Ind. Code ch. 12-15-11

in effect

Ind. Code § 12-15-11-1 Physician services defined

Sec. 1. (a) As used in this chapter, "physician services" means services provided by an individual licensed under IC 25-22.5 while engaged in the practice of medicine (as defined in IC 25-22.5-1-1.1(a)). (b) The term does not include the decision to admit a patient to a hospital. [Pre-1992 Revision Citation: 12-1-7-15.1(a).] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-11-2 Provider agreement; filing

Sec. 2. A provider desiring to participate in the Medicaid program by providing to individuals eligible for Medicaid services shall file a provider agreement with the office on forms provided by the office. [Pre-1992 Revision Citation: 12-1-7-15.1(b) part.] As added by P.L.2-1992, SEC.9. Amended by P.L.195-2018, SEC.3.

Ind. Code § 12-15-11-2.5 Surety bond requirement for certain transportation providers; requirements; revocation or denial of provider agreement for failure to comply; demonstration of compliance; refund

Sec. 2.5. (a) As used in this section, "transportation provider" means a person: (1) that is a common carrier, including a person that provides transportation by a taxi; and (2) that: (A) is enrolled; or (B) applies for enrollment; in the Medicaid program as a Medicaid provider to render transportation services to Medicaid recipients. (b) This section does not apply to a transportation provider that is: (1) exempt from federal taxation under Section 501(c)(3) of the Internal Revenue Code; (2) at the discretion of the secretary, granted a waiver of the bond requirement under subsection (c) to provide transportation services in a federal or state designated underserved area; (3) at the discretion of the secretary, granted a waiver of the bond requirement under subsection (c) based on the determination that the provider does not pose a significant risk of submitting fraudulent or false Medicaid claims; (4) owned or controlled by a person that is licensed or certified by an entity described in IC 25-0.5-11; (5) owned or controlled by a pharmacy that has a permit issued under IC 25-26-13; (6) owned or controlled by a hospital licensed under IC 16-21; or (7) required under federal law to obtain a surety bond to cover Medicaid overpayments and false Medicaid claims and has obtained a bond that complies with the applicable federal law. (c) A transportation provider that applies for enrollment as a Medicaid provider: (1) as a new applicant; (2) due to a change in ownership of a transportation provider currently enrolled; or (3) due to a purchase or transfer of the assets of a transportation provider currently enrolled; shall, at the time the transportation provider files a provider agreement with the office, submit to the office a surety bond that meets the requirements of subsection (d) and is issued by a surety that is authorized by the office of the secretary. (d) The following apply to a surety bond filed with the office under this section: (1) The surety bond must be continuously in effect for at least three (3) years after the application is made as described in subsection (c). (2) The surety bond must provide coverage for liability of at least fifty thousand dollars ($50,000). (3) The surety bond must name the: (A) transportation provider as the principal; (B) office as the obligee; and (C) person that issues the surety bond, including the person's heirs, executors, administrators, successors, and assignees, jointly and severally, as surety. (4) The surety bond must provide the surety's name, street address or post office box number, city, state, and ZIP code. (5) The surety bond must provide that the surety is liable under the surety bond for a duplicate, erroneous, or false Medicaid claim paid by the office or its fiscal agent to the transportation provider during the term of the surety bond. (6) The surety bond must provide that the bond may not be void on a first recovery, but that suits may be instituted until the penalty is exhausted. (7) The surety bond must guarantee that the surety will, not later than thirty (30) days after the surety receives written notice from the office containing sufficient evidence to establish the surety's liability under the surety bond as described in subdivision (5), pay to the office the following amounts, not to exceed the full amount of the surety bond: (A) The amount of the duplicate, erroneous, or false claim that was previously paid by the office or its fiscal agent to the transportation provider, plus accrued interest. (B) An assessment imposed under IC 12-15-22 by the office on the transportation provider. (8) The surety bond must provide that if the transportation provider's provider agreement is not renewed or is terminated, the surety bond submitted by the transportation provider remains in effect until the last day of the surety bond coverage period and the surety remains liable for a duplicate, erroneous, or false claim paid by the office or its fiscal agent to the transportation provider during the term of the surety bond. (9) The surety bond must provide that actions under the surety bond may be brought by the office or the attorney general. (e) The office may revoke or deny a provider agreement for a transportation provider's failure to comply with this section. (f) The office may revoke a provider agreement if a transportation provider cancels a surety bond required by this section. (g) The office or its designee may, at any time, require a transportation provider to demonstrate compliance with this section. (h) If: (1) a surety has paid the office for a liability incurred under a surety bond under this section; and (2) the transportation provider is subsequently successful in appealing the determination of liability; the office shall, upon completion of the appellate process, refund the surety or the transportation provider the full amount paid for the liability. As added by P.L.197-2013, SEC.11. Amended by P.L.3-2014, SEC.4.

