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32 – Waiver Provider

The Indiana Health Coverage Programs (IHCP) enrolls the following specialty under provider type 32 – Waiver Provider:

  • 350 – Indiana PathWays for Aging Waiver / Health & Wellness Waiver (formerly the Aged and Disabled [A&D] Waiver)
  • 356 – Traumatic Brain Injury (TBI) Waiver
  • 359 – Community Integration and Habilitation Waiver
  • 360 – Family Supports Waiver
  • 363 – Money Follows the Person (MFP) Demonstration Grant

Waiver providers deliver home- and community-based services (HCBS) to eligible IHCP members.

Initiating Your Enrollment Transaction

The following steps outline the basic enrollment process for this provider type. More detailed information is available in the Provider Enrollment provider reference module.

  1. Before submitting an IHCP enrollment application, waiver providers must have Indiana Family and Social Services Administration (FSSA) certification. The provider must be certified for the corresponding service by the appropriate agency: the Office of Medicaid Policy and Planning (OMPP) for Traumatic Brain Injury (TBI), Health and Wellness (H&W), or Indiana PathWays for Aging (PathWays) waiver services, or the Bureau of Disabilities Services (BDS) for Family Supports Waiver (FSW) or Community Integration and Habilitation (CIH) waiver services. For OMPP certification, providers must submit the request through the OMPP HCBS Certification Portal. For BDS certification, providers must submit the request to BDSProviderServices@fssa.in.gov. Waiver specialties are assigned during the certification process. For more information, see the following provider reference modules, available on this website:
  2. Refer to the IHCP Provider Enrollment Type and Specialty Matrix for a list of the documentation required for IHCP enrollment or revalidation under each applicable provider specialty.
  3. See the IHCP Provider Enrollment Risk Category and Application Fee Matrix to determine your risk level and whether you are required to pay an application fee. The enrollment or revalidation screening process is determined by the risk level that applies to your provider type. At its discretion, the IHCP may assign a provider a higher risk level that supersedes the risk level assigned by the Centers for Medicare & Medicaid Services (CMS) and noted on the matrix.
    • Some waiver specialties and subspecialties are considered "high" or "moderate" risk providers. Both high- and moderate-risk provider types are subject to additional screening measures at enrollment or revalidation, including pre-enrollment site visits. High-risk specialties and subspecialties are also subject to fingerprint background checks. Individuals with at least 5% ownership or controlling interest in the enrolling entity must be fingerprinted before submitting the enrollment application, and the fingerprinting confirmation number must be included with the submission. See Provider Enrollment Risk Levels and Screening for instructions for fingerprinting.
    • Check the IHCP Provider Enrollment Risk Category and Application Fee Matrix for the specialties and subspecialties affected.
    • Some waiver specialties and subspecialties require the payment of application fees during enrollment, revalidation or change of ownership for each service location. Submit confirmation of your electronic payment of the fee to the IHCP or document in your enrollment submission that you have paid the fee to Medicare or another state Medicaid program.
  4. Providers are encouraged to use the IHCP Provider Healthcare Portal (IHCP Portal) to enroll, add a service location, report a change of ownership, revalidate or update provider profile information. Providers will find the online process much quicker and easier than using paper forms. Online help guides users through the process from start to finish and provides immediate confirmation of enrollment submissions.

    If you choose to enroll or update by mail, complete the appropriate IHCP provider packet, based on your provider classification (detailed instructions are included in the packets):
    • To enroll as a billing provider, use the IHCP Waiver Billing Provider Enrollment and Profile Maintenance Packet.
    • To enroll as a group, use the IHCP Waiver Group Provider Enrollment and Profile Maintenance Packet.
    • To enroll a new waiver rendering provider with an existing waiver group or clinic, use the IHCP Waiver Rendering Provider Enrollment and Profile Maintenance Packet.
    • To enroll, add a service location, report a change of ownership or revalidate a current IHCP enrollment, you must complete and submit the entire packet.
    • To update an existing provider profile, submit the appropriate provider profile maintenance form, or complete the relevant sections and submit the IHCP provider packet, following the instructions provided. See the Update Your Provider Profile page on this website.
    • The paper IHCP provider packet is an interactive PDF file, allowing you to type information into the fields electronically, save the completed file to your computer and print the file for mailing.
    • Before mailing, make a copy of the completed IHCP provider packet and required documentation for your records.
    • Mail the packet and other required documentation to the following address:
      IHCP Provider Enrollment
      PO Box 50443
      Indianapolis, IN 46250-0418
  5. For providers enrolling under specialty 350 – After you are enrolled as an IHCP waiver provider, if you are interested in providing services for Indiana PathWays for Aging Waiver members, you must apply directly to one or more of the PathWays managed care entities (MCEs). Please see the Enrolling as a Managed Care Program Provider page for the IHCP MCE Enrollment Form for HCBS Waiver Providers as well as MCE enrollment instructions and links to websites for each of the MCEs.

Processing Your Enrollment Transaction

Please allow at least 15 business days for processing before checking the status of your submission. After your transaction is processed, the IHCP Provider Enrollment Unit will notify you of the results.

  • 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 you are enrolling via the IHCP Portal and your submission is rejected for missing or incomplete information, the submission must be corrected in the portal. Providers will have 21 business days to make corrections, or the application will expire.
    • If you are enrolling via paper, a letter will be sent indicating what needs to be corrected or attached. Providers must attach a copy of this letter as a cover sheet when they submit the missing or corrected pages.

  • If the submission is complete, the Provider Enrollment Unit will process your transaction and conduct the appropriate screening associated with your assigned risk level.

  • If the IHCP approves your enrollment or revalidation, you will receive a verification letter from the Provider Enrollment Unit.

  • If the IHCP denies your enrollment or revalidation, you will receive a notification letter explaining the reason for denial. If you believe your enrollment or revalidation was denied in error, you may appeal. See the Provider Enrollment provider reference module for information about the appeal process.

Note: Letters from the IHCP Provider Enrollment Unit are sent in envelopes that display the Indiana Family and Social Services (FSSA) logo and the words "IMPORTANT MEDICAID INFORMATION INSIDE."

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