Get the free Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form
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This document provides guidelines and requirements for agents and submitters to register for billing under the Louisiana Medicaid Program, including the submission of electronic claims and necessary
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How to fill out louisiana medicaid third party
How to fill out Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form
01
Obtain the Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form from the Louisiana Medicaid website or a local Medicaid office.
02
Fill in the required contact information for the billing agent, including name, address, phone number, and email.
03
Provide the Tax Identification Number (TIN) or Social Security Number (SSN) for the billing agent.
04
Indicate the type of billing services being provided (e.g., service type, specialties).
05
Complete the section regarding the provider information, including the provider’s name and Medicaid provider ID, if applicable.
06
Review the form for accuracy and completeness to ensure all required fields are filled.
07
Sign and date the form to certify the information is correct.
08
Submit the completed form to the appropriate Louisiana Medicaid office via mail or electronically as per the instructions provided.
Who needs Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form?
01
Health care providers who plan to use a third-party billing agent to submit claims to Louisiana Medicaid.
02
Billing agents or companies that are designated to handle Medicaid billing on behalf of healthcare providers.
03
Any entity or individual who intends to register as a billing agent for the purpose of submitting claims to Louisiana Medicaid.
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People Also Ask about
How to contact Louisiana healthcare connections?
To ensure the safety of your protected health information (PHI), please send us a message through the Secure Member Portal or Provider Portal, or you can call us at 1-866-595-8133 to speak directly to a customer service representative.
What is the phone number for LA Medicaid provider claims?
The Provider Relations Department is available to help providers with all of their billing and training questions. Provider Relations maintains a telephone inquiry staff as well as a correspondence unit. To contact the Provider Relations Department, call (800) 473-2783 or (225) 924-5040.
How do I contact the Louisiana Medicaid provider?
Provider services: 1-800-448-3810 (TTY: 711), Monday – Friday, 7 a.m. – 7 p.m. Physician-administered medications prior authorization requests: 800-461-7273, Monday – Friday, from 7 a.m. – 7 p.m. Medication prior authorization: 866-730-4357, Monday – Saturday, from 8 a.m. – 6 p.m.
How many digits is a Louisiana Medicaid number?
The provider's 7-digit Louisiana Medicaid identification number.
What is the timely filing limit for Louisiana Medicaid?
TIMELY FILING GUIDELINES Print Straight Medicaid claims must be filed within 12 months of the date of service. KIDMED claims must be filed within 60 days from the date of service.
How do I contact UnitedHealthcare Medicaid Louisiana?
Please call 1-866-633-2446, 8 a.m. – 8 p.m. local time, Monday through Friday. Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.
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What is Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form?
The Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form is a document that allows third-party billing agents or submitters to register with Louisiana Medicaid to submit claims on behalf of healthcare providers.
Who is required to file Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form?
Any individual or organization that intends to act as a billing agent or submitter for Louisiana Medicaid claims on behalf of healthcare providers is required to file this form.
How to fill out Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form?
To fill out the form, provide accurate information regarding the billing agent's details, services offered, and authorization to submit claims. Ensure all required fields are completed and check for accuracy before submission.
What is the purpose of Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form?
The purpose of the form is to ensure that all billing agents and submitters are properly registered and authorized to submit claims to Louisiana Medicaid, facilitating compliance and efficient processing of claims.
What information must be reported on Louisiana Medicaid Third Party Billing Agent/Submitter Registration Form?
The form requires reporting of the billing agent's name, address, contact information, tax identification number, and details about the healthcare providers for whom claims will be submitted.
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