Want to enroll a provider to an existing contract?

Step 1: Submit a Network Participation Request.

A network participation request is when the provider makes a formal request to enter into a new agreement/contract with MHS, or to add additional enrollment to an existing MHS contract. This includes the mechanism utilized by MHS to receive the request from the provider or group to join MHS’s network as a contracted provider.

An enrollment request is when the provider has an existing agreement/contract with MHS and wishes to add additional practitioners or facilities to that agreement. The enrollment request must include at minimum the information/fields outlined on the Indiana Health Coverage Programs (IHCP) MCE Practitioner and IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing Forms and any supporting documentation required from providers for the MCE to credential, if required, and enroll the provider.

If you currently have an MHS contract and want to submit and enrollment request to add additional physicians/mid-levels or facilities to your contract:

• Go to mhsindiana.com.
• Select For Providers tab.
• Select Enrollments and Updates.
• Select Add Provider to Existing Contract (Enroll a Contracted Provider).
• Complete the Contracted Enrollment Request.
• Attach the required documents.
• MHS Credentialing will verify completion of required criteria. Requests will receive a unique identifier that will confirm receipt of the enrollment request. This can be used to check the status of all components of the network participation request.
  • Missing or incomplete requests will result in a pended request. Notification of will be emailed within 5 business days of receipt of request. Providers have 30 days to complete the missing or incomplete information before the request is rejected.
• MHS Data Team will enroll Facility/Hospital (Provider) and/or Physician/Mid-Level (Practitioner) as requested.
• Facility/Hospital (Provider) and/or Physician/Mid-Level (Practitioner) will receive a welcome letter with their effective date once complete.

Step 2: Verification of complete Network Participation Request.

The network participation request must include at a minimum the information/fields outlined on the Indiana Health Coverage Programs (IHCP) MCE Practitioner and IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing Forms and any supporting documentation required from providers for MHS to enroll and credential the provider.

The below information is the minimum required and obtained from the IHCP MCE Practitioner Enrollment Form and the current CAQH credentialing application (*if applicable):

• A current valid license to practice.
• Status of clinical privileges at the hospital designated by the practitioner as the primary admitting facility.*
• Current and valid Drug Enforcement Administration (DEA) or controlled-substance registration (CSR) certificate, as applicable (DEA certificates are not applicable to chiropractic settings).*
• Proof of graduation from medical school and completion of a residency, or board certification for doctors of medicine (MDs) and doctors of osteopathy (DOs), as applicable, since the last time the provider was credentialed or recredentialed.
• Proof of graduation from a chiropractic college for doctors of chiropractic medicine (DC).*
• Proof of graduation from podiatry school and completion of residency program for doctors of podiatric medicine (DPMs).*
• Work history that includes a minimum of five years on the curriculum vitae (the MCE is not required to verify work histories).
• Current, adequate malpractice insurance, according to the MCE’s policies.
• History detailing any pending professional liability claims and claims resulting in settlements or judgments paid by or on behalf of the practitioner.
• Proof of board certification if the practitioner states he or she is board certified.
• Verification of IHCP enrollment.
• For a group enrollment, verify that the provider is linked appropriately to the group, and that the provider is enrolled at the appropriate service locations.
• Verification that the provider, or an agent or managing employee of the provider, is not debarred, suspended, or otherwise excluded by Federal agencies or from participating in any contract paid with Federal funds.

MHS will use NCQA standards to provisionally credential both professional and organizational providers when the credentialing process cannot be completed with fifteen (15) business days of a clean credentialing application submission.

Provisional Credentialing applies to only providers who have never been credentialed or enrolled with MHS. Provisional credentialing will not apply to any providers that are contracted though a delegation agreement.

Please note, provider has five (5) business days to respond to an incomplete credentialing or network participation request. If no response after five (5) business days, MHS may reject the request. An incomplete network participation request also includes an unclean credentialing application.

Required forms for Credentialing and Enrolling a Facility/Hospital (Provider)

• IHCP MCE Hospital/Ancillary Provider Enrollment and Credentialing application
• Behavioral Health Facility and Ancillary Demographic Information (if applicable)
• Valid IN License
• Accreditation certificate (if applicable)
• Copy of Medicare certification letter
• Copy of Medicaid certification letter
• Liability coverage face sheet
• Clinical Laboratory Improvement Amendments (CLIA) certificate (if applicable)
• Drug Enforcement Agency (DEA)# (if applicable)
• Provider Location Listing
• W-9 Form

Required forms for Credentialing and Enrolling a Physician/Midlevel (Practitioner)

• Physicians/Mid-Levels require the following forms:
  • IHCP MCE Practitioner Enrollment Form
  • Collaborative Agreement
    • Nurse Practitioner
    • Physician Assistant
    • Clinical Nurse Specialist
    • Midwives
  • Provider Credentialing Application Accessibility Form Supplement Form (New Contract Request Only)
  • Provider Location Listing
  • W-9 Form
• All Behavioral Health Physicians/Mid-Levels require the following forms:
  • IHCP MCE Practitioner Enrollment Form
  • Behavioral Health Specialty Form
  • HSPP Attestation (Psychologists Only)
  • Provider Credentialing Application Accessibility Supplement Form (New Contract Request Only)
  • Provider Location Listing
  • W-9 Form

Helpful Tip: If you have more than 10 rendering practitioners linked to your Group NPI, instead of using the IHCP MCE Practitioner Enrollment Form, use the MHS Enrollment Spreadsheet provided on the request page.

Step 3: Contracting/Negotiating a new contract or adding a line of business or service.

Contracting/negotiating is the process of the provider and MHS formally executing an agreement (or amendment) for the provider to deliver medical or behavioral health services, that outlines reimbursement rates, scopes of services, etc.

Unsure if you have a contract with MHS or want to know which networks you are currently contracted with? Select “I am unsure if I have an MHS contract” on the next page and compete the fields provided. Our MHS Contracting Team will outreach with your current network status and next steps.

Step 4: Credentialing and enrollment into the MHS Provider Network.

Credentialing is the process of reviewing the qualifications and appropriateness of a provider to join the health plan’s network. Credentialing requirements and processes will follow the National Committee for Quality Assurance (NCQA) guidelines.

Enrollment is the process of loading a contracted and credentialed provider to all MHS internal systems, loading for claims payment, and loading to the provider directory (if applicable).

To be credentialed with MHS, you must submit an IHCP MCE Practitioner Enrollment Form and current and complete CAQH application attested within the last 120 days.

Providers have five (5) business days to respond to an incomplete credentialing or network participation request. If no response after five (5) business days, MHS may reject the request. An incomplete network participation request also includes an unclean credentialing application.

The following specialty types require credentialing:

Ancillary Providers

• Ambulance
• Ambulatory Surgery Center
• Clinic Facility
• Dialysis
• DME
• Home Health
• Home Infusion
• Hospice
• Imaging/Radiology
• Labs
• Urgent Care
• Hospitals
  • Critical Access Care
  • Behavioral Health (CMHC)
  • Long Term Acute Care
  • Long Term Care
  • Rehabilitation
• FQHC (Federally Qualified Health Centers)
• RHC (Rural Health Clinic)
• Skilled Nursing Facilities. 

Medical or Behavioral Health Practitioners (participating in a group, RHC, or FQHC setting)

Credentialing is not required for Anesthesiology, Diagnostic Radiology, CRNA, ER Physicians, Pathology or Hospital-based Physicians.

Please note, MHS does not enroll Locum Tenum physicians/mid-levels.

Step 5: Welcome to the Network!

You will receive a welcome letter with your effective date and important contact information, including Provider Services and your dedicated Provider Partnership Associate.

