ProTips
Provider type is based on the provider’s registration with the IHCP according to the
IHCP Specialty Matrix.
Out-Of-State Provider
MDwise requires out-of-state providers to be certified, licensed, registered, or authorized as
required by the state in which the provider is located and must fulfill the same conditions as
an in-state provider. Please refer to the IHCP Provider Enrollment Type and Specialty
Matrix at https://www.in.gov/medicaid/providers/files/matrix.pdf. which lists out-of-state
provider document requirements and which provider types, and specialties are ineligible for
out-of-state enrollment. For more information, see the Out-of-State Providers module
(https://www.in.gov/medicaid/providers/files/out-of-state-providers.pdf).
Common Issues Associated with network participation:
- Not registering the providers location with IHCP prior to sending enrollment forms.
- Not completing required forms.
- Not completing all required fields on the forms.
- Unsigned forms.
- W-9 not signed and dated within the last 12 months.
- Invalid state medical license or inappropriate professional license.
- Missing explanation for work history gaps greater than six months.
- Omission to disclose sanctions information on the CAQH enrollment form.
Providers should visit our website for additional resource materials
and regular updates. In particular: