Indiana Health Coverage Programs (IHCP) Managed Care Entity (MCE) Provider Enrollment Form Completed Form Examples and Samples
Explore practical examples and samples of the Indiana Health Coverage Programs (IHCP) Managed Care Entity (MCE) Provider Enrollment Form. Learn how to accurately complete your provider enrollment documentation with our detailed guides and automated processing use cases.
Automated Processing of the IHCP MCE Provider Enrollment Form
How this form was filled:
This example demonstrates how AI models can intelligently extract complex provider information from an unstructured professional onboarding email. The system parses narrative text to map provider credentials, practice locations, and specialty data into the standardized IHCP MCE Enrollment Form fields.
Source document used: Provider Onboarding/Credentialing Email
Subject: Onboarding Details for Dr. Elena M. Rodriguez - New Practice Start Date Jan 2026. Hi Team, I am writing to confirm the enrollment details for Dr. Elena M. Rodriguez, who will be joining our network as a Primary Medical Provider (PMP) for the Hoosier Healthwise program. Her NPI is 1234567890 and her CAQH ID is 99887766. Elena is a Board Certified MD and has been practicing for 10 years. We are registering her at our primary office at 4500 W. 10th St, Indianapolis, IN 46222-1234. The main office phone is 317-555-0199 and the fax is 317-555-0100. We would like to assign PMP membership to this location, and the office contact is Maria Santos ([email protected]). Our practice group name is 'Indy Primary Care Associates', with Group NPI 9876543210 and Tax ID 11-2233445. The office operates Monday through Friday, 8:00 AM – 5:00 PM. We do not offer weekend or evening hours. The facility is fully accessible with ramps and parking, and we provide services to children with special health care needs. Dr. Rodriguez is fluent in Spanish and English. Please note she holds hospital privileges at IU Health Methodist, located at 1701 N Senate Blvd, Indianapolis, IN 46202. We look forward to getting her credentialed before her February 1st start date. Regarding her background, she has no history of exclusion from Medicare or Medicaid programs. If you need anything further, please let me know.
Information used to fill out the document:
- Practitioner Name: Elena M. Rodriguez
- Credentials: MD
- NPI: 1234567890
- Program: Hoosier Healthwise
- Primary Practice Location: 4500 W. 10th St, Indianapolis, IN 46222
- Practice Group: Indy Primary Care Associates
- Languages: Spanish, English
- Hospital Privileges: IU Health Methodist
What this filled form sample shows:
- Contextual entity extraction from narrative prose
- Mapping of unstructured address and contact data to specific form constraints
- Identification of PMP-specific program eligibility
- Normalization of date and time formats for official requirements
- Boolean logic inference for disability and language checkboxes
Form specifications and details:
| Form Name: | Indiana Health Coverage Programs (IHCP) Managed Care Entity (MCE) Provider Enrollment Form |
| Target Program: | Hoosier Healthwise |
| Enrollment Type: | New enrollment |
| Practitioner Role: | Primary Medical Provider (PMP) |
| Practice Type: | Group |
| Categories: | CAR forms, enrollment forms, health care forms, health forms, managed care forms, L.A. Care forms |
| Created: | March 26, 2026 07:02 PM |