Ind. Code § 12-15-11-3 Provider agreement requirements

Sec. 3. A provider agreement must do the following: (1) Include information that the office determines necessary to facilitate carrying out of IC 12-15. (2) Prohibit the provider from requiring payment from a recipient of Medicaid, except where a copayment is required by law. (3) For providers categorized as high risk to the Medicaid program under 42 U.S.C. 1395cc(j)(2)(B) and 42 CFR 455.450, require the submission of necessary information, forms, or consents for the office to obtain a national criminal history background check or, as allowed by the office, a fingerprint-based criminal history check, through a contractor under IC 12-15-30 or the state police department under IC 10-13-3-39 of any person who: (A) holds at least a five percent (5%) ownership interest in a facility or entity; or (B) is a member of the board of directors of a nonprofit facility or entity; in which the provider applicant plans to provide Medicaid services under the provider agreement. The provider applicant is responsible for the cost of the national criminal history background check or fingerprint-based criminal history check. [Pre-1992 Revision Citation: 12-1-7-15.1(b) part.] As added by P.L.2-1992, SEC.9. Amended by P.L.197-2013, SEC.12; P.L.35-2016, SEC.38.

Ind. Code § 12-15-11-4 Provider agreement to provide physician services; site visit for moderate or high categorical risk designees

Sec. 4. (a) A provider desiring to participate in the Medicaid program by providing physician services as a managed care provider must enter into a provider agreement with the office or the contractor under IC 12-15-30 to provide Medicaid services. (b) Before the office may approve a provider agreement, the office shall conduct a pre-enrollment site visit for provider applicants that are designated as moderate or high categorical risks to the Medicaid program under 42 U.S.C. 1395cc(j)(2)(B) and 42 CFR 455.450. [Pre-1992 Revision Citation: 12-1-7-15.1(c).] As added by P.L.2-1992, SEC.9. Amended by P.L.197-2013, SEC.13.

Ind. Code § 12-15-11-5 Compliance with enrollment requirements

Sec. 5. A provider who participates in the Medicaid program must comply with the enrollment requirements that are established under rules adopted under IC 4-22-2 by the secretary. [Pre-1992 Revision Citation: 12-1-7-15.1(d).] As added by P.L.2-1992, SEC.9. Amended by P.L.195-2018, SEC.4; P.L.190-2023, SEC.2.

Ind. Code § 12-15-11-6 Prohibition on exclusion of Medicaid provider from participation in Medicaid and other networks

Sec. 6. (a) After a provider signs a provider agreement under this chapter, the office may not exclude the provider from participating in the Medicaid program by entering into an exclusive contract with another provider or group of providers, except as provided under section 7 of this chapter. (b) The office or a managed care organization contracting with the office may not prohibit a provider from participating in a network of another insurer, managed care organization, or health maintenance organization. [Pre-1992 Revision Citation: 12-1-7-15.1(e).] As added by P.L.2-1992, SEC.9. Amended by P.L.93-2020, SEC.1.

Ind. Code § 12-15-11-7 Competitive bids; services and items for which bids may be sought

Sec. 7. The office may seek competitive bids for the following items or services provided under Medicaid: (1) Prescribed drugs and services for state operated institutions. (2) Physical therapy and other therapeutic services. (3) Prescribed laboratory and x-ray services. (4) Eyeglasses and prosthetic devices. (5) Medical equipment and supplies. (6) Transportation services. [Pre-1992 Revision Citation: 12-1-7-15.1(f).] As added by P.L.2-1992, SEC.9.

Ind. Code § 12-15-11-8 Use of provider identification number; prohibition on limiting claims for primary care services

Sec. 8. (a) A community mental health center may use the center's provider identification number to file any Medicaid claim, including primary care health services, if the community mental health center: (1) is otherwise treating the individual for a mental health condition or an addictive disorder; and (2) meets the requirements to provide the services rendered. (b) The office may not require a community mental health center to obtain a separate provider identification number to provide services that the community mental health center meets the requirements to provide. (c) The office may not limit the filing of a Medicaid claim by a community mental health center for primary care services, mental health conditions, and addictive disorders on the same day as long as the claim is filed in accordance with the rules set forth by the office and the services are covered services and necessary to ensure coordinated care for the recipient. As added by P.L.185-2015, SEC.12.

