Medicaid Provider Enrollment Portal Frequently Asked Questions
Will current providers be grandfathered in under the first cycle or will all current network providers have to re-enroll?
No, current providers will not be grandfathered in under the first cycle of provider enrollment. Previously, managed care providers have not been required to enroll directly with Louisiana Medicaid through the fiscal intermediary. They have only completed the Medicaid enrollment process with a managed care organization . 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. All current providers, network and out-of-network, must complete the states enrollment process for claims to be approved by fee-for-service Medicaid and/or any of the MCOs.
What address on file with Medicaid is the invitation going to?
For providers enrolled with an MCO, Gainwell Technologies will send the invitation to the mailing address that is on file with the MCO. For providers only enrolled in fee-for-service Medicaid and not with any of the MCOs, Gainwell Technologies will send the invitations to the service location address which they have on file.
If a provider needs to update their contact information, use the guidance below to determine how best to update their information.
Will providers have individual logins for the Louisiana Medicaid Provider Enrollment Portal? Can providers revalidate by group?
Will the portal use electronic signatures?
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.
Youre Invited To Join A Teleecho Clinic
AmeriHealth Caritas Louisiana is excited to launch TeleECHO clinics an emerging case-based learning model for practitioners at all levels.
At TeleECHO clinics, practitioners from multiple locations connect via teleconferencing to present de-identified patient cases to a team of peers and experts for mentoring and shared learning. Case-based discussions may also be supplemented with short didactic presentations to improve content knowledge and share evidence-based practices.
This opportunity is free for participating AmeriHealth Caritas Louisiana practitioners and includes continuing education units offered through the Louisiana Counseling Association . The sessions will be held on the first and third Thursday of each month from noon to 1 p.m. CT. Learn more about this integrated care TeleECHO clinic or register to participate.
Don’t Miss: Qualifying For Medicaid In Arizona
Urgent: Louisiana Medicaid Provider Enrollment
Posted3 months agoinNP Practice
This announcement has1 attachment:
If you file claims with Louisiana Medicaid, you must enroll in the new Medicaid Provider Enrollment Portal to continue getting reimbursed.
Enrollment is mandated by CMS and applies to any provider that provides care to Medicaid members, which includes current managed care organization only providers, Dental Benefits Program Manager providers, Coordinated System of Care providers, existing fee-for-service providers, and any new providers enrolling for the first time.
In fall 2021, Louisiana Medicaid mailed letters to providers about this enrollment requirement. We are sending you this email because we want to make sure all of our providers complete enrollment timely. We dont want anyone missing out on payment for services rendered.
To make things easier on you, weve partnered with Louisiana Medicaid for an enrollment drive from DECEMBER 1 to DECEMBER 29. During this time, we will do everything we can to help simplify the enrollment process. We will be sharing resources, training and answers to commonly asked question. And, as always, we are advocating for your concerns, and sharing those directly with Louisiana Medicaid.
Our goal is to have NPs enrolled by DECEMBER 29. Please help us achieve this goal by carving out some time this week to devote to your enrollment. A few tips:
Ldh Schedules New Medicaid Provider Enrollment Web Training
Louisiana Primary Care Associate is providing a training that requires all health providers to learn about the new Medicaid Provider Enrollment Web Portal Training required by the federal government.
Training will be in two, one-hour sessions on October 13 and 14 and will be conducted by Lauren C. Vaughn of the Louisiana Department of Health Medicaid Provider Enrollment Section.
Why you might need this training:
All managed care organization and FFS providers are now required to enroll as Louisiana Medicaid providers using Medicaid’s new Provider Enrollment Portal. Enrollment is necessary to comply with federal laws and continue to receive reimbursement for providing care to Louisiana Department of Health Medicaid recipients.
Enrollment in the Provider Enrollment Web Portal is separate from the enrollment, screening, and credentialing processes you completed to join the MCO provider network. Managed care providers must still be enrolled, credentialed, and contracted in keeping with MCO requirements.
