March 1, 2001, the Department of Health and Hospitals transferred administrative
responsibilities for the Provider Enrollment Unit from the DHH MMIS Unit to
Gainwell Technologies 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:
- A cover letter of
explanation should be included with the application/request.
applications/requests and requests that are unclear will be returned to the requestor.
forms/correspondence must be mailed (faxed requests are not accepted and
will be returned).
- Forms must be completed in
- Two-sided forms MUST BE
submitted as two-sided forms.
- Applications/requests must
be signed and dated with original signature (stamped signatures/initials are
- 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
- 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.
- 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
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
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
Providers must always notify Gainwell Technologies 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 Gainwell Technologies 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.
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 Gainwell Technologies receives an electronic tape from the IRS that shows
numerous mismatches from our Medicaid provider files and the IRS files for
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
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
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.>/p>
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
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:
Gainwell Technologies Provider Enrollment
P. O. Box 80159
Baton Rouge, LA 70898-0159
Phone: (225) 216-6370