Initiating Your Enrollment Transaction
- See the IHCP Provider Enrollment Type and Specialty Matrix on this website for a list of the documentation you must submit to be enrolled or revalidated as an Indiana Health Coverage Programs (IHCP) provider. Possible specialties under this provider type are:
- 260 – Ambulance
- 261 – Air Ambulance
- 262 – Bus
- 263 – Taxi
- 264 – Common Carrier (Ambulatory)
- 265 – Common Carrier (Non-Ambulatory)
- 266 – Family Member*
- 267 – Transportation Network Company (TNC)
- 268 – Nursing Home Transportation
- 269 – Broker Fleet [Preapproval required prior to application]
*Note: Individuals enrolling as provider specialty 266 – Family Member should follow the enrollment process and instructions on the Family Member/Associate Transportation Provider page.
- See the IHCP Provider Enrollment Risk Category and Application Fee Matrix on this website to determine your risk level and whether you are required to pay an application fee. The enrollment or revalidation screening process is determined by the risk level that applies to your provider type. At its discretion, the State may assign a provider a higher risk level that supersedes the risk level assigned by the Centers for Medicare & Medicaid Services (CMS) and noted on the matrix.
- Generally, provider specialties 266, 267, 268, and 269 are considered "limited" risk at enrollment and revalidation and are not subject to additional screening measures.
- Generally, provider specialties 260 and 261 are considered "moderate" risk at enrollment and revalidation and are subject to additional screening measures, including pre-enrollment site visits.
- Generally, provider specialties 262, 263, 264, and 265 are considered "high" risk at enrollment, and "moderate" risk at revalidation. Both risk categories are subject to additional screening measures, including pre-enrollment site visits. High-risk provider types are also subject to fingerprinting and criminal background-check requirements. Individuals with at least 5% ownership or controlling interest in the enrolling entity must be fingerprinted before submitting the enrollment application, and the fingerprinting confirmation number must be included with the submission. See the Provider Enrollment Risk Levels and Screening page for instructions for fingerprinting.
- A transportation enrollment, revalidation, or change of ownership for specialties 260, 261, 262, 263, 264, 265, and 267 requires the payment of an application fee for each service location. Submit confirmation of your electronic payment of the fee to the IHCP or document in your enrollment submission that you have paid the fee to Medicare or another state Medicaid program.
- State law requires transportation providers with specialty 263, 264, 265, 267, 268, or 269 to purchase a surety bond to be eligible to enroll. This requirement applies to providers that are newly enrolling, reporting a change of ownership, or reporting a purchase or transfer of assets. Indiana Code exempts certain providers from this requirement, including 501(c)(3) nonprofit organizations, providers that are owned or controlled by a hospital or pharmacy licensed in Indiana, as well as other providers as specified in IC 12-15-11-2.5(b). A surety bond that meets State requirements can be obtained by contacting a licensed insurance broker and providing the broker with a copy of the Indiana Medicaid Surety Bond Requirements.
- Providers are encouraged to use the IHCP Provider Healthcare Portal (Portal) to enroll, add a service location, report a change of ownership, revalidate, or update provider profile information. Providers will find the online process much quicker and easier than using paper forms. Online help guides users through the process from start to finish and provides immediate confirmation of enrollment submissions. For more information about enrolling through the Portal, see the Provider Enrollment provider reference module.
- If you choose to enroll or update via paper, the IHCP Transportation Provider Enrollment and Profile Maintenance Packet is the appropriate IHCP provider packet for you to complete for enrollment-related transactions. (Exception: For specialty 266, use the IHCP Family Member or Associate Transportation Provider Enrollment and Profile Maintenance Packet.) Detailed instructions are included in the packet. See the Provider Enrollment provider reference module for more information.
- To enroll, add a service location, report a change of ownership, or revalidate a current IHCP enrollment, you must complete and submit the entire packet.
- To update an existing provider profile, submit the appropriate provider profile maintenance form, or complete the relevant sections, and submit the IHCP provider enrollment packet, following the instructions provided. See Update Your Provider Profile on this website.
- The paper 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.
- Before mailing, make a copy of the completed IHCP provider packet and required documentation for your records.
- Mail the packet and other required documentation to the following address:
IHCP Provider Enrollment Unit
P.O. Box 7263
Indianapolis, IN 46207-7263
- After you are enrolled as an IHCP provider, you must contract with one or more of the transportation brokers that manage transportation service for members. Refer to the links below:
- Nonemergency transportation for Traditional Medicaid members - contact Southeastrans Inc.
- All transportation services for Healthy Indiana Plan (HIP) and Hoosier Healthwise members contact:
- All transportation services for Hoosier Care Connect members contact:
Processing Your Enrollment Transaction
Please allow at least 15 business days for processing before checking the status of your submission. After your transaction is processed, the IHCP Provider Enrollment Unit will notify you of the results.
- 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 you are enrolling via the Portal and your submission is rejected for missing or incomplete information, the submission must be corrected in the Portal. If you are enrolling via paper, a letter will be sent from DXC Technology indicating what needs to be corrected or attached. When submitting the correction or missing information, providers MUST return the entire packet, along with a copy of the letter explaining the errors or omissions as a cover sheet.
- If the submission is complete, the Provider Enrollment Unit will process your transaction and conduct the appropriate screening associated with your assigned risk level.
- If the IHCP confirms your enrollment or revalidation, you will receive a verification letter from DXC Technology.
- If the IHCP denies enrollment or revalidation, you will receive a notification letter from DXC Technology explaining the reason for denial. If you believe your enrollment or revalidation was denied in error, you may appeal. See the Provider Enrollment provider reference module for information about the appeal process.