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Use this form to select one of your billing provider locations to be the default location for all Indiana Health Coverage Programs (IHCP) claim processing. It is necessary when an entity has multiple
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How to fill out ihcp npi default agreement

01
Obtain the IHCP NPI Default Agreement form from the Indiana Health Coverage Programs website.
02
Complete the required identification fields, including your name, address, and provider type.
03
Fill in your National Provider Identifier (NPI) number in the designated section.
04
Provide any additional required information such as tax identification number (TIN) and contact information.
05
Review the form for accuracy and completeness.
06
Sign and date the agreement at the bottom of the form.
07
Submit the completed form to the appropriate IHCP office or through the specified submission method.

Who needs ihcp npi default agreement?

01
Healthcare providers who want to participate in IHCP programs.
02
Providers needing to establish their NPI for billing and reimbursement purposes.
03
Individuals or organizations offering services covered by Indiana Health Coverage Programs.
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The IHCP NPI Default Agreement is a document used by Medicaid providers to establish their National Provider Identifier (NPI) with the Indiana Health Coverage Programs (IHCP), ensuring compliance with billing and payment processes.
All healthcare providers and organizations that wish to participate in Indiana's Medicaid program and bill for services must file the IHCP NPI Default Agreement.
To fill out the IHCP NPI Default Agreement, providers should complete the form with accurate personal and business information, including their NPI number, and submit it according to the instructions provided by IHCP.
The purpose of the IHCP NPI Default Agreement is to facilitate the integration of providers into the Medicaid system, allowing them to be recognized for reimbursement purposes through their NPI.
The IHCP NPI Default Agreement requires providers to report their legal name, business address, NPI number, contact information, and any other relevant details necessary for claims processing.
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