Get the free Louisiana Medicaid Dental Electronic Claims Enrollment Registration

This document serves as a registration form for electronic claims submission to Louisiana Medicaid, including necessary agreements and requirements for providers and billing agents.

How to fill out louisiana medicaid dental electronic

How to fill out Louisiana Medicaid Dental Electronic Claims Enrollment Registration

1. Obtain the Louisiana Medicaid Dental Electronic Claims Enrollment Registration form from the Louisiana Department of Health website.
2. Complete the required sections of the form, including provider information, contact details, and tax identification numbers.
3. Provide the necessary documentation such as proof of licensure and any other required certifications.
4. Sign and date the form to verify that all information is accurate and complete.
5. Submit the completed form and documentation via mail, fax, or online submission as instructed on the form.
6. Follow up with Louisiana Medicaid to confirm the receipt of your enrollment application.

Who needs Louisiana Medicaid Dental Electronic Claims Enrollment Registration?

1. Dental providers who wish to bill Louisiana Medicaid for dental services.
2. New dental practices looking to enroll in the Louisiana Medicaid program.
3. Existing dental providers wanting to switch to electronic claims submission.

People Also Ask about

What is needed to apply for Medicaid in Louisiana?

To be eligible for Medicaid in Louisiana, you must be resident of Louisiana and either U.S. citizen or a non-citizen who is lawfully present in the U.S. Non-citizens (residing legally or illegally) can qualify for coverage for emergencies and labor and delivery services if income requirements are met.

What is the submitter ID for Medicaid in Louisiana?

What is my submitter ID? The submitter ID is a seven-digit number issued by Louisiana Medicaid that begins with 450. If you do not know your number, submit a written request on letterhead showing your submitter name and address, to request a copy of the original correspondence.

What is the easiest way to apply for Medicaid?

Create an account with the Health Insurance Marketplace and fill out an application. If it looks like anyone in your household qualifies for Medicaid, your information will be sent to your state agency.

How do I update my Medicaid information in Louisiana?

Call Your Health Plan You can also call Medicaid Customer Service at 1-888-342-6207, between the hours of 8 a.m. and 4:30 p.m.

How do I check my Medicaid eligibility in Louisiana?

RECIPIENT ELIGIBILITY VERIFICATION SYSTEM (REVS) INFORMATION The toll free number is (800) 776-6323. The local Baton Rouge number is (225) 216-REVS (or 7387). With its enhancements, REVS provides verbal confirmation, but no printed verification, of: Recipient eligibility.

How to claim Medicaid in Louisiana online?

Apply online by visiting the Medicaid Self-Service Portal. Download and print an application. Then mail or fax all pages to Medicaid as directed on the form. Call Medicaid Customer Service toll free at 1-888-342-6207 to apply by phone.

How much money can you have in the bank to get Medicaid in Louisiana?

In LA, the “spend down” is calculated for a 3-month period. Once one's “spend down” has been met, they will be income-eligible for Medicaid benefits for the remainder of the period. The medically needy asset limit is $2,000 for an individual and $3,000 for a couple.

What is documentation required for Medicaid in Louisiana?

What you may need to apply: Social Security Numbers (or document numbers for any legal immigrants who need insurance) Employer and income information for everyone in your family (for example, from paystubs, W-2 forms, or wage and tax statements) Policy numbers for any current health insurance.

For pdfFiller’s FAQs

What is Louisiana Medicaid Dental Electronic Claims Enrollment Registration?

Louisiana Medicaid Dental Electronic Claims Enrollment Registration is a process that allows dental providers to enroll in the Louisiana Medicaid program for the purpose of submitting electronic claims for dental services provided to Medicaid recipients.

Who is required to file Louisiana Medicaid Dental Electronic Claims Enrollment Registration?

All dental providers who wish to submit electronic claims for reimbursement from Louisiana Medicaid for dental services must file the Louisiana Medicaid Dental Electronic Claims Enrollment Registration.

How to fill out Louisiana Medicaid Dental Electronic Claims Enrollment Registration?

To fill out the Louisiana Medicaid Dental Electronic Claims Enrollment Registration, dental providers must obtain the specific form from the Louisiana Medicaid website, complete all required sections accurately, and submit it according to the instructions provided.

What is the purpose of Louisiana Medicaid Dental Electronic Claims Enrollment Registration?

The purpose of the Louisiana Medicaid Dental Electronic Claims Enrollment Registration is to establish a formal enrollment process for dental providers that facilitates the submission and processing of electronic claims for Medicaid dental services.

What information must be reported on Louisiana Medicaid Dental Electronic Claims Enrollment Registration?

The information that must be reported on the Louisiana Medicaid Dental Electronic Claims Enrollment Registration includes the provider's name, NPI number, practice location, contact information, and other relevant details regarding the dental services provided.