Get the free ihcp rendering provider agreement and attestation form

IHCP Rendering Provider Agreement and Attestation Form Version 6. 3E February 2017 Page 1 of 6 This agreement must be completed signed and returned to Hewlett Packard Enterprise for processing. By execution of this Agreement the undersigned entity Provider requests enrollment as a provider in the Indiana Health Coverage Programs IHCP. As an enrolled provider in the IHCP the undersigned entity agrees to provide covered services and/or supplies to IHCP members. As a condition of enrollment...

How to fill out ihcp rendering provider agreement

How to fill out ihcp rendering provider agreement

1. Obtain the IHCP rendering provider agreement form, either by downloading it from the IHCP website or contacting the IHCP provider enrollment unit.
2. Read the instructions provided with the form thoroughly to understand the requirements and obligations of the agreement.
3. Fill out the required personal and professional information accurately and completely. This may include your name, address, contact details, medical license number, and specialty.
4. Provide any supporting documentation required by the IHCP, such as proof of licensure or certification.
5. Review all the terms and conditions of the agreement carefully to ensure compliance.
6. Sign and date the agreement.
7. Submit the completed IHCP rendering provider agreement form and any required documentation via mail or electronically, as specified by the IHCP.
8. Await confirmation from the IHCP regarding the acceptance of your agreement. This may involve further verification or review.
9. Once approved, keep a copy of the signed agreement for your records and start rendering services as authorized by the IHCP.
10. Regularly review and update your IHCP rendering provider agreement as necessary, ensuring you comply with any changes in policies or regulations.

Who needs ihcp rendering provider agreement?

1. Healthcare providers who wish to participate in the Indiana Health Coverage Programs (IHCP) as rendering providers need to complete IHCP rendering provider agreement.
2. Common healthcare professionals who may need IHCP rendering provider agreement include physicians, nurse practitioners, dentists, physical therapists, occupational therapists, speech-language pathologists, audiologists, and other licensed healthcare practitioners who offer services covered by IHCP.
3. It is necessary for these providers to have an IHCP rendering provider agreement in order to receive reimbursement for services provided to IHCP members and to comply with IHCP enrollment requirements.

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