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  • Indiana Medicaid Application Pdf

Get Indiana Medicaid Application Pdf

HOOSIER HEALTHWISE HEALTHY INDIANA PLAN HOSPITAL/ANCILLARY CREDENTIALING/ENROLLMENT FORM Please select the program(s) for which this form applies: q Healthy Indiana Plan (HIP) q Hoosier Healthwise.

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TMHP Application Fee for LTC Providers Each year, the Centers for Medicare & Medicaid Services publishes the application fee in the Federal Register 60 days before the new calendar year. The fee for calendar year 2022 is $631. The fee for calendar year 2021 is $599. The fee for calendar year 2020 is $595.

Health coverage applications are processed by the Family and Social Services Administration (FSSA), Division of Family Resources (DFR). You can apply in person, online, by mail, or by phone. Once you submit your complete application, it can take up to 90 days to determine if you are eligible.

The CMS sets the application fee amount, which may be adjusted annually: The application fee for enrollments received in 2023 is set at $688. The application fee for enrollments received in 2022 is set at $631.

Who is eligible for Indiana Medicaid Program? Household Size*Maximum Income Level (Per Year)1$16,9712$22,9303$28,8884$34,8464 more rows

Enrollment Status. Enter your assigned Tracking number and Federal Tax Indentification Number (TIN or EIN) that you used for your enrollment to verify the current status of your enrollment application. For any further queries, please contact Provider enrollment at 1-800-457-4584.

INFORMATION REQUIRED TO COMPLETE THE INDIANA MEDICAID APPLICATION Names and dates of birth. Social Security Numbers. Income from jobs or training. Benefits you get now (or got in the past), such as Social Security, Supplemental Security Income (SSI), veteran's benefits, or child support.

The fee for 2022 is $631 per application and is not refundable. How do I check on the status of my application? Once an application has been submitted, you can go to the Medicaid Provider Portal to check the status. From the providers home page select the Registration ID of interest.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232