Indiana Application Service Provider Agreement
Description
How to fill out Application Service Provider Agreement?
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FAQ
Enroll as an IHCP provider for the first time ? When you enroll as a provider with the IHCP, you will need to enroll online through the portal or complete and submit the appropriate IHCP provider packet in its entirety.
Indiana Medicaid Members Home Healthy Indiana Plan. Hoosier Care Connect. Traditional Medicaid.
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 ( ) 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.
Enroll as an IHCP provider for the first time ? When you enroll as a provider with the IHCP, you will need to enroll online through the portal or complete and submit the appropriate IHCP provider packet in its entirety.
Visit the Provider Portal. Click on the ?Register Now? button and complete the three-step registration process. You will need your Tax ID number and your CareSource Provider Number, located in your welcome letter. Click the ?Continue? button.
How Do Indiana Medicaid Transportation Providers Apply for Enrollment? Step 1 ? Determined the Enrollment Specialty. ... Step 2 ? Purchase a Surety Bond. ... Step 3 ? Purchase Insurance. ... Step 4 ? Complete the Application.