New Enrollment Requirements for All Medicaid Providers
Date: 09/08/21
All Medicaid providers are now required to enroll as a Louisiana Medicaid provider using Medicaid's new Provider Enrollment Portal. Enrollment is necessary to comply with federal laws and continue to receive reimbursement for providing care to our members.
This is separate from the enrollment, screening and credentialing processes you completed to join the our provider network. Managed care providers must still be enrolled, credentialed and contracted in keeping with Louisiana Healthcare Connections requirements.
Please keep reading for guidance on how to comply with the new requirements. Additional information is also available at www.ldh.la.gov/medicaidproviderenrollment.
Why is Louisiana Medicaid changing their enrollment process?
As a part of the Affordable Care Act and later refined in the 21st Century Cures Act, federal laws enforced by the Centers for Medicare and Medicaid Services (CMS) require that states screen and enroll ALL providers. In order to come into compliance with federal law, the Louisiana Department of Health launched a web-based portal on July 26, 2021, for Medicaid and its providers to complete the necessary screenings required by CMS. This includes existing managed care organization (MCO) only providers, Dental Benefits Program Manager (DBPM) providers, Coordinated System of Care (CSoC) providers, and existing fee-for-service providers. Provider types include, but are not limited to:
- Individual practitioners—such as physicians, nurse practitioners, and physical therapists.
- Any physicians and other professionals who may only order or refer beneficiaries to services, but do not render services – for example, providers who only prescribe medications or order imaging services, such as an x-ray.
- Provider organizations such as hospitals, group practices, and skilled nursing facilities.
- Providers and suppliers of medical equipment or goods, for example, pharmacy providers and medical equipment providers.
- Dental providers.
- Behavioral health providers.
- Out of state providers who treat Louisiana Medicaid members.
- Waiver providers and support coordination agencies.
- Providers who enter single case agreements with a managed care organization for claims payment.
New providers enrolling for the first time will not need to utilize the portal until a later date, to be announced. Five years after completion of enrollment through the portal, providers will be due for re-validation.
How and when should providers enroll?
Gainwell, the state’s fiscal intermediary and current provider enrollment vendor, is sending providers an invitation to the mailing address on file when it is time for the provider to enroll through the portal. If a provider has filed a claim with Louisiana Medicaid in the last 18 months, they should receive a letter.
Due to the large volume of enrollments, Gainwell is staggering invitations to avoid overwhelming the system. MCO-only providers should receive their invitation between August 2 and September 6, 2021. Providers should wait until they receive their invitation to access the portal.
The invitation will include instructions for how to access the portal as well as training resources for providers and their enrollment staff. Providers must log in and submit an application through the Medicaid Provider Enrollment Portal by March 31, 2022, to continue receiving Medicaid reimbursement. Claims denials for providers who have not enrolled are expected to begin April 1, 2022.
Questions and resources
Providers can find additional information on the Medicaid provider enrollment webpage. If providers encounter any issues or do not receive their portal invitation within the specified timeframe, they should contact the Gainwell call center at (833) 641-2140, Monday – Friday between the hours of 8 a.m. and 5 p.m. central time or by email at: louisianaprovenroll@gainwelltechnologies.com.