Medicaid Provider Enrollment Portal
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.
In order to come into compliance with federal law, 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 enrollment portal must be used by all Medicaid providers. This includes current managed care organization (MCO) only providers, Dental Benefits Program Manager (DBPM) providers, Coordinated System of Care (CSoC) providers, existing fee-for-service providers, and any new providers enrolling for the first time.
Who does this new requirement apply to?
This requirement applies to all Medicaid providers. This includes any provider that cares for Medicaid members. 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
- Dental 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, DBPM and/or Magellan. 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, DBPMs and/or Magellan. 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, DBPMs and Magellan complete every three years. Providers also must still complete the recredentialing process with MCOs, DBPMs and/or Magellan every three years.
Why is Louisiana developing this new process rather than relying on current enrollment and application processes?
In order to come into compliance with 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 anticipated launch date for the Louisiana Medicaid Provider Enrollment Portal is July 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.
How will I know when it is time to visit the portal?
Gainwell will send out an invitation to current providers informing them that they can now visit the new Louisiana Medicaid Provider Enrollment Portal.
The portal is anticipated to go live in July 2021, and invitations will go out to providers when it is time for them to enroll through the portal. Not all invitations will be mailed at the same time. Due to the large volume of enrollments, LDH plans to stagger invitations to avoid overwhelming the system. Providers should wait until they receive their invitation to access the portal. The invitation will include instructions for how to access the portal as well as training resources for providers and their enrollment staff.
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, the MCOs, the DBPMs, and/or Magellan.
What does this mean for my credentialing with an MCO, DBPM and/or Magellan?
This process does not take the place of the normal MCO, DBPM or Magellan credentialing process. Current providers have no additional steps to complete after completing the enrollment process through the new Louisiana Medicaid Provider Enrollment Portal, but they will need to complete the recredentialing process every three years for each MCO and/or DBPM with which they are contracted and with Magellan if applicable. 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, DBPMs and/or Magellan 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 National Provider Identifier (NPI) and assigned taxonomies here.
- Review all taxonomy options here.
It is important that providers identify their assigned taxonomy in preparation for the enrollment and screening process because the use of assigned taxonomies will be new for fee-for-service providers and different for MCO providers. Although MCO providers currently use a taxonomy, they are free to use any taxonomy, which means their taxonomy may not necessarily match their provider type and specialty. To complete the enrollment process in the portal, both MCO and fee-for-service providers will be asked to select a taxonomy in the portal, and their available choices will be limited to taxonomies that relate to their provider type and specialty.
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.
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