The Indiana Health Coverage Programs (IHCP) enrolls the following specialty under provider type 30 – End-Stage Renal Disease Clinic:
- 300 – Free-Standing Renal Dialysis Clinic
Initiating Your Enrollment Transaction
The following steps outline the basic enrollment process for this provider type. More detailed information is available in the Provider Enrollment provider reference module.
- Refer to the IHCP Provider Enrollment Type and Specialty Matrix for a list of the documentation required for IHCP enrollment or revalidation under each applicable provider specialty.
- See the IHCP Provider Enrollment Risk Category and Application Fee Matrix 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, an end-stage renal disease clinic enrollment or revalidation is considered "limited" risk and is not subject to additional screening measures.
- An end-stage renal disease clinic enrollment, revalidation, or change of ownership 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.
- 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.
If you choose to enroll or update by mail, complete the IHCP Hospital and Facility Provider Enrollment and Profile Maintenance Packet (detailed instructions are included in the packet):
- 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 packet, following the instructions provided. See the Update Your Provider Profile page 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
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 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 approves your enrollment or revalidation, you will receive a verification letter from the Provider Enrollment Unit.
- If the IHCP denies enrollment or revalidation, you will receive a notification letter 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.
Note: Letters from the IHCP Provider Enrollment Unit are sent in envelopes that display the Indiana Family and Social Services (FSSA) logo and the words “Office of Medicaid Policy & Planning” above the return address.