During enrollment, all providers must identify the type, specialty and classification under which they wish to enroll.
The IHCP Provider Healthcare Portal (IHCP Portal) guides providers through the enrollment application based on their selections for provider classification, type and specialty. Providers who opt to apply for or update their enrollment by mail may use the IHCP Provider Enrollment Packet Finder to access the correct IHCP provider packet based on their provider type, specialty classification.
Provider Classifications
Providers fall into one of the following four classifications for claim submission and reimbursement purposes. See the Provider Enrollment provider reference module for more information about determining the appropriate provider classification for your circumstances.
- Billing provider – A practitioner operating as an individual or sole proprietor, or an organization operating as a business entity, billing for services at a distinct service location, with no rendering providers linked to the practice or entity
- Group provider – A practice or business entity operating at a distinct service location with one or more practitioners or rendering providers linked to a common taxpayer identification number (TIN) for billing
- Rendering provider – A practitioner or other provider rendering services for a group practice and linked to a common TIN
- A provider enrolled as a rendering provider under one or more groups at one or more service locations may also enroll as a billing provider at a different service location.
- Ordering, Prescribing, Referring (OPR) – Practitioners who do not bill the IHCP for services rendered but who may order, prescribe, or refer services or medical supplies for IHCP members
Note that the preceding classifications refer to the way a particular provider is enrolled with the IHCP. These terms mean something different in the context of billing claims. The “billing provider” on the claim could be enrolled under either the billing or group classification. The “rendering provider” on the claim could be enrolled under either the rendering or billing classification. The “OPR provider” on the claim could be enrolled under the OPR, rendering or billing classification.
Provider Type and Specialty
Refer to the IHCP Provider Enrollment Type and Specialty Matrix to determine the documentation required to enroll or revalidate as an IHCP provider under a given provider type and specialty. The matrix also provides information about out-of-state enrollment requirements, if allowable for a given provider specialty.
For risk factors and application fees associated with a provider type and specialty, see the IHCP Provider Enrollment Risk Category and Application Fee Matrix.
The following is a list of all provider types; click each one to reveal the specialties allowable for that type.
- Type 01 – Hospital
- 010 – Acute Care
- 011 – Psychiatric
- 012 – Rehabilitation
- 013 – Long-Term Acute Care
- Type 02 – Ambulatory Surgical Center
- 020 – Ambulatory Surgical Center (ASC)
- Type 03 – Extended Care Facility
- 030 – Nursing Facility
- 031 – Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)
- 032 – Pediatric Nursing Facility
- 033 – Residential Care Facility
- 034 – Psychiatric Residential Treatment Facility (PRTF)
- Type 04 – Rehabilitation Facility
- 040 – Rehabilitation Facility
- 041 – Comprehensive Outpatient Rehabilitation Facility (CORF)
- Type 05 – Home Health Agency
050 – Home Health Agency
- Type 06 – Hospice
- 060 – Hospice
- Type 08 – Clinic
- 080 – Federally Qualified Health Center (FQHC)
- 081 – Rural Health Clinic (RHC)
- 082 – Medical Clinic
- 083 – Family Planning Clinic
- 084 – Nurse Practitioner Clinic
- 086 – Dental Clinic
- 087 – Therapy Clinic
- 088 – Birthing Center
- Type 09 – Advanced Practice Registered Nurse (APRN)
- 090 – Pediatric Nurse Practitioner
- 091 – Obstetric Nurse Practitioner
- 092 – Family Nurse Practitioner
- 093 – Clinical Nurse Specialist
- 094 – Certified Registered Nurse Anesthetist (CRNA)
- 095 – Certified Nurse Midwife
- Type 10 – Physician Assistant
- 100 – Physician Assistant
- Type 11 – Behavioral Health Provider
- 110 – Outpatient Mental Health Clinic
- 111 – Community Mental Health Center (CMHC)
- 114 – Health Service Provider in Psychology (HSPP)
- 115 – Adult Mental Health and Habilitation (AMHH) Service Provider
- 611 – Children's Mental Health Wraparound (CMHW) Service Provider
- 612 – Behavioral and Primary Healthcare Coordination (BPHC) Service Provider
- 613 – Medicaid Rehabilitation Option (MRO) Clubhouse
- 615 – Applied Behavior Analysis (ABA) Therapist (Masters/Doctoral or HSPP)
- 616 – Licensed Psychologist
- 617 – Licensed Independent Practice School Psychologist
- 618 – Licensed Clinical Social Worker (LCSW)
- 619 – Licensed Marriage and Family Therapist (LMFT)
- 620 – Licensed Mental Health Counselor (LMHC)
- 621 – Licensed Clinical Addiction Counselor (LCAC)
- 622 – Mobile Crisis Unit
- 623 – Certified Community Behavioral Health Clinic (CCBHC)
- 624 – Applied Behavior Analysis (ABA) Therapist (Bachelors)
- 625 – Applied Behavior Analysis (ABA) Therapist (Registered Behavior Technician [RBT])
- 835 – Opioid Treatment Program (OTP)
- 836 – Substance Use Disorder (SUD) Residential Addiction Treatment Facility
- Type 12 – School Corporation
- 120 – School Corporation
- Type 13 – Public Health Agency
- 130 – County Health Department
- Type 14 – Podiatrist
- 140 – Podiatrist
- Type 15 – Chiropractor
- 150 – Chiropractor
- Type 17 – Therapist
- 170 – Physical Therapist
- 171 – Occupational Therapist
- 173 – Speech/Hearing Therapist
- Type 18 – Optometrist
- 180 – Optometrist
- Type 19 – Optician
- 190 – Optician
- Type 20 – Audiologist
- 200 – Audiologist
- Type 22 – Hearing Aid Dealer
- 220 – Hearing Aid Dealer
- Type 24 – Pharmacy
- 240 – Pharmacy
- 241 – Pharmacist
- 250 – Durable Medical Equipment (DME)/Medical Supply Dealer
- 251 – HME/Home Medical Equipment
Note: Pharmacies must have specialty 240 as their primary specialty, and may add specialty 250 and/or 251 as secondary specialties. A pharmacy may opt to enroll as a group provider, with individually enrolled rendering pharmacists (specialty 241) linked to the group, to receive reimbursement for select pharmacist services billed on a professional claim.
