ClaimRev Support Documentation

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**Enrollment Instructions for Medicaid Louisiana EDI**

*Louisiana Medicaid requires claims to be submitted via a dial-up modem connection. We have partnered with Office Ally to get your claims to this payer.*


To enroll for Electronic Data Interchange (EDI) with Medicaid Louisiana, please complete the following steps:

1. **Complete the Required Forms:**

   - **Louisiana Medicaid EDI Agreement:**
     - Choose the appropriate form:
       - [[https://cms.officeally.com/OfficeAlly/Forms/ERA/Medicaid-LA-EDI%20Individuals_1.1.25.pdf?ver=7JbMW71_Dw4CWMDnhpXdOA%3d%3d|EDI for Individual]] or
       - [[https://cms.officeally.com/OfficeAlly/Forms/ERA/Medicaid-LA-EDI%20Entities%20-%20Businesses_1.1.25.pdf?ver=7sDNRtdLQjUCSwkJGO4G1Q%3d%3d|EDI for Entity / Business]]

   - **2025 EDI Annual Certification Form [[https://cms.officeally.com/OfficeAlly/Forms/ERA/2025%20EDI%20ANNUAL%20CERTIFICATION%20FORM.PDF?ver=N6zp-2ZSfv2lbQGvHIr1UQ%3d%3d|2025 EDI Annual Certification Form]]:**
     - Submitter Number: **4507197**
     - Submitter Name: **Office Ally, Inc**
     - Primary Contact: **EDI Enrollment Dept** – payerenrollment@officeally.com
     - Secondary Contact: **Cara Trahey** – cara.trahey@officeally.com
     - Phone number: **360-975-7000**

     *Please note: Forms must be submitted with an original signature and notarized.*

2. **Mailing Addresses:**

   - **EDI Contract(s):**
     - Mail to:
       <code>
          Gainwell Technologies Provider Enrollment Unit  
          PO Box 80159  
          Baton Rouge, LA 70898-0159
       </code>
   - **2025 Annual Certification Form:**
     - Mail to:
       <code>
          Gainwell Technologies Provider Enrollment Unit  
          PO Box 91025  
          Baton Rouge, LA 70821-9025
       </code>

3. **Processing Time:**

   - Standard processing time is **3-4 weeks**.
   - You will receive a letter from Medicaid LA informing you of your approval.
   - You may also call Medicaid LA at **(225) 216-6303** to confirm if you have been linked to Office Ally’s Submitter ID **4507197**.

4. **Post-Approval Steps:**

   - Once you receive confirmation that you’ve been linked to Office Ally, email brad.sharp@claimrev.com with the following information prior to submitting claims electronically:

     - **Email Subject:** Medicaid Louisiana (MCDLA) – EDI Approval
     - **Body of Email:**
       - Provider Name
       - NPI
       - Tax ID
       - Medicaid Provider Number
       - Transaction: 837 and/or 835