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Bureau of Health Services Financing (Medicaid)
Provider Enrollment Feedback Form

Provider Enrollment Feedback Form

We value our stakeholders and strive to meet everyone’s needs in compliance with federal requirements. As we move forward with completing the state’s web-based portal for Centers for Medicare and Medicaid (CMS) required provider screenings, we welcome your feedback.

Please provide your feedback/comments by completing the following form.

Name

Phone Number

How would you describe yourself? Provider
Provider Advocate
Managed Care Organization
Medicaid Recipient
LDH Employee
Other

Other (please describe)

Please share your feedback here:

Provider Enrollment Feedback Form

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein