Please follow the Enrollment Instructions below to become an electronic submitter to Indiana Medicaid.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the Medicaid office prior to initiation of electronic claims submission or inquiry.

1. IHP Trading Partner Profile (must be completed online)

2. IHP Trading Partner Agreement (must be printed and mailed in)

If the above links do not work properly, please download the forms here:
  http://provider.indianamedicaid.com/general-provider-services/electronic...

If you have any questions regarding any of the documents in this package, please call the Medicaid EDI Technology Support Center at 1-877-877-5182.

IHCP Trading Partner Profile

For Providers Please go to http://provider.indianamedicaid.com/general-provider-services/electronic-data-interchange-(edi)-solutions.aspx and click on the link for the IHCP Trading Partner Profile. This is an online form that you will need to complete.

Section 1

• Choose Provider or Billing Service

• Complete the Trading Partner Contact Information with your information

Section 2

• Select 2 password reset questions and fill in your answers for the questions

Section 3

• There is no need for you to press the Companion Guides Button

• Fill in your Medicaid Provider Number

• New Applicants may skip the Sender ID box

Section 4 – Transaction Sets To IHCP

• Place a check mark on either the 837I (for Institutional Claims) or the 837P (for Professional Claims) option

  • If you are using ClaimShuttle to send your claims please mark the box for Software Vendor and enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

Section 5 – Transaction Sets From IHCP

• Please skip all the options in this section

Section 6 – Transaction Sets From IHCP/IPDP

• Place a check mark on 835 (for Electronic EOBs) and enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

Press Submit and then complete the IHP Trading Partner Agreement

For Billing Services

Please follow the same instructions above and apply the changes below for the following sections:
Section 3 – New applicants may leave the Sender ID box blank
Section 4 – Choose 837P or 837I and place a check mark for Secure FTP

• Section 6 – If the providers you are billing for would like for you to receive their EOBs electronically on their behalf then place a check mark on the 835 option and enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our billing software please call our support line for our software information.

Press Submit and then follow the instructions below to complete the IHP Trading Partner Agreement

IHCP Trading Partner Agreement

Section 1 is for Billing Services using ClaimShuttle

• Enter Company/Business name

• Leave the Trading Partner ID Number blank, as that’s what your applying for

• Enter the name of the primary contact person for your office

• Fill in your demographic information, number, fax, and email address

• Describe your line of business (e.g., billing service, )

• List the names, addresses, and NPI numbers of the Medicaid Providers you represent.

• Select the types of transactions you will be sending. ClaimShuttle is compatible with these transactions:

  • 837 I – Batch Health Care Claim Institutional

  • 837P – Batch Health Care Claim Professional

  • 835- Remittance Advice

Section 2 is for Provider’s using ClaimShuttle

• Enter the Provider’s Name

• Enter the Provider’s NPI and Tax ID

• Leave the Trading Partner ID Number blank

• Enter the Name, Address, Phone, Fax, and email for the primary contact for your office

• Check the boxes next to the types of data you are exchanging

  • 837 I – Batch Health Care Claim Institutional

  • 837P – Batch Health Care Claim Professional

  • 835- Remittance Advice

Complete the last page of this agreement with your information and signature, and then mail it to the address below.

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the IHP Trading Partner Agreement reflecting original signatures to:

HP Enterprise Services
Electronic Data Interchange (EDI) Solutions
Trading Partner Agreement 950 N. Meridian Street
Suite 1150
Indianapolis, IN 46204

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 1-877-877-5182.

Testing

Once you have received your Submitter ID and Password from Medicaid, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to Medicaid.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.