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, […]
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.
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) […]
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 […]
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 […]
12-15-11-5. Compliance With Enrollment Requirements; Centralized Credentials Verification Organization
Sec. 5. (a) 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. (b) A provider who participates in the Medicaid program may be required to use the centralized credentials verification organization established in section 9 of this chapter. […]
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 […]
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: […]
12-15-11-8. 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 […]
12-15-11-9. Implementation of Centralized Credentials Verification Organization; Requirements; Prohibition on Requiring Additional Credentialing; Managed Care Organizations; Administrative Review; Rules
Sec. 9. (a) The office shall implement a centralized credentials verification organization and credentialing process that: (1) uses a common application, as determined by provider type; (2) issues a single credentialing decision applicable to all Medicaid programs, except as determined by the office; (3) recredentials and revalidates provider information not less than once every three […]