Louisiana Medicaid

Please follow the Enrollment Instructions below to become an electronic submitter for Louisiana Medicaid.


Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the Medicaid office prior to initiation of electronic claims submission or inquiry.

1. EDI Contract and Power of Attorney Forms

If you have any questions regarding any of the documents in this package, please call the Medicaid EDI Technology Support Center at (225) 216-6303


We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.


Provider EDI Form

  • Please enter your Medicaid Provider Number

  • New applicants may leave the Submitter Number blank

  • Please enter your NPI

  • Enter your Business/Practice or Provider Name

  • Enter the Name and Phone number for the Contact person in your office

  • The next section is only if you already have a Submitter ID so Skip this section

  • Select the first box if you are going to be submitting claims directly

  • Select the second box if you are using a Third Party such as a Billing Service

  • On the next page, enter the Provider’s Name, then enter it again at the bottom

  • Have the Provider Sign and Date the application

  • If you are electing to use a billing service, you must complete the next page and sign in front of a Notary Public

  • The last page containing the EDI Annual Certification must be completed with the Provider/Submitters information, signature and date, and a similar form MUST be completed every year or the submitter ID will be deactivated


Medicaid Electronic Media Limited Power of Attorney

This form is only to be filled out by providers using a Billing Service.

  • Enter your Medicaid Provider Number

  • New applicants may leave the Submitter Number blank

  • Enter your Business/Practice or Provider Name

  • Enter the Billing Services Name

  • The rest of the information on this form should be completed by the Notary Public


EDI Annual Certification

  • Enter your Medicaid Provider Number

  • New applicants may leave the Submitter Number blank

  • Enter your Business/Practice or Provider Name

    • Select the first option if Provider is submitting claims

    • Select the second option if a Third Party is submitting claims

  • Sign and Date the bottom of the form


Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:


Molina – EDI Department,
PO Box 80159
Baton Rouge, LA 70898-0159

It is very important that you complete and return the entire enrollment packet as described above.Incomplete packets will not be processed and will be returned to the submitter.


Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be mailed to you with your Submitter ID and further instructions. You will be asked to contact the Molina EDI Department to get set up with your password and electronic remits. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center at 225-216-6303.



Once you have received your Submitter ID and Password from Medicaid, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to Medicaid.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.

Make sure you choose a file extension on the Mailbox Connection tab when setting up your mailbox in ClaimShuttle This is a field that only shows up when Louisiana Medicaid receiver is selected, and it is required or things don't work.

They issue two different IDs. The first one starts with a T and is used for testing. Subsequently you get one that starts with a P that is used for production. Don't forget to change the ID on the mailbox settings in all FOUR places, the Submitter ID, Sender ID, Sender Code, and Logon ID. Version 3 and higher does prompt you to do this automatically.