INSTRUCTIONS FOR ENROLLMENT AND CREDENTIALING WITH HOOSIER HEALTHWISE (HHW), HEALTHY INDIANA PLAN (HIP) AND CARE SELECT MANAGED CARE ENTITIES To reduce the need for practitioners to complete multiple.
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How to fill out the (MCE) Provider Enrollment Form - Indiana Medicaid online
Filling out the (MCE) Provider Enrollment Form for Indiana Medicaid can seem daunting, but with clear guidance, you can complete it efficiently. This guide will walk you through each section and field of the form to ensure you provide all necessary information accurately.
Follow the steps to successfully complete the provider enrollment form:
- Click ‘Get Form’ button to acquire the enrollment form and open it for editing.
- Begin by selecting the program(s) for which you are enrolling, such as Healthy Indiana Plan (HIP), Hoosier Healthwise (HHW), or Care Select. Ensure to check the appropriate box that corresponds to your choice.
- Fill in your practitioner data, including your CAQH number, name, degree, social security number, and date of birth. Be sure to capture all relevant identifiers, such as your National Provider Identifier (NPI) and any licenses.
- Indicate your practice type and primary specialty. Specify if you are enrolling as an individual, group, or other entities, and provide secondary specialties if applicable.
- Complete the section on hospital privileges, indicating whether you have delivery privileges if relevant. List any relationships or privileges you may have with hospitals.
- Provide your primary practice information, including practice group name, service location address, and contact information. Make sure to check if your office is handicap accessible.
- Fill out pay-to information by entering billing details such as billing address and contact information. This is crucial for ensuring correct payment processes.
- If you have additional practice locations, list them in the designated section. Include similar details as requested for the primary practice.
- Review and complete the attestation and authorization section. This part is crucial as it grants permission for credentialing entities to access your information. Ensure you read and understand your rights regarding the credentialing process.
- Once all sections are completed, save your changes. You may choose to download, print, or share the completed form as needed.
Start your enrollment process by completing the provider enrollment form online today!
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How do I find my Medicaid provider number for Indiana?
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.
How do I get a CIH waiver in Indiana?
To qualify for the Community Integration and Habilitation Waiver, you must have been diagnosed with an intellectual disability, developmental disability or related condition with an onset prior to the age of 22 years and the condition must be expected to continue indefinitely. You must meet Level of Care.
What is an MCE in Indiana?
If you are a member of the Healthy Indiana Plan, Hoosier Healthwise, or Hoosier Care Connect, you will need to choose a health plan, also known as a managed care entity (MCE). A health plan, or MCE, is a health insurance company.
How do I become a Medicaid waiver provider in Indiana?
To enroll a new waiver rendering provider with an existing waiver group or clinic, use the IHCP Waiver Rendering Provider Enrollment and Profile Maintenance 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.
Does Medicaid waiver pay for assisted living in Indiana?
Indiana Aged & Disabled Medicaid Waiver While Medicaid doesn't directly pay for assisted living in Indiana, there is a waiver program which does. The Indiana Aged & Disabled Medicaid Waiver is designed to help the elderly and disabled who require care services similar to that of nursing homes.
How long is the wait for Indiana Medicaid waiver?
You can expect to wait at least five years before getting Medicaid waiver services in Indiana. What assistance is available while you wait? Utilize Medicaid State Plan Services, if eligible. Apply for caregiver supports (respite), as they are available.
How do I enroll in Medicaid provider in Indiana?
Enrollment Status. Enter your assigned Tracking number and Federal Tax Indentification Number (TIN or EIN) that you used for your enrollment to verify the current status of your enrollment application. For any further queries, please contact Provider enrollment at 1-800-457-4584.
What is a CIH waiver in Indiana?
The Community Integration and Habilitation (CIH) waiver provides services that enable individuals to remain in their homes or community-based settings. The CIH waiver also assists individuals who are transitioning from state-operated facilities or other institutions into community settings.
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