Louisiana Medicaid Application Center Resource Library

 

CONTACT INFORMATION

Josie McElroy

ApplicationCenter.Service@la.gov

Fax: (225) 376-4736

 

ALERT: If your facility is an Outstation Site, you should have received a separate email in regard to registering.

LaMEDS Self-Service Portal Demo and Q&A 

Date: November 7, 2018        Time: 8:30 a.m. – 9:30 a.m. or 10 a.m. – 11 a.m.

  1. Space is limited so if possible share computers and phone lines.
  2. Please register for the time that works best for you.
  3. Prerequisite training will be posted to Coursemill on October 17, 2018. 
  4. You must view these prerequisite LaMEDS training videos prior to the Demo on November 7.

Registration is now available at the following link:  https://attendee.gotowebinar.com/rt/6443595929437946371

After registering, you will receive a confirmation email containing information about joining the webinar.
REMEMBER:  Please direct all inquiries to ApplicationCenter.Service@la.gov . Emails will be responded to in the order received.

 

Application Center Websites

AC Demo Changes/Replacement Cards  
App Center Online Training  
Online Application  

 

Application Center Documents

Application Center Evaluation  
Application Center Handbook

 

AC-2 and addendum (Application Center Contractual Agreement & HIPAA Business Associate Addendum)

Instructions

AC-2a (Standard Board Resolution Form)

Instructions

AC-3 (Confidentiality Responsibilities / Agreement)

Instructions

AC-4 (Application Center Request for Representative Training)

Instructions

AC-5 (Log of Referrals) Instructions

AC-7 (RightFAX Cover and Transmittal Log)

Instructions

AC-8 (Inspection / Monitoring Report)

Instructions

AC-8a (Monitoring Corrective Action Results)

Instructions

AC Signage Template

 

AR (Consent for Authorized Representation)

Instructions

Clearance (Statement of Applicant)

Instructions

Electronic Funds Transfer (EFT) Enrollment Form  

General Application

 
General Application - Additional Persons  
General Application - Employer Coverage Tool  
General Application - Appendix D - Personal Assets  
General Application - Spanish  
General Application - Vietnamese  
Health Plan Non-Timely Filing Procedures  
Healthy LA Comparison Chart - Printout  
Healthy LA Comparison Chart - Web Viewing  
HIPAA 202L (Authorization to Release Health Information)  

HIPAA 402P (Authorization to Release or Obtain Health Information)

Instructions

Ins-LR (Request for Life Insurance Policy Information)

Instructions

MS (Social Information Interview)

Instructions

MS/C (Child's Medical & Social Interview)

Instructions

Resources (Request for Resources & Interest Income Information)

Instructions

Verification (Application Verification Request Form)

Instructions

Voter Registration Application (LR-1 & 1M)

 

Voter Registration Declaration (English)

 

Voter Registration Declaration (Spanish)

 
Voter Registration Declaration (Vietnamese)  


Voter Registration Poster (English)

 

Voter Registration Poster (Spanish)

 

Voter Registration Poster (Vietnamese)

 

Wages (Personal Wage Record)

 Instructions
WIC 38 Flyer