Become a preferred provider for skilled facility

Thank you very much for your interest in becoming part of the OrthoIndy Hospital (OIH) Preferred Provider List. All providers who receive referrals from OIH must be committed to assisting OIH patients move through the continuum of post-acute care appropriately. 

Applications should be submitted between January 1 and January 31 each calendar year. All providers (including those providers who may currently appear on the list) are still required to resubmit annual applications. Applications not received between January 1 and January 31 will be reviewed from time to time, and providers may be added to or removed from the list at OIH discretion.  OrthoIndy’s current preferred provider lists can be found here

To apply for preferred provider status, each facility or agency must provide:

  1. Completed questionnaire/score card below
  2. Copy of most recent data from Medicare.gov - Go to Medicare.gov and print most recent:
    • Nursing Home Compare General Information Page (which lists star ratings for overall, health inspection, staffing, and quality measures). Do not submit application if facility has less than 3 stars for any of those categories.
    • Home Health Compare General Information page, Quality of Patient Care page, AND Patient Survey Results page. Do not print details of reports, submit only those 3 pages. Do not submit application if agency has less than 3 stars for quality of patient care or patient survey results.

If your provider is selected, you will be notified by email. The email address you use to provide the materials requested will be the one the hospital will use for that purpose. If you encounter difficulty with the application process, please call 317.956.1148 or 317.956.1188.

Please fill out the entire form to be considered for our preferred provider list.

 

 

 


 

 

 

 

 

 

 




 




 

 

 


 


All fields must be completed.