Louisiana Medicaid Management Information System (LMMIS)
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1 Louisiana Medicaid Management Information System (LMMIS) EFT Authorization Application User Guide Date Created: 1/23/2014 Date Revised: 8/03/2018 Prepared By Technical Communications Group
2 Molina Medicaid Solutions and the Louisiana Department of Health Proprietary Data Notice The information contained in this document is proprietary to Molina and the Louisiana Department of Health. The information in this document shall not be reproduced, shown or disclosed outside Molina or Louisiana Department of Health (LDH)/BHSF without written permission. Information contained in this document is highly sensitive and of a competitive nature. NO WARRANTIES OF ANY NATURE ARE EXTENDED BY THIS DOCUMENT. Any product and related material disclosed herein are only furnished pursuant and subject to the terms and conditions of a duly executed license or agreement to purchase services or equipment. The only warranties made by Molina, if any, with respect to the products, programs or services described in this document are set forth in such license or agreement. Molina cannot accept any financial or other responsibility that may be the result of your use of the information in this document, including but not limited to direct, indirect, special or consequential damages. Exercise caution to ensure the use of this information and/or software material complies with the laws, rules, and regulations of the jurisdictions with the respect to which it is used. The information contained herein is subject to change without notice upon LDH approval. Revisions may be issued to advise of such changes and/or additions. Molina is a registered trademark of Molina Medicaid Solutions. Copyright 2018 Molina Medicaid Solutions All rights reserved 2
3 PROJECT INFORMATION Document Title Louisiana Medicaid Management Information System (LMMIS) EFT Authorization Application User Guide Author Technical Communications Group, Molina LMMIS QA Revision History Date Description of Change LIFT By 01/23/14 Initial draft 03/22/17 Provider Web Applications Update Bria Beathley 08/03/18 Updated as per LAMedicaid Secure Redesign J. Lavigne 3
4 EFT Authorization Application User Guide This section provides information on how to access the EFT Authorization application via Provider Login. It includes instructions on how to establish an online account with Louisiana Medicaid and complete the Login ID and password process. The Louisiana Department of Health (LDH) determines who is an authorized user defining all user access capabilities. Directions for establishing a valid online provider account are available on the Louisiana Medicaid website at The Provider Web Account Registration Instructions link located on the left side of the Louisiana Medicaid main menu contains the instructions for setting up an online account. 4
5 Providers who are experiencing difficulty in establishing an account or with the application may contact the Molina Technical Support Desk at , Monday Friday 8:00 a.m. 5:00 p.m. CT or request support by ing In order to access the EFT Authorization application, or any other secure application, users must navigate through the Provider Login section of the Louisiana Medicaid web site. Open a web browser and enter the URL for Louisiana Medicaid at Click the Provider Login button to continue. 5
6 At the Provider Login screen, users may read through the Notice to Users. In order to continue, users must enter their 10-digit National Provider Identifier (NPI) or 7-Digit Medicaid Provider ID in the field provided and enter the characters from the CAPTCHA image before clicking the Next button. 6
7 At the User Login screen, users must input their Login ID and Password before clicking the Next button to continue. Note: Login ID and Password are case sensitive. 7
8 Users will be directed to the Provider Applications page where they can access their authorized applications Click the EFT Authorization link to continue. 8
9 New Functionality Please note that with the new redesign, backwards navigation throughout any application can be done by clicking on the breadcrumb trail located on the blue ribbon at the top of any screen. Users also have access to a Print screen button located on the top right hand corner of every screen. The EFT Authorization Agreement When you select the EFT Authorization link from the Provider Applications Area page, the EFT Authorization Agreement is displayed: At the bottom of the page are two radio buttons. Click on the one that best matches your status and then click on the Accept and Proceed button. 9
10 The electronic form, similar to the one shown below, is displayed: Enter data in the text boxes as required, using the following guide: 1. Provider Name Complete legal name of institution, corporate entity, practice or individual provider. The Provider Name on record is already displayed. 2. DBA Name Enter the name by which the provider is conducting business, even if it is the same as the displayed legal name. 3. Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN) 4. National Provider Identifier (NPI) The Federal Tax Identification Number, also known as an Employer Identification Number (EIN) is used to identify a business entity (9 digits); the TIN or EIN on record is already displayed. A Health Insurance Portability and Accountability Act (HIPAA) identification number Administrative Simplification Standard. The NPI is a unique identification number for covered healthcare providers. Covered healthcare providers and all health plans and healthcare clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. The NPI on record is already displayed. 10
11 5. Assigning Authority Louisiana Medicaid is automatically populated as the government entity assigning authority. 6. Trading Partner ID The 7-digit Louisiana Medicaid Provider ID of the provider s trading partner (submitter). The trading partner ID is already displayed. 7. Provider Contact Name 8. Provider Contact Telephone Number 9. Provider Contact Address 10. Financial Institution Name 11. Financial Institution Routing Number 12. Type of Account at Financial Institution 13. Provider Account Number with Financial Institution 14. Account Number Linkage to Provider Identifier 15. Reason for submission 16. Include with Enrollment Submission Enter the name of a contact in the provider s office for handling EFT issues. Enter the area code and phone number associated with the contact person. Enter an electronic mail address at which the health plan might contact the provider. Enter the official name of the provider s financial institution. Enter the 9-digit identifier of the financial institution where the provider maintains an account to which payments are to be deposited. Click on the radio button that best describes the account type, Checking Account or Savings Account. Enter the provider s account number at the financial institution to which EFT payments are to be deposited (up to 10 digits). The Account Number Linkage, whether Provider Tax Identification Number (TIN) or National Provider Identifier (NPI), is already displayed. The reason for submission displays as Change Enrollment. Use the Browse and Upload buttons to attach the required documentation. 11
12 Upload Files In order to process your request, supporting documentation in the form of a Voided Check or a Bank Letter must be submitted. Start by ensuring that on your computer you have an electronic copy of the Voided Check or Bank Letter that you intend to upload. Accepted file types are: pdf, jpg, or tif. Click on the Browse button and navigate to the file you intend to upload. Make sure the file name is displayed in the text box just to the left of the Browse button. Use a radio button to specify whether the file is a voided check or a bank letter, and then click on the Upload button. Once the file has been uploaded, the bottom of the page will be redrawn in a grid to display your uploaded files, in a manner similar to that shown below: Click on the Continue button. The application responds by displaying a screen similar to the one shown below: 12
13 Is this change based on a Change of Ownership? Is this a Bank Change? Is this bank account located in the United States? Please enter the reason for the change Click on the Yes radio button or the No radio button. Click on the Yes radio button or the No radio button. Click on the Yes radio button or the No radio button. If the answer is Yes, please identify the Country of the bank in the text box that is provided. Enter the reason for the change in the text box provided. Digital Signature The Digital Signature page enables you to enter your digital signature and enter into the EFT Authorization Agreement with Louisiana Medicaid: Text boxes are provided for you to enter the Name of the Person Submitting, the Initials of the Person Submitting, and the Title of the Person Submitting. The Login User ID is displayed automatically. Once you have entered the correct data into the text boxes, click on the Submit button to continue. 13
14 The Confirmation of Submission page is displayed: You are enabled to view a summary of your request by clicking on the Confirmation Summary Report link. A report similar to the one shown below is displayed: 14
15 Click on the End button to complete the authorization process and return to the Provider Applications Area. End 15
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