Please note: Many of these forms are currently being revised. To obtain the most current forms, contact the
KIDMED hotline at 800.259.4444.
Non-Medicaid providers must enroll in Medicaid before they can become CommunityCARE or KIDMED Providers. Non-Medicaid providers should
contact the Unisys Provider Enrollment Unit at 225.216.6370 to request a Medicaid
enrollment packet, or should go to http://www.lamedicaid.com and follow the appropriate link for Provider Enrollment. Providers already enrolled in Louisiana Medicaid, who want to become CommunityCARE and/or KIDMED providers, should
download the appropriate forms below in the format of their choice. All forms require an original signature. Completed forms should be mailed to the address below.
Download any of the following forms in the format of your choice.
For questions regarding site certification issues, you may contact AHS at 225.757.4366.
General questions regarding CommunityCARE
policies and procedures may be directed to the Unisys Provider Enrollment Unit at 225.216.6370.
NOTE: Please visit www.lamedicaid.com to
retrieve the most recent PE-50 KIDMED Provider Enrollment Supplement Agreement.
Downloads: