Welcome to the Online Provider Enrollment Process
Please complete each step in the enrollment process. Click Continue to proceed within the enrollment application and choose Finish Later to exit and return at another time. When you have completed all steps of
the application, click Submit and then Confirm to submit your application.
What do you want to do?
- New Enrollment: You are enrolling in the IHCP for the first time.
- Change of Ownership: The ownership of your business has changed.
- Add Service Location: You are already enrolled in the IHCP and want to enroll an additional service location.
You will need the following information to complete your enrollment request:
- National Provider Identifier (NPI) unless you are an atypical (for instance, transportation or waiver) provider type
- Address including ZIP Code/postal code + 4
- Provider taxonomy unless you are an atypical (for instance, transportation or waiver) provider type
- Provider taxpayer identification number (TIN), which is either an Employer Identification Number (EIN) or a Social Security Number (SSN)
- Provider license number if applicable to your provider type
- Address, SSN, and date of birth for disclosed individuals (owners, board members, and managers)
- Address and TIN for disclosed corporations (corporations with an ownership or control interest in the applicant)
- All attachments must be uploaded at the end of your application submission
- The following types of files are allowed to be uploaded: pdf, bmp, gif, jpg, jpeg, tiff, tif, png
Please click Continue to start the enrollment application