Medicaid Provider Enrollment Portal

Deadline to submit an application - June 30, 2022. Enroll Now!

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

The enrollment portal must be used by all Medicaid providers. This includes fee-for-service, managed care organization (MCO) only, Dental Benefits Program Manager (DBPM), and Coordinated System of Care (CSoC) providers. 

The deadline for providers to submit an application to the enrollment portal is June 30, 2022. Any existing Medicaid provider that does not submit an application to initiate the screening process through the new portal will have their claims denied.

 

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
  • Out-of-state providers who treat Louisiana Medicaid members
  • 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.

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

Gainwell sent an invitation to current providers informing them that they can now visit the new Louisiana Medicaid Provider Enrollment Portal.

The invitation includes instructions for how to access the portal as well as training resources for providers and their enrollment staff. Providers can request a reprint of the letter if they do not have the letter or the information contained in the letter. The reprint must be requested by email and the reprint will be mailed to the address on file.

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.

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 by June 30, 2022 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.

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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