Why is Louisiana Medicaid changing its enrollment process?
LPCA Medicaid Provider Enrollment Web Portal Training Series’ schedule:
SESSION 1: Wednesday, October 13, 20211:00 – 2:00 PM
Don’t Miss: Medicaid Omaha Nebraska Phone Number
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 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.
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.
Don’t Miss: Inpatient Alcohol Rehab Colorado Medicaid
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
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 states 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:
Louisiana Medicaid Provider Enrollment Disaster Relief
Department of Health & Human ServicesCenters for Medicare & Medicaid Services1301 Young Street
Ms. Jen Steele, State Medicaid DirectorDepartment of HealthBaton Rouge, LA 70821-9030
Dear Ms. Steele:
We have reviewed your request for relief to CMS existing regulations and requirements to provider enrollment. You indicated the need for temporary waivers to give you the needed flexibility to address the disaster caused by Tropical Storm Barry. Under section 1135 waiver authority, we are able to grant your request. The language below outlines what provisions CMS has waived:
Louisiana Medicaid Provider Enrollment Disaster Relief
Louisiana currently has the authority to rely upon screening that is performed by other SMAs and/or Medicare. Louisiana is not required to create a temporary provisional enrollment for providers who are enrolled with another SMA or Medicare.
With respect to providers not already enrolled with another SMA or Medicare, CMS will waive the following screening requirements so the state/territory may provisionally, temporarily, enroll the providers:
For those providers located out of state/territory and from which Louisiana Medicaid participants seek care, enrollment is not necessary if the following criteria are met:
Read Also: How To Renew Medicaid Colorado
Become A Medicaid Provider
Thank you for your interest in participating as a Medicaid provider. To become a Medicaid provider, you must complete the PRISM online enrollment and submit the required forms and documents. If you do not wish to be reimbursed by Medicaid for your services but would still like to order, refer or prescribe to Medicaid members, you will still need to complete the PRISM online enrollment.
Creating a Utah ID Account
A provider will have to register with the State of Utah by creating a Utah-ID Account. If you have a Utah-ID and password, simply log in to access the PRISM Portal. for more information and instructions if you have not previously created a Utah-ID account.
Starting April 1, 2021, providers will need to go through a multi-factor authentication process to access the PRISM application. Please visit the links below for additional information:
Welcome Texas Medicaid Providers
AMA/ADA End User License AgreementLICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION
You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, Intellectual Property Services, 515 N. State Street, Chicago, Illinois, 60610. Applications are available at the American Medical Association website, www.ama-assn.org/go/cpt.
U.S. Government Rights
Disclaimer of Warranties and Liabilities
This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled “accept”.
Read Also: What Is The Number To Apply For Medicaid
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.
Louisiana Medicaid Launches New Provider Enrollment Portal
If you file claims with Louisiana Medicaid, you must enroll in the new Medicaid Provider Enrollment Portal to continue receiving reimbursement. CMS mandates enrollment for any provider that provides care to Medicaid members. The mandate includes current managed care organization only, Dental Benefits Program Manager , Coordinated System of Care , existing fee-for-service providers, and any new providers enrolling for the first time. Read more
You May Like: Does Medicaid Pay For Partials
Medicaid Urges Enrollees To Update Information To Maintain Eligibility
The Louisiana Department of Health is seeking provider assistance to encourage their Medicaid patients to keep their case information updated to ensure eligibility. This can be done through Medicaids new Self-Service Portal.
Providers are asked to remind their Medicaid patients to respond to any mail from Louisiana Medicaid in the timeline provided in the letter. Failure to respond could result in case closure.
Important Information For Families Impacted By Hurricane Ida
If you live in one of the 25 parishes that FEMA approved for disaster relief because of Hurricane Ida, you now have until 6 p.m. on to change your health plan or dental plan. Or you can do nothing and keep the plans you have now.
