Please select a Provider Type/Classification from the list below.
A Billing Provider is a practitioner, facility, or transportation provider operating under a unique taxpayer identification number. A Group Provider is any practice with one or more practitioners (rendering providers) sharing a common taxpayer identification number. A Rendering Provider refers to a provider that performs the service, whereby reimbursement is paid to the group.
	Provider Type Provider Classification 01 - Hospital  Billing      02 - Ambulatory Surgical Center  Billing      03 - Extended Care Facilities  Billing      04 - Rehabilitation Facilities  Billing      05 - Home Health Agencies  Billing      06 - Hospice  Billing      08 - Clinic     Group     09 - Advanced Practice Nurse  Billing    Group   Rendering 11 - Mental Health Provider  Billing    Group   Rendering 12 - School Corporation  Billing      13 - Public Health Agency  Billing    Group     14 - Podiatrist  Billing    Group   Rendering 15 - Chiropractor  Billing    Group   Rendering 17 - Therapist  Billing    Group   Rendering 18 - Optometrist  Billing    Group   Rendering 19 - Optician  Billing    Rendering 20 - Audiologist  Billing    Group   Rendering 21 - Case Manager  Billing    Group   Rendering 22 - Hearing Aid Dealer  Billing      24 - Pharmacy  Billing      25 - DME  Billing      26 - Transportation  Billing      27 - Dentist  Billing    Group   Rendering 28 - Laboratory  Billing      29 - Radiology  Billing    Group     30 - End-Stage Renal Disease (ESRD) Clinic  Billing      31 - Physician  Billing    Group   Rendering 32 - Waiver  Billing    Group   Rendering

NOTE: The Web Provider Enrollment tool is designed for providers that are not currently enrolled with IHCP. If you are an enrolled IHCP provider: to add a Service Location, select the “Update Provider Profile Information” option above, and proceed as directed using paper forms to enroll and link a new or existing rendering provider to your group, select the “Enroll a New Provider in the IHCP using paper forms” option above, and proceed as directed Do you want Help? Web Enrollment FAQs
	Please select a Provider Type/Classification from the list below.
A Billing Provider is a practitioner, facility, or transportation provider operating under a unique taxpayer identification number. A Group Provider is any practice with one or more practitioners (rendering providers) sharing a common taxpayer identification number.
	Provider Type Provider Classification 01 - Hospital  Billing    02 - Ambulatory Surgical Center  Billing    03 - Extended Care Facilities  Billing    04 - Rehabilitation Facilities  Billing    05 - Home Health Agencies  Billing    06 - Hospice  Billing    08 - Clinic     Group   09 - Advanced Practice Nurse  Billing    Group   11 - Mental Health Provider  Billing    Group   12 - School Corporation  Billing    13 - Public Health Agency  Billing    Group   14 - Podiatrist  Billing    Group   15 - Chiropractor  Billing    Group   17 - Therapist  Billing    Group   18 - Optometrist  Billing    Group   19 - Optician  Billing    20 - Audiologist  Billing    Group   21 - Case Manager  Billing    Group   22 - Hearing Aid Dealer  Billing    24 - Pharmacy  Billing    25 - DME  Billing    26 - Transportation  Billing    27 - Dentist  Billing    Group   28 - Laboratory  Billing    29 - Radiology  Billing    Group   30 - End-Stage Renal Disease (ESRD) Clinic  Billing    31 - Physician  Billing    Group   32 - Waiver  Billing    Group