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Complete an IHCP Provider Enrollment Application


Note: If you are enrolling in the Indiana Health Coverage Programs (IHCP) as an ordering, prescribing or referring (OPR) provider or updating an OPR enrollment, this page does not apply. See the Ordering, Prescribing or Referring Providers page on this website for more information.

If you are enrolling to receive gas mileage reimbursement for transporting a family member or close associate to medical appointments, see the Family Member/Associate Transportation Providers page for more information.


Providers are encouraged to use the IHCP Provider Healthcare Portal (Portal) to enroll in the IHCP, 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 submissions.

Providers who choose not to use the Portal must complete an Indiana Health Coverage Programs Enrollment and Profile Maintenance Packet (IHCP provider packet) to enroll, add a service location, report a change of ownership, revalidate, or update certain provider profile information. The completed IHCP provider packet must be printed and submitted by mail along with any required attachments.

A provider enrollment application must be submitted, either via the Portal or using the appropriate IHCP provider packet, for the following transactions:

  • Enroll as an IHCP provider for the first time – When you enroll as a provider with the IHCP, you will need to enroll online through the Portal or complete and submit the appropriate IHCP provider packet in its entirety.
  • Add a service location to an existing IHCP provider – When you add a service location to an existing IHCP provider, that service location is treated as a new enrollment. You will need to enroll the service location through the Portal or complete and submit the appropriate IHCP provider packet in its entirety.
  • Convert an enrollment from an OPR provider to a rendering provider – When you convert an OPR provider enrollment to a rendering provider enrollment, you will need to apply for the conversion online through the Portal or complete and submit the rendering provider packet. Converting the enrollment classification allows the start and end dates to be effective simultaneously, with no enrollment gap for the provider.
  • Report a change of ownership (CHOW) for an existing IHCP provider – When you report a change of ownership for an entity that is already enrolled with the IHCP, the change is treated as a new enrollment. The new owner will need to enroll online through the Portal or complete and submit the appropriate IHCP provider packet in its entirety, including new ownership information and signatures.
  • Revalidate enrollment as an IHCP provider – When it is time to revalidate your enrollment as an IHCP provider, you will receive notice on your Portal account, as well as written notification of the revalidation deadline. Revalidation is similar to a new enrollment. You will need to revalidate through the Portal or complete and submit the appropriate IHCP provider packet in its entirety, with all current information. See the Provider Enrollment Revalidation page on this website for more details.

In addition, an IHCP provider packet may be required to update certain provider profile information for an existing IHCP provider. Although most provider updates can be made via the Portal or by submitting a stand-alone maintenance form, some updates may require providers to complete and submit the relevant sections of the IHCP provider packet. See Update Your Provider Profile on this website for more details.


Provider Classification, Type and Specialty

The Portal will guide you through enrollment transactions based on your provider classification, as well as your provider type and specialty. Your provider classification, type, and specialty will also determine the appropriate paper IHCP provider packet to use and the specific instructions for completing it.

All providers fall into one of the following three 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.

Use the IHCP Provider Enrollment Type and Specialty Matrix to determine your provider type and specialty and to identify the proper IHCP provider packet and documents you must submit to enroll or revalidate as an IHCP provider. Choose your provider type from the following list.


Providers Located Outside Indiana

The IHCP Provider Enrollment Type and Specialty Matrix includes special documentation requirements for providers that are located outside Indiana. It also indicates particular provider types and specialties that are ineligible for IHCP enrollment if not located in Indiana.

Special prior authorization requirements apply for services rendered by IHCP providers with an out-of-state enrollment status. However, eligible providers located in certain designated areas outside Indiana can enroll in the IHCP with an in-state status for prior authorization purposes. For applicable ZIP Codes, see Out-of-State Areas Designated as In-State for IHCP Providers. Some other circumstances, identified during the enrollment application process, may also qualify an eligible out-of-state provider to enroll in the IHCP with an in-state status for prior authorization purposes.

Note: The designated areas and other circumstances that allow an out-of-state provider to enroll in the IHCP with an in-state status apply only to provider types and specialties that are eligible for enrollment if located outside Indiana. This option is not available to provider types and specialties that are excluded from out-of-state enrollment.

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