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| Step #1:
You will need
Adobe Acrobat Reader to view the documents. Get Adobe here- it's FREE! |
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| Step #2: Everyone needs all of these forms: | ||
| IHCP Enrollment Application Packet | ||
| Handy CRO Numbers | ||
| W-9 | ||
| CRO Agreement | ||
| Glossary of Terms | ||
| Personnel Guide | ||
| EFT | Direct Deposit Authorization | ||
| Service Definitions | ||
| Usual and Customary Rate Information | ||
| EI Procedure Code/CPT Crossreference PDF CSV | ||
| Provider Enrollment Information/Application | ||
| Step #3: Download one checklist to determine what files you need for Step #4. | ||
| Initial Credentialing | ||
| Annual Credentialing | ||
| DME/Assistive Technology or Interpreter | ||
| Independent Provider | ||
| New First Steps Facility | ||
| Provider with Established First Steps Facility | ||
| SPOE Service Coordinator | ||
| Family Member Transportation | ||
| Transportation Provider | ||
| Step #4: Download the individual files you need determined from Step #3: | ||
| IHCP Medicaid Agreement |
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| Rider A | ||
| Rider A Attachment | ||
| Rider B | ||
| Back to Documents Main Page | ||
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