Professional Licensing Agency Forms and Office Locations – Government Agency in Indiana

101 - 120 of 206 forms

Form Title	Topics
IHCP Prior Authorization Request Form (universal PA form)
IHCP Prior Authorization Revision Request Form
IHCP Professional, Dental, or Medicare Part B Crossover Claim Adjustment Request
IHCP Reassessment Form for Continued Substance Use Disorder (SUD) Treatment
IHCP Residential/Inpatient Substance Use Disorder Treatment Prior Authorization Request Form
IHCP Third-Party Liability (TPL)/Medicare Special Attachment Form
IHCP Third-Party Liability (TPL)/Medicare Special Attachment Form
IHCP Third-Party Liability (TPL)/Medicare Special Attachment Form Instructions
IHCP Third-Party Liability (TPL)/Medicare Special Attachment Form Instructions
Indiana FADS Secure File Transfer Instructions
Indiana FADS Secure File Transfer Instructions
Indiana Fraud and Abuse Detection System (FADS) Secure File Transfer Form
Indiana Health Coverage Programs Claim Administrative Review Request
Indiana Health Coverage Programs Written Inquiry Form
Instructions for School Invoicing
Letter of Credit Suggested Language
List of Exempted Sources of Reimbursement for Judicial Education
Medicaid Hospice Discharge Form
Medicaid Hospice Physician Certification Form
Medicaid Hospice Plan of Care for Curative Care – Members 20 Years and Younger

Professional Licensing Agency