Medicaid Provider Enrollment Portal

The Provider Enrollment Portal remains open for providers required to enroll who have not yet applied. Providers with multiple provider types must complete enrollment for each type. 

Federal laws enforced by CMS, including the Affordable Care Act and the 21st Century Cures Act, require providers who file claims with Louisiana Medicaid to enroll in Medicaid's web-based provider enrollment portal.

The Provider Enrollment Portal remains open for providers required to enroll who have not yet applied. Providers with multiple provider types must complete enrollment for each type.

For providers who missed the initial deadline of September 30, 2022, the Provider Enrollment Portal at www.lamedicaid.com remains open for providers required to enroll who have not yet applied. Providers with multiple provider types must complete enrollment for each type (for additional information, see scenario 5 below).

Providers who submit provider enrollment applications should allow several weeks for application processing.

Any providers who have not completed enrollment by June 30, 2023 will have their patients assigned to another primary care physician and will be terminated from the program.

It is extremely important to act now to avoid disruption in payments. Providers should expect impacts to claims processing, and risk not getting paid if enrollment is not complete.

Providers should visit www.lamedicaid.com to enroll. Providers will need several data points to complete enrollment, including Louisiana Provider ID, NPI, city, state and zip code. This information is included in a letter from Gainwell Technologies.

Who is required to enroll?

  • Providers who file claims with Louisiana Medicaid (providers enrolled in Fee-for-Service (FFS) Medicaid before December 31, 2021, and providers enrolled with an MCO, DBPM, or Magellan before March 31, 2022.)
  • Ordering, Prescribing, or Referring Providers
    • Ordering, prescribing or referring (OPR) providers do not bill Medicaid for services rendered, but may order, prescribe or refer services/supplies for Medicaid beneficiaries.

Additional Information about Ordering, Prescribing or Referring Providers (OPR)

For Medicaid to reimburse for services or medical supplies resulting from a practitioner's order, prescription or referral, the OPR provider must be enrolled in Medicaid.

Furthermore, if items or services are ordered, prescribed or referred by a resident or intern, the claim must identify the intern or resident’s National Provider Identifier (NPI) as the ordering or referring practitioner. Interns and residents are allowed to enroll in the Medicaid program as an OPR provider only.

If you are an OPR provider, those physicians, other practitioners and facilities who render services to Medicaid beneficiaries based on your order, prescription or referral, will not be paid for such items or services, beginning July 1, 2023, unless you enroll in Medicaid prior to that date and your NPI is included on the claim submitted to Medicaid by the rendering provider (42 CFR 455.440).

Please note that this extends to pharmacy Point of Sale (POS) systems as well. The POS system will deny any claims submitted, beginning July 1, 2023 for a Medicaid beneficiary with a prescriber, pharmacy provider, or vaccinating pharmacist who is not enrolled as a Medicaid provider.

Critical Deadlines – Claims Adjudication

Claims processing guidelines depend on when a provider enrolls. If enrollment is not complete, claims and payments will be impacted. The following scenarios outline those impacts.

Scenario 1: Claims for dates of service on or before December 31, 2022, will be adjudicated for providers who have and have not completed enrollment.

Scenario 2: Claims for dates of service on or after January 1, 2023, will be adjudicated for providers who have completed enrollment.

Scenario 3: Providers who have not completed enrollment on or before December 31, 2022, will have their claims denied for dates of service on or after January 1, 2023.

Providers still wishing to complete enrollment must submit an enrollment application by June 1, 2023 in order to complete the enrollment process by June 30, 2023.

Once the enrollment is completed, the provider may resubmit previously denied claims for dates of service between January 1, 2023 and June 30, 2023. Providers will not receive payment until their provider enrollment is complete.

