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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 where 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, the provider types and specialties that 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, including the following in particular: