For Medicaid Providers

 

The Provider Enrollment Portal remains open for newly credentialed providers who have not yet enrolled. Providers must complete enrollment within 120 days of receiving their invitation letter to avoid claim denials and potential deactivation from the Medicaid program.

Louisiana's Medicaid providers deliver a valuable service to the state's Medicaid recipients, and their continued input and participation are critical as the State works to create a care delivery system that leads to better health outcomes and more effectively coordinates services and treatment.

The Department of Health is more effectively managing Medicaid enrollees' health care through Healthy Louisiana. This program includes six managed care organizations (MCO) that aim to improve recipient health outcomes and add benefits for recipients. These Health Plans are:

Important information for Medicaid providers

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Administrative Simplification Committee

The Administrative Simplification Committee (ASC) was formed to reduce the administrative burden for healthcare providers through identifying and implementing common processes that streamline administrative requirements and eliminate duplication.  ASC members include representation from providers, managed care organizations, and Medicaid program administrators.

OB/Anesthesia Subcommittee

The OB/Anesthesia Subcommittee is a subcommittee of the Administrative Simplification Committee (ASC), formed to reduce the administrative burden for healthcare providers through identifying and implementing common processes that streamline administrative requirements and eliminate duplication.

Provider Enrollment Information

The Centers for Medicare and Medicaid Services (CMS) federal regulations, 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.

In October 2024, Louisiana Medicaid launched its Provider Enrollment Rebaseline effort, which facilitates Medicaid enrollment for newly credentialed managed care organization (MCO) providers. Enrollment with the state Medicaid agency is required, and separate and apart from the credentialing process with any MCO.

Every two months, Louisiana Medicaid will send invitation letters to new providers not yet enrolled with Louisiana Medicaid. These letters include detailed instructions and specific provider information required for enrollment. Providers must complete enrollment within 120 days of receiving the letter to avoid claim denials and potential deactivation from the Medicaid program.

Billing, attending, rendering, ordering, servicing, prescribing or referring providers on recent claim(s) filed with Louisiana Medicaid must enroll directly with Louisiana Medicaid to avoid claims denials and remain active.

Providers with multiple provider types must complete an enrollment for each type.

To access the portal, visit www.lamedicaid.com and click on the blue banner to begin the enrollment process. 

Providers will need several data points to complete enrollment, including Louisiana Provider ID, NPI, city, state and zip code. This information is included in the portal invitation letter.

 

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 or 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.

 

How do I request a reprinted letter?

If a provider does not have their  Louisiana Medicaid enrollment invitation letter or the information needed to enroll, they can email louisianaprovenroll@gainwelltechnologies.com to request a reprinted letter.

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. Providers will receive a confirmation email from Gainwell when the submission is received, with an anticipated turnaround time

 

How do I check my enrollment status?

https://www.lamedicaid.com/portalenrollmentstatus/search    

Results will show the provider’s status as either enrollment complete, action required, application not submitted, or currently in process by Gainwell Technologies. 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 status tool is updated daily.

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

  • New FFS Medicaid providers should continue to follow the enrollment processes outlined for FFS Medicaid.
  • 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.
For more info, contact Gainwell Technologies via email or at 1(833) 641-2140,
Monday - Friday between the hours of 8 a.m. and 5 p.m. Central Time

 

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Resources

Surgeon General Ralph L. Abraham, M.D.

Secretary Bruce D. Greenstein

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