Effective Date Policy: (Effective 1/1/2024)

• A brand-new provider that is not part of an existing contract with MHS will be effective the first of the month following the contract execution. Contract execution is the date that MHS countersigns the first signature agreement received from the Provider.
  • The network participation receipt date is the date MHS receives the provider’s complete network participation request electronically via an online portal, email, postal mail, or fax. All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete.
  • An incomplete network participation request also includes an unclean credentialing application. MHS notify the provider within fifteen (15) business days of the full credentialing decision in writing.
  • If a provider and MHS cannot come to terms with a contract, the provider will not be effective with MHS.
  • If a provider requires credentialing and is not able to be credentialed, the provider will not be effective with MHS.
• A provider that is being added to an existing contract will be effective the first of the month following receipt of the network participation request from the provider.
  • The network participation receipt date is the date MHS receives the provider’s complete network participation request electronically via an online portal, email, postal mail, or fax. All required fields must be completed, required supporting documentation provided, etc. for the network participation request to be considered complete.
  • An incomplete network participation request also includes an unclean credentialing application. MHS notify the provider within fifteen (15) business days of the full credentialing decision in writing.
  • If a provider requires credentialing and is not able to be credentialed, the provider will not be effective with MHS.
• Provider has five (5) business days to respond to an incomplete credentialing or network participation request. If no response after five (5) business days, MHS may deny the request.
• For reimbursement of medically necessary services rendered between the credentialing decision date and the network participation date, the MHS will utilize the out-of-network reimbursement rate for all services. 
• The network effective date must also be after the IHCP effective date. Providers must be enrolled and effective with IHCP prior to being effective with MHS.
• In order to be able to receive reimbursement for medically necessary covered services, the contract or contract amendment must still be executed by both parties.
• Notification from MHS will be sent to the original submitter of an incomplete network participation request within five (5) business days after receipt of initial request. An incomplete network participation request is a request that MHS cannot fully process because there is missing documentation, information needed to write a contract, etc.
• Providers should hold all claims until the final welcome letter from MHS is received confirming that they are effective with the MHS network. Claims submitted prior to receipt of a welcome letter will not automatically be reprocessed and providers will need to submit a Medical Claim Dispute/Appeal Form to request reconsideration of the claim. MHS and providers are expected to complete all pieces of the network participation process timely. However, in instances where the network participation process extends for a time period longer than the standard timeframe, MHS will not hold providers to the timely filing limit for claims rendered before the provider was confirmed effective.
• OMPP provides MHS flexibility to deny the network participation request if the contracting phase cannot be completed in an acceptable timeframe that is no more than 60 (sixty) days. This will allow the effective date policy to remain consistent but also hold all parties accountable for the turnaround of necessary items for the network participation process. MHS will educate providers on the significant impact any delay in signing a contract will have and that if they do not meet the timeframe their request will be denied.
• MHS will reimburse for medically necessary services provided between the date in which the provider was credentialed and the network participation date according to the following rules:
  • If the provider was fully credentialed without the need for provisional credentialing, MHS will reimburse to the date in which the provider was fully credentialed.  
  • If the provider was provisionally credentialed and then fully credentialed, MHS will reimburse back to the date in which the provider was provisionally credentialed.
  • If the provider was provisionally credentialed but not fully credentialed, MHS is not required to reimburse for any services during the provisionally credentialed timeframe.
• For reimbursement of medically necessary services rendered between the credentialing decision date and the network participation date, the provider will be reimbursed at the out-of-network reimbursement rate for all services, until their contract effective date.  
• Services provided before a provider has successfully completed the network participation process are subject to the prior authorization process.
• Exceptions to the effective date policy outlined may be granted by MHS in the following circumstances:
  • When the retroactive date is in the best interest of member care.
  • In situations involving changes of ownership, including provider mergers, acquisitions, or tax identification changes.
  • In situations where a provider has a preexisting contractual relationship with an MCE and has sought a change in their provider enrollment type or classification with IHCP (i.e., when a provider was enrolled as a billing provider but has decided to enroll as a group provider).
  • Upon request from providers in FQHCs or RHCs. The effective date cannot be prior to the date established by IHCP.
• The effective date policy does NOT affect delegated provider arrangements.