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37 – Medicare-Only Provider

Medicare-enrolled providers who are not currently enrolled in the Indiana Health Coverage Programs (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 the following provider type and specialty:

  • Provider type 37, specialty 370 – 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.

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.

  1. Refer to the IHCP Provider Enrollment Type and Specialty Matrix for a list of the documentation required for IHCP enrollment or revalidation under the applicable provider specialty.

  2. 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 and revalidation screening process is determined by the risk level that applies to your provider type. At its discretion, the IHCP 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, a Medicare-Only Provider enrollment or revalidation is considered "limited" risk and is not subject to additional screening measures.
    • A Medicare-Only Provider enrollment, revalidation, added service location or change of ownership does not require the payment of an application fee.
  3. Providers are encouraged to use the IHCP Provider Healthcare Portal (IHCP 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, the IHCP Medicare-Only Provider Enrollment and Profile Maintenance Packet is the appropriate IHCP provider packet for you to complete for enrollment-related transactions (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 7236
    • 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 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 IHCP Portal and your submission is rejected for missing or incomplete information, the submission must be corrected in the portal. Providers will have 21 business days to make corrections, or the application will expire.
    • If you are enrolling via paper, a letter will be sent indicating what needs to be corrected or attached. Providers must attach a copy of this letter as a cover sheet when they submit the missing or corrected pages.

  • 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.

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