Go to Home Page. Search the Matrix for a Provider's Profile Update Your Matrix Entry/Login Help for Providers, Agencies, Parents and SPOES General Contact Information. Provider and Agency documents.
What forms do I need to enroll?
     
  Step #1: You will need Adobe Acrobat Reader to view the documents.
Get Adobe here- it's FREE!
 
     
  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 (Effective 09/30/2010) PDF CSV   
  EI Procedure Code/CPT Crossreference (Effective 12/01/2010) PDF CSV   
  CRO Provider Enrollment Form  
     
  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   
  Agency Application Checklist 12/1/2010   
  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:  
  Rider A    
  Rider B    
  Attachment B    
     
  Back to Documents Main Page  
     




Privacy Policy    Feedback