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IHCP Rendering Provider Agreement and Attestation Form Version 6. 4E July 2017 Page 1 of 6 This agreement must be completed signed and returned to the IHCP 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 Indiana Health Coverage Program members members. As a condition...

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What is ihcp rendering provider agreement?

The IHCP rendering provider agreement is a contract between a healthcare provider and the Indiana Health Coverage Programs (IHCP) that outlines the terms and conditions for providing services to IHCP members.

Who is required to file ihcp rendering provider agreement?

Any healthcare provider who wishes to provide services to IHCP members must file a rendering provider agreement.

How to fill out ihcp rendering provider agreement?

The IHCP rendering provider agreement can be filled out online through the IHCP Provider Healthcare Portal or submitted as a paper form.

What is the purpose of ihcp rendering provider agreement?

The purpose of the IHCP rendering provider agreement is to establish a formal agreement between the provider and IHCP, ensuring that the provider meets all IHCP requirements and guidelines.

What information must be reported on ihcp rendering provider agreement?

The IHCP rendering provider agreement requires providers to report their contact information, licensure, accreditation, and agreement to follow IHCP policies and procedures.

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