For the most part, the new system does not change provider interaction with Medicaid.
There is one major difference that does require action by some providers. The new system includes a provider portal that replaces the Facility Notification System (FNS). FNS allows nursing homes, hospitals, support coordination agencies and other community partner representatives to submit forms to Medicaid. This includes requests for long term care, waivers and newborn health assistance.
Any provider previously using FNS will need to register with the new system to continue submitting forms to Medicaid. FNS is no longer available.
For any provider-related issues, please contact email@example.com. If you are working to resolve an issue on behalf of a patient, please contact our Medicaid Customer Service Unit, toll free at #1-888-342-6207 or at MyMedicaid@la.gov.
The implementation of Medicaid’s new eligibility and enrollment system resulted in a backlog of applications as eligibility staff overcame the learning curve of this dynamic system upgrade. By diligently processing applications in the order they were received, all applications submitted through the end of March have been approved, denied, or additional information requested to make an eligibility determination. Applications received in April and May are pending. We sincerely appreciate the patience of the provider community as we work through this backlog.
The new eligibility and enrollment system automatically checks an applicant’s eligibility for all Medicaid programs. If an LTC applicant does not qualify for LTC coverage, or another full-benefit Medicaid program, but qualifies for the Take Charge Plus program, they are automatically enrolled. This automatic enrollment does not allow eligibility staff to first contact the applicant to determine if the coverage is wanted or not, as in the past. If claims are submitted for an LTC applicant who is denied LTC coverage, the claim will deny as well.
Please refer to the published Provider Bulletin from 4/26/19 under the heading “Patient Liability” for a detailed explanation. The new eligibility and enrollment system shows PLI on notices only for the LTC eligibility period the resident was in the nursing home and not always the same as the full month.
. Previously, decision letters referenced the invoice number, provider, and date of service. However, the Centers for Medicare and Medicaid Services (CMS) set specific requirements for notice content, making notices more generic. LDH will consult with CMS to determine if dental specifics can be included in the notice. If LDH is unable to make this change, we recommend obtaining the bill between the recipient and the dentist to pay the refund.
The resident’s ID number is considered protected health information (PHI) and therefore prohibited from inclusion in notices by CMS. Please see information published in the Provider Bulletin published on 5/8/19 about how to obtain the Member ID for billing.
The system default, or preferred method of notice delivery, has been updated to email. Notices were previously mailed to the address on file for the recipient. If this was not the provider, the provider would not receive the notice. With email as the default delivery method, more notices will go direct to the provider. Medicaid – with the Office of Aging and Adult Services (OAAS) and the Office for Citizens with Developmental Disabilities (OCDD) – updated provider email addresses so that providers will receive notices via email instead of direct mail.