Medicaid Provider Enrollment Portal

The Louisiana Department of Health is launching a Medicaid Provider Enrollment Portal. This portal is required by the Centers for Medicare and Medicaid Services (CMS) so states can screen and enroll providers and it will strengthen program integrity.

This requirement applies to both fee-for-service Medicaid providers and managed care network providers. All providers are subject to the CMS requirements.

Providers include, but are not limited to:

  • Individual practitioners—such as physicians, nurse practitioners, and physical therapists
  • Any physicians and other professionals who may only order or refer beneficiaries to services, but do not render services – for example, providers who only prescribe medications or order imaging services, such as an x-ray.
  • Provider organizations such as hospitals, group practices, and skilled nursing facilities
  • Providers and suppliers of medical equipment or goods
  • Behavioral Health providers
  • Waiver providers and support coordination agencies
  • Non-emergency transportation (NEMT) providers
  • Providers who enter single case agreements with a managed care organization for claims payment

Why is there a new process for enrollment and screening that providers need to complete for Louisiana Medicaid?

As a part of the Affordable Care Act and later refined in the 21st Century Cures Act, federal laws enforced by CMS require that states screen and enroll all providers.

The state’s fiscal intermediary and current provider enrollment vendor, Gainwell (formerly DXC Technology), will create a web-based portal for Medicaid and its providers to complete the necessary screenings required by CMS. The portal will be designed for new providers enrolling for the first time, MCO-only providers who are not already enrolled with the state, and existing fee-for-service providers that need to be revalidated because they first enrolled with Medicaid more than five years ago.

Who does this new requirement apply to?

This requirement applies to all Medicaid providers. This includes any provider that cares for Medicaid members, whether the member receives those services through the fee-for-service or managed care delivery model. All providers are subject to the CMS requirements. Providers include, but are not limited to:

  • Individual practitioners—such as physicians, nurse practitioners, and physical therapists
  • Any physicians and other professionals who may only order or refer beneficiaries to services, but do not render services – for example, providers who only prescribe medications or order imaging services, such as an x-ray.
  • Provider organizations such as hospitals, group practices, and skilled nursing facilities
  • Providers and suppliers of medical equipment or goods, for example, pharmacy providers and medical equipment providers.
  • Behavioral health providers
  • Waiver providers and support coordination agencies
  • Providers who enter single case agreements with a managed care organization for claims payment

How does this new enrollment and screening process on the state portal differ from enrollment and screening as a managed care provider or a fee-for-service provider?

Under the current process, managed care providers have not been required to enroll directly with Louisiana Medicaid through the fiscal intermediary. A provider that becomes a managed care provider is credentialed and contracted with an MCO. If the provider is a fee-for-service provider, they must enroll as a Louisiana Medicaid provider and complete a screening process through the state’s fiscal intermediary, Gainwell.  

The new enrollment and screening process will be managed for all providers through the new web-based portal. This will bring the state into compliance with current federal requirements. Completing this enrollment process through the fiscal intermediary does not require a provider to participate in the fee-for-service model. Providers may continue with their current business model and will not be mandated to provide care through the fee-for-service model, unless that is their preference. Managed care providers must still be enrolled, credentialed and contracted with the MCOs. Fee-for-service providers will not have to complete additional enrollment forms with Gainwell.

Per CMS requirements, all providers must be screened by the state at the following intervals:

  • When they initially apply for and submit an application to become a Medicaid provider;
  • Upon reenrollment (reactivation of a previously closed provider number) in the state’s Medicaid program; and
  • At least once every five years to revalidate their enrollment, which is similar to the recredentialing process that all MCOs complete every three years. (MCO providers also must still complete the recredentialing process with MCOs every three years)

Why is Louisiana developing this new process rather than relying on current enrollment and application processes?

In order to adhere to federal law, the new Louisiana Medicaid Provider Enrollment Portal will allow Louisiana Medicaid to comply with CMS revalidation and managed care screening requirements. The portal is also meant to streamline the enrollment process by eliminating the need to complete a paper application and mail in the packet to Gainwell.  Providers will have the ability to track their application through the portal which was not previously available with the paper application.

When will I need to complete my enrollment and screening?

The estimated launch date for the Louisiana Medicaid Provider Enrollment Portal is May 2021. All current providers, whether participating as a fee-for-service provider, MCO-only provider, or both, must validate their information and sign the state’s provider participation agreement through the portal within six months of its launch. This time frame is necessary to allow time for application review.

How will I know when it it time to visit the portal?

Gainwell will send out an invitation to current providers informing them that they can now visit the new Louisina Medicaid Provider Enrollment Portal.

Additionally, providers should check for updates on the Medicaid fiscal intermediary web site, www.lamedicaid.com, the Medicaid Provider and Plan Resources web page through provider organizations and in Medicaid publications including Informational Bulletins and Health Plan Advisories.

What happens if I don't complete this process?

Any existing Medicaid provider that does not complete the enrollment and screening process through the new Louisiana Medicaid Provider Enrollment Portal within the established timelines will have their claims denied. These providers must complete the state’s enrollment process for claims to be approved by fee-for-service Medicaid and/or the MCOs.

What does this mean for my MCO credentialing?

This process does not take the place of the normal MCO credentialing process. Although providers currently contracted with MCOs do not have to take any additional steps after completing the enrollment process through the new Louisiana Medicaid Provider Enrollment Portal, they will need to complete the recredentialing process by the MCOs every three years. If they do not do so, they will be disenrolled from the managed care plan with which they are contracted. New providers, however, will need to complete the credentialing process with MCOs after they complete the enrollment process through the new Louisiana Medicaid Provider Enrollment Portal.

How can I best prepare for the new enrollment and screening process?

Providers should talk to their office staff that typically help with enrollment and credentialing processes.

Providers should determine their taxonomy information. If a provider does not already know their taxonomy information, they can:

  • Look up their NPI and assigned taxonomies here.
  • Review all taxonomy options here.

Additionally, MCO providers should decide whether they also want to participate in the fee-for-service model. Providers will not be forced to enroll as fee-for-service, unless they would like to do so.

 Resources