Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives

211 - Get Connected. Get Answers.

EIDR Medicaid Claims Request Form (Replaces MRO14)

Wednesday, August 15, 2012  |  Contact: Rate Setting & Audit 225.342.6116

Click below to download the EIDR request form and sample form for Nursing Home and Adult Day Health Care Facilities.

 Please submit completed request form via email to or fax 225-242-0469.  Contact Sharon Burch, DHH Medicaid Rate & Audit Unit, with questions or requests for information at 225-342-6116 or