IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing Form 2024-2025 free printable template
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IHCP MCE HOSPITAL/ANCILLARY PROVIDER
ENROLLMENT AND CREDENTIALING FORM
This form is used to enroll participating facilities such as hospitals, home health agencies, and other nonpractitioner providers
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How to fill out IN IHCP MCE HospitalAncillary Provider Enrollment and
How to fill out IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing
01
Obtain the IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing form from the official state health department website.
02
Fill out the provider information section, including the hospital or ancillary provider's name, address, and contact details.
03
Provide details about the services offered by the facility or provider.
04
Complete the section that requests tax identification and National Provider Identifier (NPI) numbers.
05
Fill out ownership information, including details about any parent companies or stakeholders.
06
Attach necessary documentation, such as licenses, certifications, and proof of insurance.
07
Review the completed application for accuracy and completeness before submission.
08
Submit the application via the specified method (e.g., online, by mail) as outlined in the instructions.
Who needs IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing?
01
Hospitals and ancillary providers who want to participate in the Indiana Health Coverage Programs (IHCP).
02
Healthcare facilities aiming to provide services to patients enrolled in IHCP managed care entities (MCEs).
03
Any new providers wishing to become credentialed under the IHCP for reimbursement purposes.
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Eligibility factors Age - These programs serve children through the age of 18. Current health insurance coverage - Having private insurance may affect eligibility. Income - See limits below.
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Traditional Medicaid members should contact the Traditional Medicaid Member Services and Pharmacy Services line. A complete list of phone numbers is provided below.Contacts by Health Plan: MHSMember Services (Healthy Indiana Plan)877-647-4848Member Services (Hoosier Care Connect)877-647-48484 more rows
What is the maximum income to qualify for Medicaid in Indiana?
Income & Asset Limits for Eligibility 2023 Indiana Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (both spouses applying)Income LimitAsset LimitInstitutional / Nursing Home Medicaid$2,742 / month*$3,000Medicaid Waivers / Home and Community Based Services$2,742 / month†$3,0001 more row • Feb 27, 2023
What documents are needed for Medicaid application in Indiana?
INFORMATION REQUIRED TO COMPLETE THE INDIANA MEDICAID APPLICATION Names and dates of birth. Social Security Numbers. Income from jobs or training. Benefits you get now (or got in the past), such as Social Security, Supplemental Security Income (SSI), veteran's benefits, or child support.
What does Medicaid pay for in Indiana?
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What is IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing?
IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing is a process that ensures hospitals and ancillary providers are properly enrolled and credentialed to provide services under the Indiana Health Coverage Programs Managed Care Entities.
Who is required to file IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing?
Hospitals and ancillary providers seeking to participate in the Indiana Health Coverage Programs must file for enrollment and credentialing.
How to fill out IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing?
To fill out the enrollment and credentialing forms, providers must complete all required sections accurately, provide necessary documentation, and submit the application to the appropriate managed care entity.
What is the purpose of IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing?
The purpose is to verify the qualifications and credentials of providers to ensure that they meet the standards set by the Indiana Health Coverage Programs, thereby maintaining high-quality healthcare services.
What information must be reported on IN IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing?
Providers must report information including ownership details, professional qualifications, licensure information, and any history of sanctions or disciplinary actions.
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