Yes! You can use AI to fill out Indiana Health Coverage Programs (IHCP) Managed Care Entity (MCE) Provider Enrollment Form

CAR forms: Form SSA-44, Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event, Form I-90, Application to Replace Permanent Resident Card, Form 2441, Child and Dependent Care Expenses, Form WH-380-E, Certification of Health Care Provider, Form 4137, Social Security and Medicare Tax on Unreported Tip Income, Form 8959, Additional Medicare Tax, Form 8919, Uncollected Social Security and Medicare Tax, Form CMS-1763, Request for Termination of Medicare Coverage, Form CMS-855O, Medicare Enrollment Application, Form CMS-460, Medicare Participation Agreement, Form CMS-4040, Request for Enrollment in Medicare Part B, Form WH-380-F, Certification of Health Care Provider, Form W-10, Dependent Care Provider’s Identification, Form 1099-K, Payment Card and Third Party Network Transactions, Form CMS-40B, Application for Enrollment in Medicare Part B, Form SS-5-FS, Application for a Social Security Card, Form REG 195, Disabled Person Placard, Form AR-11, Alien's Change of Address Card, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, Form I-131A, Application for Carrier Documentation

health care forms: Form WH-380-E, Certification of Health Care Provider, Form WH-380-F, Certification of Health Care Provider, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, DHS-6696-ENG, Minnesota Health Care Programs Application (MNsure/DHS), Form CH-006: PA-BH-Res-PCS, Oregon Behavioral Health Support Program Plan of Care Authorization (Plan of Care Request for Behavioral Health Residential or Personal Care Services), Prior Authorization (PA) Request Form – Adult Palliative Care (Alameda Alliance for Health), Medicare Enrolment Application (Australia) – Enrol in Medicare, Re-enrol/Extend Eligibility, Enrol a Newborn, and Register for My Health Record, Alameda Alliance for Health Prior Authorization (PA) Request Form – Adult Palliative Care, Health Assessment – Ontario Health atHome (Fixing Long-Term Care Act, 2021) (Form 4768-69E), Health Assessment - Ontario Health atHome (Fixing Long-Term Care Act, 2021) — Form 4768-69E, Request for Transfer of Records (Adelaide Health Care) – AHC-0013-05-PS (Version 2), Application for Access to Health Care Records (Nepean Blue Mountains Local Health District) – NBMA-431, L.A. Care Behavioral Health Treatment Applied Behavioral Analysis Authorization Request Form, Medicaid Managed Care Applied Behavior Analysis — Authorization Request (Healthy Blue Louisiana, BLAPEC-1989-20), Iowa Advance Directive: Durable Power of Attorney for Health Care and Declaration (Living Will), Direct Rollover Request for Appalachian Regional Healthcare, Inc. Voluntary Plan, Molina Healthcare Prior Authorization Request Form, UnitedHealthcare Prior Authorization Request Form, Optum Rx / UnitedHealthcare Prior Authorization Request Form, Texas Standard Prior Authorization Request Form for Health Care Services

enrollment forms: Form CMS-855O, Medicare Enrollment Application, Form CMS-4040, Request for Enrollment in Medicare Part B, Form CMS-40B, Application for Enrollment in Medicare Part B, Providence Health Plan Out-of-Area Dependent Enrollment Form, Empower Enrollment Form, Empower Enrollment Form, Principal Life Insurance Company UCTIE INTERNATIONAL UNION 401(K) SAVINGS PLAN Enrollment Form, Enrollment Application, Northwell Residents Open Enrollment Benefits Guide 2026, University of Colorado 403(b) Plan – DSW Scudder Enrollment and Beneficiary Designation Form, Merrill Funds Transfer Service Enrollment Form, Funds Transfer Service Enrollment Form, Standing Letter of Authorization / Instruction Enrollment Form, Merrill RMD Service Enrollment and Authorization Form, Fidelity Investments Account Application/Enrollment Form and Beneficiary Designation, MyMerrill® Client Order Entry Enrollment Form, CMS-855I, Medicare Enrollment Application for Physicians and Non-Physician Practitioners, Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits, CMS-855R, Medicare Enrollment Application: Reassignment of Medicare Benefits

