Ind. IHCP Hospice Services Provider Reference Module, Section 2, Basic Hospice Provider Enrollment Requirements

Hospice provider participation in the IHCP requires submission of the following documentation:

• The IHCP Hospital and Facility Provider Enrollment and Profile Maintenance Packet or equivalent

online application through the IHCP Provider Healthcare Portal (IHCP Portal)

➢ This application (including the IHCP Provider Agreement) must be completed even when a

provider currently participates as an IHCP provider of another type of service.

➢ The hospice provider must have obtained a National Provider Identifier (NPI) before completing

the application.

➢ Hospice providers are required to include a Medicare number on the application.

➢ Application information and related resources are available on the IHCP Provider website at

in.gov/medicaid/providers. See the Complete an IHCP Enrollment Application page for general

enrollment information; from there, click 04 – Hospice for instructions and resources specific to

enrolling as a hospice provider.

• A copy of the hospice license from the Indiana Department of Health (IDOH)

➢ This document should be submitted as an attachment to the IHCP enrollment application, an d

updated with the Provider Enrollment Unit as needed

➢ For state-licensed hospitals, health facilities and home health agencies, an IDOH approval to

operate a hospice program is acceptable in lieu of a hospice license.

• A copy of a Certification and Transmittal (C&T) for each hospice office location, sent from the

IDOH to the IHCP Provider Enrollment Unit

See the Provider Enrollment module for more information about enrolling as a provider in the IHCP.