Office: 317-291-9318

Toll free: 800-508-7230

How to Apply

Mileage Reimbursement

 To expedite your credentialing for mileage reimbursement, we have transitioned to directing members to the state of Indiana online portal to complete the forms required by the state. Please follow the guided directions included below.

Click on the link shown here to enroll online:  https://www.in.gov/medicaid/providers/provider-enrollment/family-memberassociate-transportation-providers/

  1. You must apply for enrollment with the IHCP as provider type 26 – Transportation; provider specialty 266 – Family Member. IHCP can make special approval for members to drive themselves if the member has no family members or friends that can driver member to their appointments.

  2. Please have the following items ready for submission:
    • A copy of the Medicaid Family Member or Associate Transportation Services Form – completed and signed by the requesting Medicaid member
    • A copy of your current driver’s license
    • A copy of your current auto insurance for the vehicle being used
    • A copy of your current auto registration for the vehicle being used
    • A W-9 tax form
  3. If you drive more than one family member, you need to enroll only once, but your enrollment must include a separate request form from each Medicaid member you will be driving.

If you have any questions about enrollment, contact Provider Healthcare Portal Support.
Phone: 1-800-457-4584
Hours: Mon – Fri 8 AM – 6 PM EST (except federal holidays)

If you wish to complete these items by mail, please print out the following packet at the link shown, and mail it to the address listed below.

Packet URL:

https://www.in.gov/medicaid/providers/files/ihcp-family-member-associate-provider-enrollment-form.pdf

Address:

IHCP Provider Enrollment Unit
P.O. Box 7263
Indianapolis, IN 46207-7263

Once you receive an approval letter from IHCP showing a Medicaid Provider ID number, please submit a clear scan of this letter, showing letterhead, to [email protected]

Once the Claims Processing Department at LCP receives this, you can begin scheduling trips under the mileage reimbursement within our call center. If you have any more questions about scheduling, please call 800-508-7230.

If you have any questions about the information provided, please don’t hesitate to contact via the information provided.

Additional Information:

Members can apply via the www.in.gov/medicaid/ provider enrollment portal.

IHCP Family Member or Associate Transportation Provider Enrollment and Profile Maintenance Packet

Medicaid Family Member or Associate Transportation Services Form

  • If the member does not have access to apply via the provider enrollment portal. Mail a complete packet to the member (which consists of a total of (12) pages.
  • Once the member receives an approved provider letter from IHCP containing the provider ID number the member needs to fax or mail a copy of the letter to LCP.
  • Registered members are required to mail, fax, or email the mileage reimbursement documentation form (within 90 days of the trips) with all areas filled out.

1. Trip ID number provided to the member when trip was scheduled.
2. The form must have the signature of the doctor or counselor seen for each trip.
3. Medical providers’  name and address
4. Pick up time and drop off time.

  • All required information needs to be mailed/faxed/email to:

LCP Transportation
Attn: Mileage Reimbursement
4310 Guion Road
Indianapolis, IN 46254

Fax: 317-291-9446

Email:  [email protected]

  • Process Mileage Reimbursement Claim Submission received from the member.
  • Verify all required information provided. (Loaded Mileage to/from appointment; Pickup/Dropoff times; Signature of member and medical provider; Trip ID #)
  • Process reimbursement claim per mileage reimbursement rate.
  • Once LCP receives documentation for reimbursement and documentation is verified as clean the payment is processed and the member is paid within 30 days of submission of clean claim.
  • Mileage reimbursement claims are processed as they are received and paid on the 1st and 15th in accordance with state guidelines for paper claim submission.