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Revised: 9/07 Louisiana s Medicaid Program Provider Enrollment Form Group Linkage/Linkage Form Instructions PURPOSE This form is used by providers to supply identifying data to the 0ROLQD Provider
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How to fill out louisiana39s medicaid program provider
How to fill out louisiana's medicaid program provider:
01
Visit the website of the Louisiana Department of Health.
02
Look for the section on medicaid program providers.
03
Download the appropriate application form.
04
Fill out the form with accurate and complete information.
05
Make sure to provide all the required documentation, such as identification, license, and certifications.
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Read and follow the instructions carefully, ensuring compliance with all the guidelines.
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Double-check the form for any errors or missing information before submitting.
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Submit the completed application form and accompanying documents through the proper channels, such as online submission or mailing it to the designated address.
Who needs louisiana's medicaid program provider:
01
Healthcare professionals, such as doctors, nurses, dentists, and therapists, who wish to participate in Louisiana's medicaid program.
02
Organizations or facilities that offer healthcare services and want to become medicaid program providers in Louisiana.
03
Individuals or entities who meet the eligibility criteria and wish to provide medical services to medicaid recipients in the state of Louisiana.
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