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  • Ihcp Ordering, Prescribing, Referring Provider Enrollment And Profile Maintenance Packet

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Bing, or referring (OPR) practioner AND are not otherwise enrolled as a provider with the Indiana Health Coverage Programs (IHCP). OPR providers do not bill the IHCP for services rendered to members; they only order, prescribe and/or refer services/supplies for their IHCP-eligible patients. If you are already enrolled as another type of provider in the IHCP you do not need to complete this form. This form should not be used to enroll as a billing, group, or rendering provider with the intent to.

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No. Indiana and another state must have reciprocity with each other at the time of Medicaid application. States can opt in and out of the reciprocity agreement with 60 days notice. If a state opts out of Reciprocity, individuals who have already accessed Medicaid would be grandfathered.

You can update your information on the benefits portal (https://fssabenefits.in.gov) or by calling 800-403-0864. It is also important to open and respond to all mail from FSSA and your health plan (Anthem, CareSource, MDwise, MHS, or United Healthcare).

Log into your Member Portal Account or create a New Account. ... Once on the Member Homepage, click on Change Primary Provider. Once you click on Change Primary Provider, select your network from Hoosier Healthwise, Healthy Indiana Plan (HIP) or Hoosier Care Connect. Review your choice of PMP by clicking Select.

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.

Anyone covered by Indiana Medicaid should make sure the Indiana Family and Social Service Administration (FSSA) has their correct address. They can update their information on the benefits portal (https://fssabenefits.in.gov) or by calling 800-403-0864.

Change of Ownership The following must be submitted along with the enrollment application: Appropriate licensure or other supporting documentation. A copy of a purchase agreement, bill of sale, or other documentation to verify the CHOW.

If there are questions about this information, contact EDS Customer Assistance at (317) 655-3240 in the Indianapolis local area or 1-800-577-1278. The quick reference is also available on the IHCP Web site at .indianamedicaid.com.

ORDERING, PRESCRIBING AND REFERRING (OPR) PROVIDERS.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232