The Indiana Health Coverage Programs (IHCP) provider enrollment instructions and processes are outlined on these web pages. Before proceeding with any enrollment-related transaction, please see the Provider Enrollment provider reference module for more information.
Use the IHCP Provider Healthcare Portal to Submit Enrollment Transactions
Providers are encouraged to use the IHCP Provider Healthcare Portal (Portal) to apply and maintain their enrollment profiles as IHCP providers. 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 transaction submissions.
The Portal's online provider enrollment feature is an easy-to-use option for providers enrolling for the first time, as well as for current providers who need to enroll a new service location, report a change in ownership, or revalidate their enrollment. The online enrollment process includes helpful features and numerous advantages over the current paper process:
- Online transactions are more efficient and convenient.
- Business and personal information is more secure.
- Systematic checks verify that information is complete, reducing inadvertent submission errors and the need for corrections.
- Enrollment applications can be easily saved and edited as needed during the process.
- Supporting enrollment documentation can be uploaded electronically and submitted with the transaction.
- Providers can monitor the status of submitted transactions in real time.
Web-based training for using the Portal to enroll is available on the Provider Healthcare Portal Training page on this site. Assistance is also available from Provider Relations field consultants. Providers not using the Portal may use paper enrollment transaction forms.
Provider Enrollment Information
- If you transport a family member or close associate to frequent medical appointments and you are interested in participating as an IHCP provider to be reimbursed gas mileage, go to the Family Member/Associate Transportation Providers page.
- If you are interested in participating as an IHCP provider so that you are eligible to order, prescribe, or refer covered services and medical supplies for your patients who are eligible for IHCP coverage, go to the Ordering, Prescribing, or Referring Providers page.
- A National Provider Identifier (NPI) is required for almost all providers that want to enroll in the IHCP. Visit the National Provider Identifier page to learn more about the NPI.
- When enrolling as an IHCP provider, certain provider types are subject to an application fee. The fee amount is set by the Centers for Medicare & Medicaid Services (CMS). Generally, the application fee applies to "institutional" providers, as defined by CMS, and not to individual professionals, such as physicians. Visit the Provider Enrollment Application Fee page to learn more about which providers are subject to fee payment.
- Each provider is subject to a pre-enrollment risk assessment screening to determine the potential level of risk for fraud, waste, and abuse. Providers are categorized by risk level - high, moderate, or limited - using the CMS guidelines for risk determination. Visit the Provider Enrollment Risk Levels and Screening page to learn more about the risk levels and the related screening activities.
- After providers are enrolled as IHCP providers, they may apply to participate as providers under the managed care program. Visit the Enrolling as a Managed Care Program Provider page to learn more about how to apply with one or more of the managed care plans.
- Recertification of expiring licenses and other certifications is necessary for a provider to continue to be eligible as an IHCP provider. Visit the Recertify Provider Enrollment Licenses and Other Certifications page to learn more about recertification requirements.
- Revalidation of provider enrollment occurs on a regular schedule. Most providers are required to revalidate at intervals not to exceed every five years; however, a more frequent three-year revalidation requirement applies to some provider types. Visit the Provider Enrollment Revalidation page to learn more about revalidation requirements.
- The information obtained from a provider during the provider enrollment process is compiled into a provider profile. All enrolled providers are required to keep their provider profiles up-to-date with current information about their business. Visit the Update Your Provider Profile page to learn more about updating your profile information.
- Providers may voluntarily disenroll from the IHCP. See Disenroll from the IHCP to learn more about this process.
Appeals Process for Involuntary Terminations and Denied Enrollments
If a provider's enrollment is involuntarily terminated or the IHCP denies a provider's enrollment or revalidation, the provider has the right to appeal the decision. See the Provider Enrollment provider reference module for details about the appeals process.
The following links provide useful information you may need after you have enrolled.
- Subscribe to email notifications - Email notifications alert subscribers to important changes on the IHCP website. Providers receive notices when new bulletins, banners, and IHCP Provider Reference Modules are published. You may change your subscription at any time, and email addresses are never sold or used for any purpose other than IHCP business. We highly recommend subscribing to email notifications.
- Set up additional users with access to the IHCP Provider Healthcare Portal - The Portal is a secure website that enables you to enroll, update your provider profile, submit claims, check member eligibility, and much more. The person listed under "Contact Information" in the Portal and on the IHCP provider packet will be set up to access the Portal. See the Provider Healthcare Portal Training page for information about setting up additional users in the Portal.
Select the Transaction That Applies
- Enroll as an IHCP provider for the first time
- Add a service location to an existing IHCP provider
- Report a change of ownership (CHOW) for an existing IHCP provider
- Revalidate enrollment as an IHCP provider
- Update provider profile information for an existing IHCP provider
- Recertify provider enrollment licenses and other certifications
- Enroll as a managed care program provider
- Disenroll from the IHCP