Skip to Main Content
Home
Find a Provider
Portal Login
Events
Careers
Contact Us
Language
English
Spanish
Enter Keyword
Search
For Members
Healthy Indiana Plan
Hoosier Care Connect
Hoosier Healthwise
Ambetter from MHS
Wellcare by Allwell
Wellcare Complete
For Providers
Login
Behavioral Health Providers
Clinical & Payment Policies
Dental Providers
Email Sign Up
Enrollment and Updates
Opioid Resources
Pharmacy
Prior Authorization
Provider Education & Training
Provider Resources
QI Program
Provider News
Get Insured
Login
Find a Provider
For Members
Healthy Indiana Plan
Login
Benefits & Services
Community Connect
Find a Provider
Health & Wellness
How to Enroll
Member Handbook
Member News
Member Resources
Opioid Resources
Redetermination
Hoosier Care Connect
Login
Benefits and Services
Caregiver Resources
Community Connect
Find a Provider
Foster Care Resources
Health & Wellness
How to Enroll
Member Handbook
Member News
Member Resources
Opioid Resources
Redetermination
Hoosier Healthwise
Login
Benefits and Services
Community Connect
Find a Provider
Health & Wellness
How to Enroll
Member Resources
Opioid Resources
Redetermination
Member Handbook
Member News
Ambetter from MHS
Wellcare by Allwell
Wellcare Complete
Get the Most from Your Coverage
For Providers
Login
Behavioral Health Providers
BH Trainings
BH Forms
Clinical & Payment Policies
Dental Providers
Email Sign Up
Enrollment and Updates
Demographic Update Tool
Become a Contracted Provider
Contracted Enrollment Request
Provider Effective Date Policy
Opioid Resources
Pharmacy
Drug Search Tool
Pharmacy Forms
Preferred Drug Lists
Prior Authorization
Medicaid Pre-Auth
Ambetter Pre-Auth
Medicare Pre-Auth
Provider Education & Training
Clinical Training
Foster Care Training
Provider Resources
Forms
Guides and Manuals
Health Library
Helpful Links
Partnered Member Events
POWER Account
Frequently Asked Questions
Grievance Process
Case and Disease Management
Electronic Transactions
Provider Performance
Resource Center
Newsletters
QI Program
Providing Quality Care
Immunization Information
Medical Records
Practice Guidelines
Report Fraud, Waste and Abuse
Provider News
Get Insured
About Us
Ramp Up Success
School-Based Services
Adopt a School Application
Telehealth Funding Application
Careers
Contact Us
Newsroom
Press Releases
entrada-del-blog-sobre-la-membresia-de-ymca
Careers
Privacy Policy
Terms & Conditions
Notice of Privacy Practices
SEARCH
MENU
Go!
Home
Find a Provider
Portal Login
Events
Careers
Contact Us
Language
English
Spanish
For Providers
Login
Behavioral Health Providers
BH Trainings
BH Forms
Clinical & Payment Policies
Dental Providers
Email Sign Up
Enrollment and Updates
Demographic Update Tool
Become a Contracted Provider
Contracted Enrollment Request
Provider Effective Date Policy
Opioid Resources
Pharmacy
Drug Search Tool
Pharmacy Forms
Preferred Drug Lists
Prior Authorization
Medicaid Pre-Auth
Ambetter Pre-Auth
Medicare Pre-Auth
Provider Education & Training
Clinical Training
Foster Care Training
Provider Resources
Forms
Guides and Manuals
Health Library
Helpful Links
Partnered Member Events
POWER Account
Frequently Asked Questions
Grievance Process
Case and Disease Management
Electronic Transactions
PaySpan - EFT/ERA
Provider Performance
HEDIS
Provider Analytics
Resource Center
CAHPS
CLAS Standards
Correct Coding Initiative
Patient Centered Medical Home Model
National Imaging Associates (NIA)
Tobacco Cessation Resources
Newsletters
QI Program
Providing Quality Care
Immunization Information
Medical Records
Practice Guidelines
Report Fraud, Waste and Abuse
Provider News
Change an IRS Number (TIN)
Group/Facility Name
*
Error:
This field is required.
Old Tax Identification Number (TIN)
*
Error:
This field is required.
Old Group NPI #
*
Error:
This field is required.
New Tax Identification Number (TIN)
*
Error:
This field is required.
New Group NPI #
*
Error:
This field is required.
Please Attach a Completed W9
*
Error:
File upload is required.
Please attach a completed W9. Please submit enrollments through your Provider Relations staff member if you bill with a SSN as your TIN.
Items in the trash will be permanently removed after 30 days.
Comments
Update Requested By:
First Name
*
Error:
This field is required.
Last Name
*
Error:
This field is required.
Date
*
Error:
This field is required.
Contact Email
*
Error:
This field is required.
Contact Phone Number
*
Error:
This field is required.
Contact Phone Number
*
Error:
This field is required.
Error:
reCAPTCHA verification failed.
Error:
Please add a Captcha.
Last Updated: 11/06/2023