Scenario 4: If an attending, or OPR provider is included on a claim or writes a prescription and has not completed enrollment, it will affect claims adjudication as follows:

  • Even if the billing provider is fully enrolled, the medical/professional claim will deny beginning July 1, 2023, if any one of the following are not enrolled:
    • Ordering provider
    • Prescribing provider
    • Referring provider
  • Even if the pharmacy is fully enrolled, the prescription will deny beginning July 1, 2023 if any one of the following are not enrolled:
    • Prescribing provider
    • Vaccinating pharmacist, or
    • Pharmacy provider
  • Even if a hospital is fully enrolled, the hospital claim will deny beginning July 1, 2023 if the attending provider is not enrolled.

Scenario 5:  For providers with multiple provider types, claims for dates of service on or after January 1, 2023, will be adjudicated for providers who have completed enrollment of at least one provider type.  Claims will deny beginning July 1, 2023 for any of the provider types not enrolled.

Scenario 6: Non-Emergency Medical Transportation (NEMT) providers who were invited to enroll must submit an enrollment application by June 1, 2023 in order to complete the enrollment process by June 30, 2023. Claims will deny beginning July 1, 2023 for NEMT providers not enrolled.

How does this 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 enrollment and screening process will be managed for all providers through the 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.

What information do I need to enroll?

Providers will need several data elements from their Gainwell letter to complete their enrollment, including Louisiana Provider ID, NPI, city, state and zip code.

How do I request a reprinted letter?

If a provider does not have their Gainwell letter or the information needed to enroll, they can email louisianaprovenroll@gainwelltechnologies.com to request a reprinted letter be mailed. Email requests must include the provider name and the NPI. Providers may send multiple provider requests in a single email.

Reprinted letter requests will only be accepted by email. No other form of submission is accepted. Providers will receive a confirmation email from Gainwell when the submission is received. That email will include an anticipated turnaround time for the response.

How do I check my enrollment status?

If providers are unsure of their enrollment status, a Provider Portal Enrollment Lookup Tool is available at www.lamedicaid.com. Data elements that may be used for lookup include:  NPI, provider name, provider type, specialty, address, city and state, or zip code.  The results given will show the provider’s status as either enrollment complete, action required or currently in process by Gainwell. Providers that are not shown in the results are not required to enroll at this time. Invitation letters for those providers will be sent at a later date. The Lookup Tool is updated daily and the results may be downloaded. If your information has not been processed within 15 business days, please contact Gainwell Technologies by emailing louisianaprovenroll@gainwelltechnologies.com or contacting  1-833-641-2140 for a status update on enrollment and any next steps needed to complete the process.

What if my Provider Type, Provider Specialty, or Taxonomy is listed incorrectly on my provider portal file?

Provider Specialty, Provider Type and Taxonomy change features are now available in the Medicaid Provider Portal.  Please continue your enrollment by logging back in to https://www.lamedicaid.com/account/login.aspx                                

Details about the new feature are available in the Provider Enrollment Portal Manuals located at https://www.lamedicaid.com/Provweb1/Forms/Forms_PES.htm

You may also contact Gainwell Technologies by email or phone at louisianaprovenroll@gainwelltechnologies.com or (833) 641-2140, for questions.

What does this mean for my credentialing with an MCO, DBPM and/or Magellan?

Providers enrolled with Fee for Service (FFS) Medicaid before December 31, 2021, and MCO, DBPM or Magellan before March 31, 2022, are required to complete the enrollment process through Phase 1 of the Louisiana Medicaid Enrollment Portal by September 30, 2022.

  • New FFS Medicaid providers should continue to follow the enrollment processes outlined for FFS Medicaid and will be invited to enroll in the portal at a later date.
  • New MCO, DBPM & Magellan providers should continue to follow the enrollment processes outlined for MCO, DBPM and Magellan and will be invited to enroll in the portal at a later date.

Questions?

If you have further questions, please email LouisianaProvEnroll@gainwelltechnologies.com or call 833-641-2140, Monday – Friday between the hours of 8 a.m. and 5 p.m. Central time.

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