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Provider Enrollment. DHH / Unisys Unisys is the Fiscal Intermediary and has a contract with DHH to process Medicaid Claims. Unisys assumed enrollment.

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Presentation on theme: "Provider Enrollment. DHH / Unisys Unisys is the Fiscal Intermediary and has a contract with DHH to process Medicaid Claims. Unisys assumed enrollment."— Presentation transcript:

1 Provider Enrollment

2 DHH / Unisys Unisys is the Fiscal Intermediary and has a contract with DHH to process Medicaid Claims. Unisys assumed enrollment responsibilities from DHH in March DHH Program Integrity monitors and supervises Unisys PE. DHH Program Integrity certifies / approves all new enrollments and all re-enrollments.

3 Unisys Provider Enrollment Department Provider Enrollment (PE) is the front door into Louisiana Medicaid. PE collects the enrollment applications and determines whether the criteria for enrollment was met. PE issues the 7-digit Medicaid number. PE establishes the main files that will be used by all departments. PE maintains all updates to the provider files.

4 Enrollment Is a Two Part Process Download the Basic Packet. Determine your Provider Type. Download

5 Click on the Provider Enrollment link.

6 Click on the Applications for New Enrollments, Reactivations, and Change of Ownership link.

7 Click on the Basic Enrollment Packet for Entities/Businesses or the Basic Enrollment Packet for Individuals link. You must also click on and download the packet for your provider type from the list. Print and fill out both packets and mail to PE.

8 NPI Information Stands for National Provider Identifier. 10-digit number. Standard Unique identifier for health care providers and health plans. Mandated by HIPAA (the Health Insurance Portability and Accountability Act of 1996). CMS developed the implementation plan and oversees the assignment of NPIs to health care providers. The purpose is to improve the efficiency and effectiveness of electronic transmission of health information.

9 NPI and Atypical Providers Federal regulations require that all providers of medical services must obtain and use the NPI (except “atypicals,” shown below). Case Management Environmental Modifications – Waiver Personal Emergency Response Systems – Waiver Assistive Devices – Waiver Non-Emergency Medical Transportation Atypical Providers will continue to use their 7-digit Louisiana Medicaid ID numbers in all dealing with LA Medicaid, including electronic claim transmission.

10 NPI and Louisiana Medicaid Providers must have an NPI in order to enroll in Louisiana Medicaid. The NPI must be on the application. Obtain your NPI through the National Plan & Provider Enumeration System (NPPES) at https://nppes.cms.hhs.gov https://nppes.cms.hhs.gov NPI regulations apply to electronic transactions only (except Atypicals).

11 Registering your NPI with LA Medicaid One to One Many to One One to Many Tiebreaker Taxonomy A taxonomy code is part of the NPI and is intended to categorize the provider by type, specialty, and sub-specialty. Providers must obtain a taxonomy code when they obtain their NPI through NPPES. LA Medicaid does not supply taxonomy codes nor do we assist providers with determining what code is appropriate. You can find taxonomy codes here: 9-digit Zip Code

12 Register Your NPI If you are an existing Louisiana Medicaid provider, your NPI must be registered with Unisys. Make sure your NPI is registered. Download the NPI Registration Form from  Important NPI Links  Register NPI Paper Application with LA Medicaid. Fill it out and fax it in. Direct link: _Form_2-Final_ pdf _Form_2-Final_ pdf Enumerator (FOX Systems)

13 How to Enroll in Louisiana Medicaid Determine your provider type. Only approved provider types may enroll. For example, massage therapists, speech therapists, and Independent Diagnostic Testing Facilities (IDTFs) are not on the list of approved provider types and may not enroll. Check the list of approved provider types on the Provider Enrollment - Applications for New Enrollments, Reactivations, and Change of Ownership page. Enrollment is a 2-part process: Basic Packet and Provider Type Packet: Download the Basic Enrollment packet (Individual or Entity / Business)  Provider Enrollment  Applications for New Enrollments, Reactivations, and Change of Ownership  Basic Enrollment Packet for Entities/Businesses OR Basic Enrollment Packet for Individuals Once you have identified your provider type, download the provider type enrollment packet. For instance, if you determine that you are a Type 20, download the 20 Physician (MD) – Individual or Group. Obtain your NPI if you have not done so.

14 PE Contact Information Main Number: FAX Number:


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