For Medicaid Providers | Louisiana Department of Health

For Medicaid Providers | Louisiana Department of Health For Providers For Medicaid Providers For Medicaid Providers Louisiana Medicaid will distribute invitation letters to new MCO providers who have not yet completed the enrollment process. Letters will contain comprehensive instructions, specific provider details, and important deadlines to facilitate the enrollment process. Providers should access the Provider Enrollment Portal to submit a Louisiana Medicaid Enrollment Application and  are encouraged to verify their enrollment status using the Provider Lookup Tool 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 managed care organizations (MCO) that aim to improve recipient health outcomes and add benefits for recipients. These health plans are: Aetna Better Health of Louisiana AmeriHealth Caritas Louisiana, Inc. Healthy Blue Humana Healthy Horizons in Louisiana Louisiana Healthcare Connections Provider News Act 437 Maternal Care Provider Webinar - April 8, 2026 Louisiana Medicaid Pharmacy Winter Storm Preparation – January 2026 Renew Your Medicaid Flyer Independent Review Notification of Pregnancy Form (for best results open in Microsoft Edge) MCO Adverse Incident Reporting Form CMS approved directed payment arrangements: LA_Fee_IPH.OPH_New_20220701-20230630 LA_Fee_IPH.OPH1_New_20220701-20230630 Important information for Medicaid providers Medicaid Provider Information Update Increased Physician Reimbursement Rates Beginning July 1, 2025 Memorandum: PCNA and OSS Amounts Increasing July 1 Louisiana Expands Developmental Screening Support for Children Through 2025 Initiative Memorandum: Providers are Required to Revalidate Enrollment Information Provider Enrollment Portal to be used by all Medicaid providers Medicaid Provider Site Healthy Louisiana Health Standards Section Pharmaceutical and Therapeutics Committee Medicaid Leadership Medicaid Quality Committee Rate Setting and Audit Section Adverse Actions - Sanctions and Exclusions Medicaid Provider Manuals Provider Self-Audit Providers are responsible for ensuring that claims submitted to the Medicaid program are accurate and appropriate. When incorrect reimbursements are identified, the provider is required to refund the erroneous amounts to the state within sixty (60) days of discovery. To aid in this endeavor, the Louisiana Department of Health (LDH) provides guidance regarding self-audits. Please use the following tools when conducting a self-audit or reporting erroneous reimbursements. Self-Audit Guidance Self-Audit Worksheet Self-Audit Worksheet Explanation Quick Links Request for Policy Change Form Clinical Policy Request for Consideration Form Contract Information Latest News Medicaid Provider Forms 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. Failure to complete enrollment by the designated deadline may result in claim denials and deactivation from the Louisiana Medicaid program. 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 will need several data points to complete enrollment, including Louisiana Provider ID, NPI, city, state and zip code. 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. Newly credentialed MCO providers are advised to verify their enrollment status using the provider lookup tool 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 [email protected] 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? 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. 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. Resources Memorandum : Updated Medicaid Provider Enrollment Portal Update and Requirements Frequently Asked Questions Provider Enrollment Portal User Manuals Instructions for Establishing an Account on lamedicaid.com Log On and Account Registration webinar Fee for Service Facility Application webinar Fee for Service Individual Application webinar MCO Facility Application webinar Informational Bulletin 22-4 MCO Individual Application webinar Enrollment Look Up Tool: Portal Enrolled Providers 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 Did you find an issue on our new website? Please share it with us. Surgeon General Evelyn Griffin, MD Secretary Bruce D. Greenstein Cicero Government