- Type 25 – Durable Medical Equipment/Medical Supply Dealer
- 250 – Durable Medical Equipment (DME)/Medical Supply Dealer
- 251 – HME/Home Medical Equipment
- 252 – Donor Milk Bank
- Type 26 – Transportation Provider
- 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)
- 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.
- Type 27 – Dentist
- 270 – Endodontist
- 271 – General Dentistry Practitioner
- 272 – Oral Surgeon
- 273 – Orthodontist
- 274 – Pediatric Dentist
- 275 – Periodontist
- 276 – Mobile Dental Van
- 277 – Prosthesis
- Type 28 – Laboratory
- 280 – Independent Lab
- 281 – Mobile Lab
- 282 – Independent Diagnostic Testing Facility (IDTF)
- 283 – Mobile Independent Diagnostic Testing Facility (IDTF)
- Type 29 – Radiology
- 290 – Freestanding X-Ray Clinic
- 291 – Mobile X-Ray Clinic
- Type 30 – End-Stage Renal Disease Clinic
- 300 – Free-Standing Renal Dialysis Clinic
- Type 31 – Physician
- 310 – Allergist
- 311 – Anesthesiologist
- 312 – Cardiologist
- 313 – Cardiovascular Surgeon
- 314 – Dermatologist
- 315 – Emergency Medicine Practitioner
- 316 – Family Practitioner
- 317 – Gastroenterologist
- 318 – General Practitioner
- 319 – General Surgeon
- 320 – Geriatric Practitioner
- 321 – Hand Surgeon
- 323 – Neonatologist
- 324 – Nephrologist
- 325 – Neurological Surgeon
- 326 – Neurologist
- 327 – Nuclear Medicine Practitioner
- 328 – Obstetrician/Gynecologist
- 329 – Oncologist
- 330 – Ophthalmologist
- 331 – Orthopedic Surgeon
- 332 – Otologist, Laryngologist, Rhinologist
- 333 – Pathologist
- 334 – Pediatric Surgeon
- 336 – Physical Medicine and Rehabilitation Practitioner
- 337 – Plastic Surgeon
- 338 – Proctologist
- 339 – Psychiatrist
- 340 – Pulmonary Disease Specialist
- 341 – Radiologist
- 342 – Thoracic Surgeon
- 343 – Urologist
- 344 – General Internist
- 345 – General Pediatrician
- 346 – Dispensing Physician
- Type 32 – Waiver Provider
- 350 – Indiana PathWays for Aging Waiver / Health & Wellness Waiver (formerly the Aged and Disabled [A&D] Waiver)
- 356 – Traumatic Brain Injury (TBI) Waiver
- 359 – Community Integration and Habilitation Waiver
- 360 – Family Supports Waiver
- 363 – Money Follows the Person (MFP) Demonstration Grant
Note: Waiver providers deliver home- and community-based services (HCBS) to eligible IHCP members.
- Type 34 – MRT Copy Center
- 366 – Medical Review Team (MRT) Copy Center
- Type 36 – Genetic Counselor
- 800 – Genetic Counselor
- Type 37 – Medicare-Only Provider
Note About Type 37:
Medicare-enrolled providers who are not currently enrolled in the IHCP, but who want to receive reimbursement for Medicaid cost-sharing obligations (such as copayments and deductibles) for their Medicare members, may enroll in the IHCP under provider type 37 – Medicare-Only Provider. This provider type is intended for providers that only see Medicaid members who are dually eligible (those who are enrolled with both Medicare and Medicaid). Providers that may see other IHCP members, in addition to dually eligible members, should instead enroll according to the provider type and specialty appropriate to their qualifications (see the Complete an IHCP Provider Enrollment Application page).
Medicare-Only Providers will not appear in the IHCP provider directory and will only be reimbursed any applicable cost-sharing obligations for dually eligible IHCP members. Medicare-Only Providers must enroll under the Billing classification. This provider type is be classified in the limited risk category. No application fee is required. Enrollment applications may be submitted online or by mail, following the steps listed below.
- Type 50 – Ordering, Prescribing, Referring
Note About Type 50:
Provider type 50 – Ordering, Prescribing, Referring (OPR) is used for all practitioners who enroll under the OPR provider classification. A variety of physician and nonphysician specialties are available under this provider type. The same licensing or certification documentation that would be required for a particular specialty enrolling under a non-OPR provider type is also required for that specialty to enroll under the OPR provider type. For more information, see the Ordering, Prescribing or Referring Providers page.