ClaimRev Support Documentation

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Enrollment Instructions for Medicaid Louisiana EDI

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

1. Complete the Required Forms:

1. Louisiana Medicaid EDI Agreement:
   1. Choose the appropriate form:
      1. EDI for Individual; or
      2. EDI for Entity / Business

1. 2025 EDI Annual Certification Form:
   1. Submitter Number: 4507197
   2. Submitter Name: Office Ally, Inc
   3. Primary Contact: EDI Enrollment Dept – payerenrollment@officeally.com
   4. Secondary Contact: Cara Trahey – cara.trahey@officeally.com
   5. Phone number: 360-975-7000

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

2. Mailing Addresses:

1. EDI Contract(s):
   1. Mail to:

          Gainwell Technologies Provider Enrollment Unit  
          PO Box 80159  
          Baton Rouge, LA 70898-0159
       

1. 2025 Annual Certification Form:
   1. Mail to:

          Gainwell Technologies Provider Enrollment Unit  
          PO Box 91025  
          Baton Rouge, LA 70821-9025
       

3. Processing Time:

1. Standard processing time is 3-4 weeks.
2. You will receive a letter from Medicaid LA informing you of your approval.
3. 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:

1. 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:

1. Email Subject: Medicaid Louisiana (MCDLA) – EDI Approval
2. Body of Email:
   1. Provider Name
   2. NPI
   3. Tax ID
   4. Medicaid Provider Number
   5. Transaction: 837 and/or 835