Get In Ihcp Mce Hospital/ancillary Provider Enrollment And Credentialing Form 2020-2025

The IN IHCP MCE Hospital/Ancillary Provider Enrollment And Credentialing Form is essential for healthcare providers seeking to enroll in Indiana's Health Coverage Programs. This guide will walk you through the process of filling out the form online, ensuring you understand each component and can complete it accurately.

Follow the steps to complete the enrollment and credentialing form effectively.

1. Press the ‘Get Form’ button to access the enrollment form and open it in your preferred editor.
2. Begin by selecting the Indiana Health Coverage Programs (IHCP) managed care program(s) applicable to your enrollment, such as Healthy Indiana Plan or Hoosier Healthwise.
3. Indicate whether you are submitting a new enrollment application or an update by checking the respective box.
4. If you are submitting an update, provide a detailed explanation of what information is being updated on a separate paper.
5. Ensure that all required documents are current and submitted along with the application, such as liability coverage, state licenses, federal forms, and other specific certificates.
6. Fill in the demographic information section completely, including entity name, contact details, accreditation type, and more.
7. If billing information differs from the demographic section, fill in the respective fields for payee and contact details.
8. Answer all disclosure questions thoroughly; indicate Yes or No and provide full details on separate sheets if necessary.
9. Complete the attestation section by authorizing the release of your organization’s credentialing information and sign and date the form at the end.
10. Once all sections are filled out, review your entries for accuracy. Save your changes, download a copy for your records, and if needed, print or share the form as required.

Start completing the IN IHCP MCE Hospital/Ancillary Provider Enrollment And Credentialing Form online today for a seamless enrollment experience.