IHCP Provider Enrollment Recertification of Licenses and 2025

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The document outlines the process for enrolled providers to recertify their licenses and certifications necessary for continued eligibility with the Indiana Health Coverage Programs (IHCP). It specifies which provider types are required to recertify, the steps involved in completing the recertification form, and the importance of submitting updated documentation before license expiration. Additionally, it includes a quality check checklist to ensure all necessary information and signatures are provided.
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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out Fields 1-6, which include your provider legal name, Legacy Provider Identifier (LPI), National Provider Identifier (NPI), Taxonomy, ZIP + 4, and Taxpayer Identification Number (TIN). Ensure accuracy as these details are crucial for your recertification.
  3. If you are a group or clinic provider, complete Fields 7-9 for each rendering provider. Each rendering provider requires a separate form for recertification.
  4. Common carrier transportation providers must also fill out Fields 10-11, providing necessary identification numbers.
  5. In the contact information section (Fields 12-14), provide the name, telephone number, and email of the person who can answer questions regarding this form.
  6. Finally, ensure that Fields 15-18 are completed with the authorized official’s name, title, signature, and date. An original signature is required to avoid processing delays.

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You can renew in one of these ways: Online. Login to your FSSA Benefits Portal at fssabenefits.in.gov to complete your renewal online. By Mail. Fill out the renewal forms. Please include any additional information the state has asked for. Redetermination | Indiana Medicaid - CareSource CareSource members renew-benefits CareSource members renew-benefits
The programs and services offered are incorporated under the umbrella of the Indiana Health Coverage Programs (IHCP).
Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves two steps, 1) Credentialing and 2) Contracting. What is Provider Enrollment - National Credentialing Solutions National Credentialing Solutions what-is-provider-enro National Credentialing Solutions what-is-provider-enro
Federal laws. Section 504 of the Rehabilitation Act of 1973. Individuals with Disabilities Education Act. Individual health care plan (IHCP)
An individualized healthcare plan, or IHCP, is the plan of care developed by a healthcare professional in any type of healthcare office, including doctors, nurses and fitness coaches. The healthcare professional creates this plan for the patient to follow during their treatment in order to achieve the best results.

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Ihcp provider enrollment recertification of licenses and certifications form Indiana Medicaid Provider Enrollment phone number Indiana Medicaid Provider Enrollment status Indiana Medicaid Provider Enrollment Portal Indiana Medicaid Provider Enrollment manual IHCP Provider Portal IHCP enrollment Form IHCP Provider Agreement

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The programs and services offered are incorporated under the umbrella of the Indiana Health Coverage Programs (IHCP). Healthcare benefits are administered through two delivery systems the fee-for-service (FFS) delivery system or the managed care delivery system. IHCP Programs and Services - Indiana Medicaid: Providers - IN.gov IN.gov medicaid ihcp-programs-and-serv IN.gov medicaid ihcp-programs-and-serv
800-457-4584 Provider Enrollment Inquiries If you have questions about IHCP provider enrollment, enrollment status or provider profile updates, call Customer Assistance at 800-457-4584 and select option 2, and then option 1 to check provider enrollment status or option 3 to update provider enrollment information. Indiana Medicaid: Providers: Contact Us - IN.gov IN.gov providers contact-information c IN.gov providers contact-information c
Indiana Medicaid Members Home Healthy Indiana Plan. Hoosier Care Connect. Traditional Medicaid.

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IHCP Provider Enrollment Recertification of Licenses and

Apr 30, 2025 Note: Any license, certification or insurance that is required for a providers enrollment in the IHCP must be kept current and active for

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