Note: Providers that no longer wish to be enrolled with the IHCP should follow the process described below to officially disenroll, rather than just allowing their enrollment to expire.
Ordering, prescribing or referring (OPR) providers that want to disenroll should see Ordering, Prescribing or Referring Providers on this website for special instructions.
Providers may voluntarily disenroll from the Indiana Health Coverage Programs (IHCP) online, using the IHCP Provider Healthcare Portal (IHCP Portal), or by mail, using the IHCP Provider Disenrollment Form on the Update Your Provider Profile page of this website. The portal or paper form may be used to:
- Disenroll a group or billing provider enrollment (each service location must be individually disenrolled)
- Remove rendering provider linkages from a group provider (rendering providers must be individually removed from each service location to which they are linked)
Before Disenrolling
Providers that want to disenroll from the IHCP should keep the following in mind:
- Providers enrolled as primary medical providers (PMPs) with a managed care entity (MCE) must contact the MCE to begin the disenrollment process before disenrolling from the IHCP.
- Waiver providers must contact the waiver divisions at the Indiana Family and Social Services Administration (FSSA) before disenrolling from the IHCP.
Basic Steps to Disenroll
Online, using the IHCP Provider Healthcare Portal:
- To disenroll a group or billing provider – Log in to the IHCP Portal account for each service location you wish to disenroll. On My Home page, select Disenroll and follow instructions.
- To end-date the linkage of a rendering provider from a group enrollment – Log in to the IHCP Portal account for the group service location from which you wish to remove the rendering provider, select Provider Maintenance on My Home page, and then select Rendering Provider Changes and click Remove for each rendering provider linkage you wish to remove from that service location.
By mail, using the IHCP Provider Disenrollment Form:
- The disenrollment form is an interactive PDF file, allowing you to type information into the fields from your computer, save the completed file to your computer, and print the file for signatures and mailing.
- Detailed instructions are included in the form.
- Be sure to get appropriate signatures.
- Make a copy of the form for your records.
- Mail the form to the IHCP at the following address:
IHCP Provider Enrollment Unit
P.O. Box 7263
Indianapolis, IN 46207-7263
Processing Your Disenrollment
Please allow at least 15 business days for processing before checking the status of your disenrollment. You will be notified after the Provider Enrollment Unit processes your disenrollment:
- If the submission needs correcting or is missing required documentation, the Provider Enrollment Unit will contact you by telephone, email or mail. This contact is intended to communicate what needs to be corrected, completed and submitted before the IHCP can process your enrollment transaction.
- If the update request is complete, it will be processed and you will receive a notification.