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Medicaid Provider Enrollment Portal Update and Requirements (IB 22-38)

Date: 11/30/22

Louisiana Healthcare Connections is sharing new information and requirements about provider enrollment. 

Providers should expect impacts to claims processing, and risk not getting paid if enrollment is not complete. 

For providers who missed the initial deadline of September 30, 2022, the Provider Enrollment Portal at www.lamedicaid.com remains open for providers required to enroll who have not yet applied. Providers with multiple provider types must complete enrollment for each type.

Providers who submit provider enrollment applications should allow several weeks for application processing. 

Who is Required to Enroll?

  • Providers who file claims with Louisiana Medicaid (providers enrolled in Fee-for-Service (FFS) Medicaid before December 31, 2021, and providers enrolled with an MCO, DBPM, or Magellan before March 31, 2022.) 
  • Ordering, Prescribing, or Referring Providers 
    • Ordering, prescribing, or referring (OPR) providers do not bill Medicaid for services rendered, but may order, prescribe, or refer services/supplies for Medicaid beneficiaries. 

Ordering, Prescribing or Referring Providers (OPR)

For Medicaid to reimburse for services or medical supplies resulting from a practitioner's order, prescription or referral, the OPR provider must be enrolled in Medicaid.

Furthermore, if items or services are ordered, prescribed or referred by a resident or intern, the claim must identify the intern or resident’s National Provider Identifier (NPI) as the ordering or referring practitioner. Interns and residents are allowed to enroll in the Medicaid program as an OPR provider only.

If you are an OPR provider, physicians, other practitioners and facilities who render services to Medicaid beneficiaries based on your order, prescription or referral, will not be paid for such items or services, beginning July 1, 2023, unless you enroll in Medicaid and your NPI is included on the claim submitted to Medicaid by the rendering provider (42 CFR 455.440). 

Please note that this extends to pharmacy Point of Sale (POS) systems as well. The POS system will deny any claims submitted, beginning July 1, 2023, for a Medicaid beneficiary with a prescriber, pharmacy provider, or vaccinating pharmacist who is not enrolled as a Medicaid provider.

Critical Deadlines – Claims Adjudication 

Claims processing guidelines depend on when a provider enrolls. If enrollment is not complete, claims and payments will be impacted. The following scenarios outline those impacts.   

Scenario 1: Claims for dates of service on or before December 31, 2022, will be adjudicated for providers who have and have not completed enrollment. 

Scenario 2: Claims for dates of service on or after January 1, 2023, will be adjudicated for providers who have completed enrollment. 

Scenario 3: Providers who have not completed enrollment on or before December 31, 2022, will have their claims denied for dates of service on or after January 1, 2023.

    Providers still wishing to complete enrollment must submit an enrollment application by June 1, 2023, in order to complete the     enrollment process by June 30, 2023.

    Once the enrollment is completed, the provider may resubmit previously denied claims for dates of service January 1, 2023, to June     30, 2023 for payment. Providers will not receive payment until their provider enrollment is complete.

Scenario 4: If an OPR provider is included on a claim or writes a prescription and has not completed enrollment: 

  •  The medical/professional claim will deny beginning July 1, 2023, if any one of the following are not enrolled: 
    • Ordering provider
    • Prescribing provider
    • Referring provider 
  •   The prescription will deny beginning July 1, 2023, if any one of the following are not enrolled:
    • Prescribing provider 
    • Vaccinating pharmacist, or 
    • Pharmacy provider

Enrollment Status

Providers that are unsure of their enrollment status may use the Provider Portal Enrollment Lookup Tool at https://www.lamedicaid.com/portalenrollmentstatus/search. Results will show the provider’s status as either enrollment complete, action required, application not submitted, or currently in process by Gainwell Technologies. Providers that are not shown in the results are not required to enroll at this time. Invitation letters for those providers will be sent at a later date. The Lookup Tool is updated daily. 

Provider Resources

For additional information, including frequently asked questions and recordings of provider presentations, visit www.ldh.la.gov/medicaidproviderenrollment. 

Informational Bulletin 22-4 contains information relevant to provider enrollment before the September 30, 2022 deadline.

Providers needing assistance with application and enrollment should contact Gainwell Technologies by emailing louisianaprovenroll@gainwelltechnologies.com or contacting 1-833641-2140 for a status update on enrollment and any next steps needed to complete the process. 

As a part of the Affordable Care Act and later refined in the 21st Century Cures Act, federal laws enforced by CMS require that states screen and enroll providers. The Louisiana Medicaid Provider Enrollment Portal will bring Louisiana Medicaid into compliance with CMS revalidation and managed care screening requirements and federal law. The portal will be prepopulated with information that the state, MCOs, DBPMs and Magellan already have on file so that the provider can more easily submit an application through the portal. This streamlined process eliminates the need to complete and mail a paper application. Also, providers will have the ability to track their application through the portal.