Effective immediately, providers who are currently required to have an NPI must supply this NPI number on the enrollment application. Failure to supply the NPI will result in the application being rejected. Also effective immediately, only the applications found on this site can be used to enroll as a Louisiana Medicaid provider. Old applications will no longer be accepted.
Louisiana Medicaid provider enrollment applications are now available online. Enrolling in Louisiana Medicaid is a two- (2) step process:
It is necessary to submit forms from both packets for enrollment requests to be processed.
Unnecessary delays may be avoided by reviewing the packets in their entirety prior to completing. Incorrect/incomplete applications will be returned to the provider for correction. A checklist has been provided in each provider specific packet identifying all required forms/documentation for enrollment. Carefully review the instructions and checklist prior to submission to ensure that all paperwork is complete. All required documentation must be submitted as one application – do not send required documentation separately as it will be rejected.
Basic Provider Enrollment Packet for Entities/Businesses - 12/19
Basic Provider Enrollment Packet for Individuals - 12/19
LaHIPP ONLY Basic Provider Enrollment Packet for Entities/Businesses – LaHIPP ONLY - 12/19
LaHIPP ONLY Basic Provider Enrollment Packet for Individuals – LaHIPP ONLY - 12/19
Provider Type Specific Packets/Checklists
03 Waiver-Children's Choice
04 Pediatric Day Health Facility
05 Coordinated Care Network – Prepaid CCN-P
06 Waiver – NOW Professional
07 Case Management - Infant & Toddlers
08 Office of Aging and Adult Services Case Management (Support Coordination)
09 Hospice Services
11 Shared Living
13 Pre-Vocational Habilitation
14 Waiver-Adult Day Habilitation
15 Waiver-Environmental Accessibility Adaptations (Environmental Modifications)
16 Waiver-Personal Emergency Response System
17 Waiver-Assistive Devices (OAAS)
17 Waiver-Assistive Devices (OCDD)
18 CMHC – Partial Hospitalization
19 Doctor of Osteopathic Medicine (DO) – Now use PT 20 Packet instead
20 Physician (MD & DO) – Individual or Group
21 Third Party Submitter
23 Independent Lab
24 Personal Care Services
25 Mobile X-Ray-Radiation Therapy Center
26 Pharmacy
27 Dentist - Individual or Group
28 Optometrist - Individual or Group
29 EarlySteps – Individual or Group
30 Chiropractor – Individual or Group
31 Psychologist
32 Podiatrist - Individual or Group
33 Prescriber-Only (Radiology Prior Authorization and/or Prescriptions)
34 Audiologist
35 Physical Therapist – Individual or Group
37 Occupational Therapist – Individual or Group
38 School Based Health Center
39 Speech Therapist – Individual or Group
40 DME Providers
41 Registered Dietician
44 Home Health Agency
45 Case Management/Support Coordination
51 Ambulance Transportation
54 Ambulatory Surgical Center
60 Hospital
64 Mental Health Hospital (Free-Standing)
65 Rehabilitation Center
68 Substance Abuse and Alcohol Abuse Clinic
69 Hospital - Distinct Part Psychiatric
70 EPSDT Health Services Provided by Local Education Agencies (LEAs)
71 Family Planning Clinic
72 Federally Qualified Health Center
73 Social Worker
74 Mental Health Clinic
75 Optical Supplier
76 Hemodialysis Center
77 Mental Health Rehabilitation (MHR)
78 Nurse Practitioner - Individual or Group
79 Rural Health Clinic (Provider Based)
80 Nursing Facility
82 Personal Care Attendant (Waiver)
83 Center-Based Respite Care
84 Waiver-Substitute Family Care
85 Adult Day Health Care
87 Rural Health Center (Independent)
88 Intermediate Care Facility for the Developmentally Disabled (ICF/DD)
89 Waiver-Supervised Independent Living
90 Certified Nurse-Midwife
91 CRNA
93 Clinical Nurse Specialist
94 Physician Assistant
95 American Indian/Native Alaskan “638” Facilities
98 Supported Employment
AM - Home Delivered Meals
AN - Community Choices Waiver – Caregiver Temporary Support
AP - Art Therapy
BC – Free Standing Birthing Center
HT - Hippotherapy
IP - Limited Medicaid Enrollment EHR Incentive Program Packet
MI - Monitored In-Home Caregiving
MT Music Therapy
MW - Licensed Midwife
PO - OPR (Ordering, Prescribing, Referring)
SP - OAAS Organized Health Care Delivery System Enrollment Packet Update
TH - Horseback Riding
WT - Aquatic Therapy