Indiana Medicaid Promoting Interoperability Program (formerly MU) Enrollment Questionnaire

To express your interest in enrolling in the Indiana Medicaid PIP (formerly MU), please provide your contact information and fill out this 13-question form.

About your Organization

Provide number of sites, and any comments regarding the sites.

Potential "Eligible Providers" under the Indiana Medicaid MU Program are Physicians (MDs & DOs); Nurse Practitioners; Certified Nurse Midwives; Dentists; and Physician Assistants who lead an FQHC or an RHC.

Health IT Questions

Next Steps

Once you submit this form, your clinic/small practice will be included on our list of organizations interested in participating in the program. A representative from Purdue Healthcare Advisors will get back to you shortly regarding your interest.

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