New Enrollment and/or Change of Ownership
Applications for New Enrollments, Reactivations,
and Change of Ownership
COVID-19 & Hurricane Emergency Expedited Applications
In response to the COVID-19 emergency, Hurricane Laura, and Hurricane Delta temporary Fee-for-Service emergency enrollments are being approved until the emergency declaration is lifted.
Temporary emergency enrollments will not be granted for an effective date prior to 3/1/20 and will be inactivated no later than six (6) months after the
emergency declaration has lifted.
The COVID-19 application can also be used for Hurricane Laura and Hurricane Delta purposes.
This temporary emergency enrollment is for the Fee-for-Service program only. For Healthy Louisiana (Managed Care) contracting and Provider Relations contact
information, please visit http://ldh.la.gov/index.cfm/page/1461.
COVID-19 Emergency Expedited Application for Individuals
COVID-19 Emergency Expedited Application for Entities
Currently Enrolled Providers
Forms to Update Existing Provider Information
Application Fee for Entities/Businesses
The Affordable Care Act requires that some entities/businesses enrolling or reenrolling in Louisiana Medicaid pay a fee to cover the cost of screening.
Entities/businesses that are currently enrolled in Medicare or Medicaid in another state are exempt. If your application is received and you are required to pay a fee,
you will receive a letter detailing the fee requirement and how to pay. The fee must be received before your application can be approved.
This will affect applicable applications received June 1, 2018, or later.
Fingerprint/Background Check Requirements
Notice of Requirement for Fingerprint Based Criminal Background Checks (FCBC) on ‘High’ Risk Medicaid Providers
Modification of Louisiana Medicaid Provider ID Numbers for New Providers - Click here for more information
Out-of-State Emergency Care
The Louisiana Medicaid Program covers
out-of-state emergency services provided to Louisiana Medicaid eligible
recipients who are absent from the state when an emergency arises from an
accident or illness, when the health of the recipient would be endangered if
the recipient undertook travel to return to Louisiana, or when the health of
the recipient would be endangered if medical care were postponed until the
recipient returns to Louisiana. For reimbursement, the out-of-state
provider must enroll as a Louisiana Medicaid Provider and must follow
established timely filing guidelines in submitting claims.
Providers having no billing activity in the
last 18 months are subject to autoclosure of their Provider Numbers.
New Address, New Telephone
Timely reporting of a new address and/or new
phone number is necessary to avoid closure of your Provider Number.
You are required to provide your NPI in order
to process any transaction or correspondence with Provider Enrollment (such
as change of address requests, group linkages, direct deposit, and any other
correspondence). Failure to provide your NPI will result in the
rejection of your request.
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