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Provider Enrollment - Indiana Medicaid Provider …

Indiana HEALTH COVERAGE PROGRAMS PR O V I D E R RE F E R E N C E MO D U L E Provider Enrollment L I B R A R Y R E F E R E N C E N UM B E R : P R O M O D 0 0 0 1 5 P U B L I S H E D : F E B R U A R Y 1 3 , 2 0 1 7 P O L I C I E S A N D P R O C E DU R E S A S O F O C T O B E R 1 , 2 0 1 6 (CoreM M I S U P D A T E S A S O F FE B R U A R Y 1 3 , 2 0 1 7 ) V E R S I O N : 1 .1 Copyright 2017 Hewlett Packard Enterprise Development LP Library Reference Number: PROMOD00015 iii Published: February 13, 2017 Policies and procedures as of October 1, 2016 (CoreMMIS updates as of February 13, 2017) Version: Revision History Version Date Reason for Revisions Completed By Policies and procedures as of October 1, 2015 Published: February 25, 2016 New document FSSA and HPE Policies and procedures as of October 1, 2016 (CoreMMIS updates as of February 13, 2017) Published: February 13, 2017 Semiannual update: Replaced Web interChange with Provider Healthcare Portal and IndianaAIM with CoreMMIS Replaced Legacy Pro

Provider Enrollment . iv Library Reference Number: PROMOD00015 Published: March 22, 2018 Policies and procedures as of September 1, 2017 Version: 2.0

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