Ind. Code § 12-15-11-9 Credentialing; provisional; application form; notification; retroactive reimbursement; adverse determination; appeal

Sec. 9. (a) As used in this section, "clean credentialing application" means an application for network participation that: (1) is submitted by a provider under this section; (2) does not contain an error; and (3) may be processed by the managed care organization or contractor of the office without returning the application to the provider for a revision or clarification. (b) As used in this section, "credentialing" means a process by which a managed care organization or contractor of the office makes a determination that: (1) is based on criteria established by the managed care organization or contractor of the office; and (2) concerns whether a provider is eligible to: (A) provide health services to an individual eligible for Medicaid services; and (B) receive reimbursement for the health services; under an agreement that is entered into between the provider and managed care organization or contractor of the office. (c) As used in this section, "unclean credentialing application" means an application for network participation that: (1) is submitted by a provider under this section; (2) contains at least one (1) error; and (3) must be returned to the provider to correct the error. (d) This section applies to a managed care organization or contractor of the office. (e) If the office or managed care organization issues a provisional credential to a provider under subsection (j), the office or managed care organization shall: (1) issue a final credentialing determination not later than sixty (60) calendar days after the date in which the provider was provisionally credentialed; and (2) except as provided in subsection (l), provide retroactive reimbursement under subsection (k). (f) The office shall prescribe the credentialing application form used by the Council for Affordable Quality Healthcare in electronic or paper format, which must be used by: (1) a provider who applies for credentialing by a managed care organization or contractor of the office; and (2) a managed care organization or contractor of the office that performs credentialing activities. (g) A managed care organization or contractor of the office shall notify a provider concerning a deficiency on a completed unclean credentialing application form submitted by the provider not later than five (5) business days after the entity receives the completed unclean credentialing application form. A notice described in this subsection must: (1) provide a description of the deficiency; and (2) state the reason why the application was determined to be an unclean credentialing application. (h) A provider shall respond to the notification required under subsection (g) not later than five (5) business days after receipt of the notice. (i) A managed care organization or contractor of the office shall notify a provider concerning the status of the provider's completed clean credentialing application when: (1) the provider is provisionally credentialed; and (2) the entity makes a final credentialing determination concerning the provider. (j) If the managed care organization or contractor of the office fails to issue a credentialing determination within fifteen (15) business days after receiving a completed clean credentialing application form from a provider, the managed care organization or contractor of the office shall provisionally credential the provider in accordance with the standards and guidelines governing provisional credentialing from the National Committee for Quality Assurance or its successor organization. The provisional credentialing license is valid until a determination is made on the credentialing application of the provider. (k) Once a managed care organization or contractor of the office fully credentials a provider that holds provisional credentialing and a network provider agreement has been executed, then reimbursement payments under the contract shall be paid retroactive to the date the provider was provisionally credentialed. The managed care organization or contractor of the office shall reimburse the provider at the rates determined by the contract between the provider and the: (1) managed care organization; or (2) contractor of the office. (l) If a managed care organization or contractor of the office does not fully credential a provider that is provisionally credentialed under subsection (j), the provisional credentialing is terminated on the date the managed care organization or contractor of the office notifies the provider of the adverse credentialing determination. The managed care organization or contractor of the office is not required to reimburse for services rendered while the provider was provisionally credentialed. (m) A managed care organization or contractor of the office may not require additional credentialing requirements in order to participate in a managed care organization's network. However, a contractor may collect additional information from the provider in order to complete a contract or provider agreement. (n) A managed care organization or contractor of the office is not required to contract with a provider. (o) A managed care organization or contractor of the office shall: (1) send representatives to meetings and participate in the credentialing process as determined by the office; and (2) not require additional credentialing information from a provider if a non-network credentialed provider is used. (p) Except when a provider is no longer enrolled with the office, a credential acquired under this chapter is valid until recredentialing is required. (q) An adverse action under this section is subject to IC 4-21.5. (r) The office may adopt rules under IC 4-22-2 to implement this section. As added by P.L.195-2018, SEC.5. Amended by P.L.32-2021, SEC.31; P.L.190-2023, SEC.3; P.L.17-2024, SEC.2.

Ind. Code § 12-15-11-10 Prohibition on requiring a telehealth provider to have an Indiana address, site, or in-state service address

Sec. 10. The office may not require the following: (1) A provider that is licensed, certified, registered, or authorized with the appropriate state agency or board and exclusively offers telehealth services (as defined in IC 12-15-5-11(a)) to maintain a physical address or site in Indiana to be eligible for enrollment as a Medicaid provider. (2) A telehealth provider group with providers that are licensed, certified, registered, or authorized with the appropriate state agency or board to have an in-state service address to be eligible to enroll as a Medicaid vendor or Medicaid provider group. As added by P.L.229-2023, SEC.1.

Ind. Code § 12-15-11-11 Requirement to provide certain records; limitations

Sec. 11. A provider of services under a home and community based services waiver (as defined in IC 12-8-1.6-2) shall do the following: (1) Upon request by an individual receiving services under the waiver or the individual's legal guardian, but not more than once per calendar quarter, provide to the individual or the individual's legal guardian the provider's accounting records of service delivery for the recipient. (2) Upon request, but not more than twice per calendar year, provide to an individual receiving services under the waiver an itemized statement of the services billed by the provider for the recipient. The statement must be in plain language. As added by P.L.160-2026, SEC.10.

Source: Open US Law by Vaquill AI (CC BY 4.0)URL: https://iga.in.gov/laws/2026/ic/titles/12Fetched: 10/17/2026