ENROLLMENT

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Effective March 1, 2001, the Department of Health and Hospitals transferred administrative responsibilities for the Provider Enrollment Unit from the DHH MMIS Unit to Molina Corporation.  Oversight and monitoring responsibilities for the Department have transitioned to the DHH Program Integrity Unit.

As part of the transition, some procedures were revised to enable enrollment applications to be processed more efficiently.  These include:

General

• A cover letter of explanation should be included with the application/request.
  
  

• Incomplete/inaccurate applications/requests and requests that are unclear will be returned to the requestor.
  
  

• Original forms/correspondence must be mailed (faxed requests are not accepted and will be returned).
  
  

• Forms must be completed in their entirety.
  
  

• Two-sided forms MUST BE submitted as two-sided forms.
  
  

• Applications/requests must be signed and dated with original signature (stamped signatures/initials are not accepted).
  
  

• All requests/correspondence should be “official” meaning on letterhead with original provider signature (faxed copies are not acceptable and will be returned).
  
  

• Requests concerning private practitioner provider numbers/files must come from that provider; requests concerning facility/company provider numbers must come from an authorized representative of that facility/company.
  
  

• Requests must contain the provider number(s).
  
  

• Direct deposit requests MUST include a voided check (deposit slip not acceptable).
  
  

• Applications should include “Year End” date; if not included on the application, December is automatically entered.

Linkages

• When linking or unlinking physicians to hospital/groups, the effective date or termination date must be included in the cover letter.
  
  

• The request must be made/signed by the physician who owns the number being linked.

The physician’s physical/location address should be his permanent physical location and should not be changed to the group/facility address unless it is the physician's permanent location.  The payment address need not be changed to the group/facility address to ensure proper payments unless it is also the permanent physical location of the provider.

Providers who change their group affiliation must notify Provider Enrollment to ensure payments are sent to the correct provider/group.  Payments and remittance advices may be delayed due to incorrect mailing addresses on the Medicaid provider file.

When submitting a change of address for linkages or office relocations, the request should contain: (1) a request that the provider's file be updated with current information; (2) include the 7-digit provider number; and (3) indicate whether the change is for a physical address or a "Pay To" address. The request requires the original signature of the provider who "owns" the number (stamped signatures/initials are not accepted).

CHANGE OF ADDRESS/ENROLLMENT STATUS

It is the responsibility of the Medicaid provider to keep all provider information current and accurate on the Louisiana Medical Assistance Program provider files. 

Providers must always notify Molina Provider Enrollment when a mailing or service address and phone number change occurs. This ensures that rejected claims and correspondence reaches  the provider in a timely manner. 

The Post Office returns excessive amounts of provider mail, including remittance advices and hardcopy checks, due to invalid or old addresses.  When attempts are made to contact these providers, the telephone numbers on file are invalid in many instances.  Additionally, many claims are returned to Molina because forwarding orders at the post office have expired.

THE PE-50 FORM

When completing the Provider Enrollment Form (PE-50), providers must submit a one-page form (front and back).  In other words, providers should not submit the form on two separate pages.  In addition, providers should ensure that the PE-50 has an original signature.  Stamped or copied signatures/initials are not accepted.

Providers who have questions pertaining to filing the PE-50 need to contact Provider Enrollment at (225) 216-6370.

CORRECT TAXPAYER ID INFORMATION

Internal Revenue Service considers a Taxpayer Identification Number (TIN), also known as Employer Identification Number (EIN), as incorrect if either the name or number shown on an account does not match a name or number combination in their files or in the files of the Social Security Administration (SSA).  Each year Molina receives an electronic tape from the IRS that shows numerous mismatches from our Medicaid provider files and the IRS files for previous years. 

If the appropriate action is not taken to correct the mismatches, the law requires the agency to withhold 31% of the interest, dividends and certain other payments that it makes to your account.  This is called backup withholding.  In addition to backup withholding, you may be subject to a $50.00 penalty by the IRS for failing to give us your correct name/TIN combination.

An individual's TIN is his or her social security number (SSN).  A provider's account should be in the name and SSN of the actual owner.

A corporation's TIN is the EIN issued to the business entity by the IRS.  The name and number in the Medicaid records must match what is in the IRS files.

Providers who have submitted a Form SS-4 to the Internal Revenue Service for a new EIN and have obtained a new number should mail a copy of the Notice of New Employer Identification Number Assigned to the Provider Enrollment Unit.  Providers must include in the cover letter all Medicaid provider numbers affected by any such change.

TELEPHONE REQUESTS

Provider Enrollment does not supply provider numbers over the telephone.  A physician’s individual provider number should be obtained from that physician provider for linkages and billing purposes when you contract with him/her to provider services at your facility.  If a physician does not know his provider number, he may request it in writing, and it will be supplied in writing to him at the address on his provider file.

Effective date of linkages will also not be given over the telephone.  These dates may be requested in writing either by the individual provider or the group/facility to which the physician is linked.

CONTACTING PROVIDER ENROLLMENT

All correspondence should be directed to:

Molina Provider Enrollment
P. O. Box 80159
Baton Rouge, LA  70898-0159
Phone:  (225) 216-6370