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  • Claims Attachment Cover Sheet - Indianamedicaid.com

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Indiana Health Coverage Programs C L A I M S A T T A C H M E N T C O V E R S H E E T Provider Name Provider Address City, State, ZIP In order to process your attachment(s), this form must be completed.

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Contact support

If you have questions about IHCP provider enrollment, enrollment status or provider profile updates, call Customer Assistance at 800-457-4584 and select option 2, and then option 1 to check provider enrollment status or option 3 to update provider enrollment information.

180-day timely filing limit. Any overpayment identified by a provider must be returned to the IHCP, regardless of the 180-day filing limit. The overpayment adjustment must be submitted with an explanation attached to justify partial recoupment; otherwise, the claim will be processed and recouped in its entirety.

Claim Filing. EDS 590 Program Claims. P.O. Box 7270. Indianapolis, IN 46207-7270. ... Checks Only* EDS Drug Rebate. P.O. Box 1937, Dept. Indianapolis, IN 46206-1937. ... *Note: The addresses in this section are for checks only. Indiana Health Coverage Programs. Telephone and Address Quick Reference. BT200254. ... EDS. P. O. Box 7263.

If you have questions about it, feel free to call us at 1-877-822-7196 or in Indianapolis, 317-822-7196. You can also fax the completed form to: 1-800-403-0864.

A member or the member's representative may write, phone, fax, or email the appeal request and consent to: Written: MHS Appeals, P.O. Box 441567, Indianapolis, IN 46244. Phone: MHS Member Services or MHS Appeals at 1-877-647-4848 (TTY: 1-800-743-3333)

submitted within 180 calendar days of the date of service or discharge.

Paper Claims Paper claim forms are encouraged only for services that require clinical documentation or other forms to process. Refer to the Provider Manual for instructions to submit paper claims.

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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