Medicaid Provider Enrollment Portal Update and Requirements (revised IB 22-38 12.9.22)

Date: 12/14/22

Louisiana Healthcare Connections would like to make providers aware of a recent revision to Medicaid Provider Enrollment Portal Update and Requirements (IB 22-38).

Revisions include:

• Providers with multiple provider types must complete enrollment for each type. 
• Any providers who have not completed enrollment by June 30, 2023 will have their patients assigned to another primary care physician and will be terminated from the program. 
• Who is required to Enroll?
  • 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. 
• 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. 
• 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:
    o Ordering provider
    o Prescribing provider o Referring provider  
    
    The prescription will deny beginning July 1, 2023 if any one of the following are not enrolled:
    o Prescribing provider
    o Vaccinating pharmacist, or 
    o Pharmacy provider 
  • Scenario 5:  For providers with multiple provider types, claims for dates of service on or after January 1, 2023, will be adjudicated for providers who have completed enrollment of at least one provider type.  Claims will deny beginning July 1, 2023 for any of the provider types not enrolled. 

Provider can contact their Provider Network Specialist or contact Provider Services at 1-866-595-8133 with any questions.