State Provider Enrollment - Frequently Asked Questions

Who needs to enroll in the Louisiana Medical Assistance Program?

Any provider who would like to receive Medicaid reimbursement for services rendered to Medicaid recipients. This includes rendering and billing providers, groups, and facilities.

How do I enroll?

Via the online enrollment page or via U.S. Mail: https://www.lamedicaid.com/provweb1/provider_enrollment/newenrollments.htm
DXC Technology Provider Enrollment Unit
P.O. Box 80159
Baton Rouge, LA 70898-0519

What information do I need?

• Provider name and abbreviation of title held, DOB, SSN
• NPI, provider type/specialty, taxonomy, and Tax ID number
• Main practice address and phone number
• Pre-printed document from IRS reflecting the Employer Identification Number, Tax Identification Number, and name that is registered to the EIN
• Disclosure of Ownership and Control Interest Statement form completed, signed, and dated
• Current State License/Approval, as applicable
• Copy of Medicare Participation Certification, as applicable
• Written statement and legal documentation related to Criminal Convictions, as applicable
• Copy of Declaration Sheet and/or Certificate of Insurance

How long does it take to hear back from enrollment?

Applications, if completed correctly, are processed within 3 weeks. Allow for an additional 3-5 business days to receive your confirmation letter via U.S. Mail.

Who should I contact with further questions?

You may contact the Provider Enrollment Unit at 225-216-6370.

For questions concerning why Envolve has requested you take action, please contact Customer Service at 1-888-898-9880.