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.

Provider Enrollment - Applications for New Enrollments, Reactivations, and Change of Ownership

Louisiana Medicaid provider enrollment applications are now available online. Enrolling in Louisiana Medicaid is a two- (2) step process:

  1. Download the Basic Enrollment Packet. (PT PO is exempt from this step)
  2. Download the additional Enrollment Packet that is applicable to each provider type.

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

12 Multi-Systemic Therapy

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 (OCDD/EPSDT)

51 Ambulance Transportation

54 Ambulatory Surgical Center

60 Hospital

64 Mental Health Hospital (Free-Standing)

65 Rehabilitation Center

69 Hospital - Distinct Part Psychiatric

70 EPSDT Health Services

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


93 Clinical Nurse Specialist

94 Physician Assistant

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