You can change your health plan, your dental plan, or both. This is not to renew your Medicaid coverage. It is a chance to change health plans or dental plans with no reason needed. If you do not want to change plans or if you already changed your plan during Open Enrollment and want to keep it, you do not have to do anything.
If you want to change your health plan or dental plan, you now have until 6 p.m. on .
This new date applies to Healthy Louisiana members whose primary residence is in these parishes:
Read Also: Does Walmart Pharmacy Take Medicaid
Prior Authorization And Notification Resources
For BH Auth Inquiries: 866.675-1607
Your “one call” resource line. Contact for information regarding:
- Behavioral Health referral
- Getting a member a ride
- Language interpreter services
- Reach a community-based case manager
- Referrals to specialists
If your office relocates or closes for an extended period, please contact us at 1-877-369-1302.
Claims and Appeals
Salt Lake City, UT 84131-0341
Claims Appeals Address
Salt Lake City, UT 84131-0364
Utilization Management Appeals Address
Are your patients prepared for hurricane season?
We want to help make sure your patients are prepared for hurricane season and the resulting hazards such as storm surge, high winds, tornadoes, and flooding.
View the Are You Storm Ready? preparation and tips flyer.
Tips from Louisiana Governor’s Office and the American Red Cross
- Update Contact Information: Encourage your patients to regularly update their address and phone contact information, so they can be reached in case of an emergency.
- Members can contact UnitedHealthcare Community Plan Member Services at 1-866-675-1607 or contact the NurseLine at 1-877-440-9409.
Adult Dental Benefits
Answer These Questions To Help You Choose A Dental Plan:
- Do you want to keep your dentist or dental clinic, or do you want a new one?
- Does the dental plan have the dentists and specialists you use? To find out, go to Find a provider.
- Do you need a dental provider who speaks a certain language?
- Does anyone in your family have special dental needs?
- What extra services does the dental plan have? To see each dental plans extra services, go to Compare plans. Or read a PDF of the dental comparison chart.
Don’t Miss: Do I Qualify For Medicaid In Alabama
New Enrollment Requirements For All Medicaid Providers
All Medicaid providers are now required to enroll as a Louisiana Medicaid provider using Medicaid’s new Provider Enrollment Portal. Enrollment is necessary to comply with federal laws and continue to receive reimbursement for providing care to our members.
This is separate from the enrollment, screening and credentialing processes you completed to join the our provider network. Managed care providers must still be enrolled, credentialed and contracted in keeping with Louisiana Healthcare Connections requirements.
Please keep reading for guidance on how to comply with the new requirements. Additional information is also available at www.ldh.la.gov/medicaidproviderenrollment.
What Happens If I Dont 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 states enrollment process for claims to be approved by fee-for-service Medicaid, the MCOs, the DBPMs, and/or Magellan.
New Medicaid Provider Enrollment Portal Launches April 2021
The Louisiana Department of Health will be launching a new Louisiana Medicaid Provider Enrollment Portal in April 2021. The portal is designed to meet Center for Medicare and Medicaid Services requirements and will be required by all Medicaid providers.
All current providers, whether participating as a fee-for-service provider, MCO-only provider, or both, must validate their information and sign the states provider participation agreement through the portal within six months of the launch date.
To prepare for the new enrollment and screening process, providers should:
- Talk to their office staff that typically help with enrollment and credentialing processes.
Additionally, MCO-only providers should decide whether they also want to participate in the fee-for-service model. Providers are not required to enroll as fee-for-service unless they would like to do so.
Enrollment and Credentialing
The new process requires that all providers complete their enrollment and screening through the new web-based portal.
All providers must be screened by the state at the following intervals:
This process does not take the place of the normal MCO credentialing process.
Purpose of the New Enrollment Portal
More updates and information will be provided in updates to Informational Bulletin 21-5. Providers are encouraged to read the complete bulletin for additional details.