L.A. Care forms: Form SSA-44, Medicare Income-Related Monthly Adjustment Amount - Life-Changing Event, Form 2441, Child and Dependent Care Expenses, Form WH-380-E, Certification of Health Care Provider, Form 4137, Social Security and Medicare Tax on Unreported Tip Income, Form 8959, Additional Medicare Tax, Form 8919, Uncollected Social Security and Medicare Tax, Form CMS-1763, Request for Termination of Medicare Coverage, Form CMS-855O, Medicare Enrollment Application, Form CMS-460, Medicare Participation Agreement, Form CMS-4040, Request for Enrollment in Medicare Part B, Form WH-380-F, Certification of Health Care Provider, Form W-10, Dependent Care Provider’s Identification, Form CMS-40B, Application for Enrollment in Medicare Part B, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, DHS-6696-ENG, Minnesota Health Care Programs Application (MNsure/DHS), California Department of Social Services (CDSS) Community Care Licensing Child Care Forms Packet (LIC 9150, LIC 282, LIC 627, LIC 700, LIC 995A, CDPH 286, LIC 9227), State of Illinois Department of Human Services (IDHS) – Bureau of Child Care and Development Child Care Application (Form IL444-3455), Form CH-006: PA-BH-Res-PCS, Oregon Behavioral Health Support Program Plan of Care Authorization (Plan of Care Request for Behavioral Health Residential or Personal Care Services), State of Illinois Department of Children and Family Services Medical Report on an Adult in a Child Care Facility (CFS 602), Carer Payment and Carer Allowance – Medical Report (SA431) for a child under 16 years

managed care forms: Medicaid Managed Care Applied Behavior Analysis — Authorization Request (Healthy Blue Louisiana, BLAPEC-1989-20)

health forms: Form 1095-A, Health Insurance Marketplace Statement, Form 8889, Health Savings Accounts, Form WH-380-E, Certification of Health Care Provider, Form 7206, Self-Employed Health Ins. Ded., Form 8885, Health Coverage Tax Credit, Form WH-380-F, Certification of Health Care Provider, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, Form 1095-B, Health Coverage, Form I-905, Application for Authorization to Issue Certification for Health Care Workers, Form BHVH, Outpatient Behavioral Health – ABA Treatment Request, Form SHA, Separation Health Assessment, DHS-6696-ENG, Minnesota Health Care Programs Application (MNsure/DHS), Geisinger Health Plan Behavioral Health Professional Services Questionnaire, Priority Health Small Group Renewal Decision Form, Form CH-006: PA-BH-Res-PCS, Oregon Behavioral Health Support Program Plan of Care Authorization (Plan of Care Request for Behavioral Health Residential or Personal Care Services), Form 7206 (2025), Self-Employed Health Insurance Deduction, HIPAA Authorization Form, Authorization for the Release of Protected Health Information, Prior Authorization (PA) Request Form – Adult Palliative Care (Alameda Alliance for Health), Medicare Enrolment Application (Australia) – Enrol in Medicare, Re-enrol/Extend Eligibility, Enrol a Newborn, and Register for My Health Record, Alameda Alliance for Health Prior Authorization (PA) Request Form – Adult Palliative Care

provider enrollment forms: CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement Checklist, CMS-855A, Medicare Enrollment Application for Institutional Providers, Form CMS-855A, Medicare Enrollment Application for Institutional Providers, Medicaid of Alaska Provider Electronic Remittance (835) Authorization and Claims Enrollment Form, Medicaid Alaska EDI Enrollment - Provider Information Submission Agreement, Arkansas Medicaid Provider Application Packet (DMS-652), Form HFS 2243, Provider Enrollment Application Illinois Medical Assistance Program, Form CMS-855R, Medicare Enrollment Application - Reassignment of Medicare Benefits, Provider Enrollment Agreement (OHA 3975), Oregon Medicaid ID Application Form, Provider Group/Facility Application (RA-02)

health care program forms: Form T-3, Children with Special Health Care Needs (CSHCN) Services Program Application, DHS-6696-ENG, Minnesota Health Care Programs Application (MNsure/DHS), Form CH-006: PA-BH-Res-PCS, Oregon Behavioral Health Support Program Plan of Care Authorization (Plan of Care Request for Behavioral Health Residential or Personal Care Services), New York State Department of Health Medicare Savings Program Application

health coverage forms: Form 8885, Health Coverage Tax Credit, Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, Form 1095-B, Health Coverage, Indiana Health Coverage Programs Prior Authorization Request Form (Version 10.0, January 2026), Indiana Health Coverage Programs Prior Authorization Request Form (Version 9.2, July 2024)