For full information regarding Provider Medicaid Enrollment in Indiana, please visit the “Indiana Medicaid for Providers,” Provider Enrollment site.

For answers to general questions, please review the FAQs below.

Who is required to enroll in the state Medicaid program?

• Billing
• Group
• Rendering
• Ordering, Prescribing, or Referring (OPR)

I am enrolled as a participating provider in another state’s Medicaid program. Am I also required to enroll in Indiana’s Medicaid Program to provide services to Medicaid beneficiaries?

Yes. To receive reimbursement for services covered under the Indiana Health Coverage Program (IHCP), including Medicaid services, a provider must be eligible for enrollment and actively enrolled in the IHCP.

How do I enroll?

Navigate to the Indiana Healthcare Portal (IHCP) and complete an online enrollment application.
Note: It is not necessary to have a Portal user account to submit or track an online enrollment application.

How does my registration relate to billing for services?

You must register with the state using the same identifiers you plan to bill with, i.e., TIN/SSN, Specialty, etc.

*The following items must be in alignment:

• Your contract with Envolve / Centene Dental and Vision
• State Registration
• Billing Set Up / Configuration

Are there additional requirements and screenings based on risk/risk level?

According to CMS/Medicaid:

Requirements by Risk Level:

All Risk Levels:

• Verify provider meets any applicable Federal regulations or State requirements for the provider type prior to making an enrollment decision.
• License Verifications.
• Conduct Database checks.

Limited Risks:

• Site visit.

High Risks:

• Any provider that has a payment suspension based on a credible allegation of fraud within the last 10 years.
• Any provider excluded within the past 10 years by HHS-OIG or a State Medicaid Agency (SMA).
• Any provider that has a qualifying Medicaid overpayment.
• The provider is enrolling within 6 months of the date of the lifting of a temporary moratorium that at the time would have barred the provider’s enrollment.

*States may impose additional screening methods “in addition to or more stringent than” those in the regulations. This could result in a change in the risk category assigned for certain types of providers. Providers should check with their SMA to determine their risk category.

Additional requirements based on Provider’s assigned risk level can be found on the Indiana Medicaid for Provider site in the Provider Enrollment Risk Levels and Screening section.

What is the enrollment application processing timeframe?

According to the state, please allow at least fifteen (15) business days for processing before checking the status of your submission.

For paper enrollment submissions, a letter will be sent indicating what needs to be corrected or attached. Providers must attach a copy of this letter as a cover sheet when they submit the missing or corrected pages.

What is my Enrollment Effective Date? / How is my Enrollment Effective Date Determined?

According to the state, the enrollment effective date is the date the Provider Enrollment Unit receives the completed IHCP provider packet or online application.

Retroactive Effective Date: If a provider requests an enrollment effective date before the date the application was received, a copy of a valid claim form or a remittance from a primary carrier should be submitted with the application as proof of service rendered.

How do I find proof of registration?

An “Enrollment Confirmation Letter” is mailed to the provider upon successful enrollment in the IHCP.

I am enrolled but recently received a letter from the State saying that I need to re-enroll, re-register, or revalidate my information. What do I need to do?

Navigate and login to the Indiana Health Care Portal (IHCP) to complete an application for revalidation.

For paper revalidations, providers should use the initial enrollment packet (there is not a different packet for revalidations).

How often do I need to re-enroll, re-register, or revalidate my information?

According to the state, the Centers for Medicare & Medicaid Services (CMS) requires state Medicaid programs to revalidate provider enrollments at intervals not to exceed every five (5) years.

I received a letter from Envolve / Centene Dental and Vision Services about my registration status. What do I do?

Your state provides us with information about each provider’s registration status regularly. We have received information that your registration is not active.

Validate your state registration status to confirm if there are any outstanding items needed to activate your registration. Remember, you’re required to revalidate your information regularly with the state.

If you have proof of current/valid registration, contact us.

Who do I contact if I have questions about my enrollment/registration or need more information?

• Gainwell Technologies Provider Healthcare Portal Support
  • 1-800-457-4584
  • Gainwell Technologies, Provider Healthcare Portal Support, PO Box 50435, Indianapolis, IN 46250-0418
    

• CMS/Medicaid Enrollment Fact Sheet (*not specific to Indiana)
  • Medicaid Provider Enrollment Requirements Fact Sheet (cms.gov)
• CMS/Medicaid Enrollment FAQ (*not specific to Indiana)
  • Medicaid Provider Enrollment Requirements Frequently Asked Questions (cms.gov)

If any of my information changes, what do I need to do and who do I need to notify?

Keep your information up to date!
Any time you have a change to your information, be sure to notify us, as well as login to your state portal and update!

Here are some examples of the details you should be sure to keep updated:

• Office Address (including suite number)
• Office Hours
• Mailing Address
• Phone Number

To check the information that Envolve / Centene Dental and Vision has both in our system and published for you, please visit our Find A Provider tool on our website. If you find any discrepancies within the Find A Provider tool data, or if anything needs updating, please contact us to report the issue and update.

Keeping your information current is essential for your practice, to ensure claims are processed appropriately, and for the convenience and satisfaction of our members.