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Provider Enrollment Portal Update (IB 22-38 revised 1.05.23)

Date: 01/05/23

Louisiana Healthcare Connections would like to share with providers a revision to IB 22-38: Provider Enrollment Portal Update issued on January 5, 2023. The edits impact claims, NEMT, provider network & contracting.

Below is a summary of the recents edits.

Medicaid Provider Enrollment Portal Update and Requirements

Providers with multiple provider types must complete enrollment for each type (for additional information, see scenario 5 below).

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.

Ordering, Prescribing or Referring Providers (OPR)

If you are an OPR provider, those 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 prior to that date and your NPI is included on the claim submitted to Medicaid by the rendering provider (42 CFR 455.440).

Critical Deadlines – Claims Adjudication

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 between January 1, 2023 and June 30, 2023. Providers will not receive payment until their provider enrollment is complete.

Scenario 4: If an attending, or OPR provider is included on a claim or writes a prescription and has not completed enrollment, it will affect claims adjudication as follows:

  • Even if the billing provider is fully enrolled, 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
  • Even if the pharmacy is fully enrolled, the prescription will deny beginning July 1, 2023 if any one of the following are not enrolled:
    • Prescribing provider
    • Vaccinating pharmacist, or
    • Pharmacy provider
  • Even if a hospital is fully enrolled, the hospital claim will deny beginning July 1, 2023 if the attending provider is not enrolled.

Scenario 6: Non-Emergency Medical Transportation (NEMT) providers who were invited to enroll must submit an enrollment application by June 1, 2023 in order to complete the enrollment process by June 30, 2023. Claims will deny beginning July 1, 2023 for NEMT providers not enrolled.