
    Provider Enrollment Unit
    P.O. Box 7263
    Indianapolis, IN 46207-7263
  • Enrollment paperwork will be reviewed by the IHCP for completeness and accuracy. If any information is missing or needs correcting, you will be contacted by telephone, email, fax, or mail.
  • Please allow at least 15 business days for processing. The IHCP Provider Enrollment Unit will notify you by mail of your enrollment status.

Trip Scheduling and Reimbursement Process

All transportation provided by family member or associate drivers must be managed through the Medicaid member's transportation broker. Once you are successfully enrolled with the IHCP, the Medicaid member's transportation broker will contact you to finalize any paperwork needed, so you can begin scheduling trips and submitting claims for reimbursement.

Before transporting a Medicaid member, authorization for the trip must be obtained from the member's transportation broker. This authorization will include information that is required for payment. The documentation and reimbursement processes will be defined by the member's transportation broker. Information required for payment may include but is not limited to:

  • Name of the Medicaid member being transported
  • Member's Medicaid ID
  • Name of the enrolled driver
  • Mailing address of the enrolled driver
  • Relationship of the driver to the member
  • Driver's Social Security number
  • Driver's telephone number
  • Trip date
  • Trip authorization number
  • Number of miles authorized
  • Name, telephone number, and signature of the medical provider
  • Signature of the Medicaid member

Keeping Your IHCP Enrollment Up-to-Date

The information that identifies and describes you as an IHCP provider is called a Provider Profile. The Provider Profile includes the information you provided in your original enrollment application. You are responsible for keeping all the information in your Provider Profile up-to-date. The following must be reported:

  • Changes to your name, address, telephone number, or other contact information
  • Changes or updates to your driver's license, vehicle registration, and vehicle insurance coverage, including providing copies of these documents when those on file with the IHCP expire

Every five years you will be asked to revalidate your IHCP enrollment. You may voluntarily disenroll from the IHCP at any time by submitting an IHCP Provider Disenrollment Form.

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