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The document is the BHSF Form 96-A, which serves as an acknowledgment of receipt of information regarding hysterectomy procedures for Medicaid beneficiaries. It outlines the necessary details to be filled out, including the beneficiary's name, ID, physician's name, and NPI. The form emphasizes that Medicaid will not authorize payment for hysterectomies performed solely for sterilization purposes unless specific conditions are met, including informed consent from the beneficiary and any legal representative. Signatures must be obtained prior to the procedure.

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How do I check my Medicaid status in Louisiana?

If you need help finding a provider in your area, please call 844-521-6941 (TTY 711), Monday through Friday from 7 a.m. to 7 p.m.

How do I report changes to Medicaid in Louisiana?

How do I report an address change? Call Medicaid Customer Service toll free at 1-888-342-6207 or go online by visiting the Medicaid Self-Service Portal to update your address. If you do not have an online account, you can create an account at any time.

What is the maximum income to qualify for Medicaid in Louisiana?

Once the enrollment process is complete, a letter will be generated and sent to the Provider at the Mailing address on file. The letter will include the Louisiana Medicaid provider number and the effective date of enrollment.

How do I find my Louisiana Medicaid provider number?

You must renew your Medicaid every year. When it is time to renew, Medicaid will send you a letter. The letter will list ways to renew. The fastest and easiest way is online.

Can I check my Medicaid status online?

Checking Your Medicaid Status Online Even if you applied for Medicaid in person or over the phone, you can still use your states website to manage your account or check your status. Go to your states Medicaid website and look for a button to register or sign up for an account. Click the button and follow the prompts.

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