APRIL 1997

Anniversary of the LMPBM Notice to Anesthesiologists, CRNAs, Obstetricians, and Other Interested Physicians  
Notice to Physicians Use of the 158-A Extension of Outpatient Visits Form 
LADUR Education Article Procedure Code Changes: DME
All DME Providers Reminder to Physician Providers: Global Surgery Policy
Notice to Certified Midwives Reimbursement for the Removal of Keloids
CPT Codes Placed in Non-Pay Status Notice to All Providers Whose Services Require Prior Authorization or Pre-Certification
Funding of Needle Aspiration Services Unisys Provider Relations Reminders to Providers

Anniversary of the LMPBM

In April 1996, the Louisiana Medicaid Pharmacy Benefits Management (LMPBM) Program's primary components, the Point-of-Sale/Prospective Drug Utilization Review (POS/ProDUR), commenced operations.  This exciting addition to the Louisiana Medicaid Program is now celebrating its one year anniversary, and we couldn't be more pleased with its success.

The essential features of the LMPBM include an emphasis on quality clinical outcomes, access by providers and pharmacists to the PBM Help Desk, and conservation of Medicaid funds.  In fact through ProDur's online "Point-of-Sale" database, pharmacists can verify Medicaid coverage and can access patient and drug product information within 15 seconds.

ProDUR enables the Department of Health and Hospitals (DHH) to effectively manage health care dollars, assure access to health care, and to provide the best quality care for Medicaid recipients, according to M. J. Terrebonne, director of DHH's pharmacy program.

The ProDUR system was designed and implemented under the direction of Carolyn Maggio, DHH's Research and Development Director.  In addition to DHH staff, the project task force includes representatives from the LSU, Tulane and Ochsner medical academic centers; Northeast Louisiana University and Xavier University schools of pharmacy; physicians; pharmacists; and Unisys, the fiscal intermediary.

As always, thank you for your continued support and participation in the Louisiana Medicaid Program.

Notice to Anesthesiologists, CRNAs, Obstetricians, and Other Interested Physicians  

Currently providers bill procedure code 00098 and receive a flat fee of $50.00 for the reinjection of the epidural catheter when a tubal ligation is performed several hours after a vaginal delivery.

Effective for dates of service on or after February 15, 1997, billing procedures and fees for code 00098 has been changed as follows:

Providers should continue to use the same modifiers and diagnosis codes with procedure code 00098 when submitting a claim for an epidural for a vaginal delivery; i.e., use diagnosis codes in the range of 650-659, 669.5, or 669.6, and modifiers of AA, AI, AE, 24, 25, etc.  

  Procedure  Code   Modifier Fee
00098 AA or AI $162.00
00098 AE or 24   $89.10  
00098 25  $72.90  

Code 00098 with no modifier will be reimbursed at $162.00.

As reimbursement for code 00098 is a flat fee determined by the modifier used, it is not necessary for minutes to be included in the units column (Item 24 G) of the HCFA 1500 claim form.  The sterilization consent Form 96 must be attached to the claim form.  If the Form 96 is not attached to the claim form, the claim will be denied.  All claims must be submitted hard copy.

Code 00098 is restricted to one per recipient per lifetime.

Notice to Physicians

CPT codes 54150 and 54160, which are circumcision procedures performed on newborns, have been removed from the global surgery edits.  Claims with these 2 codes as well as claims for office visits that denied because of the global surgery edits will be recycled within the near future.  

Notice to Physicians:  Use of 158-A Extension of Outpatient Physician Visits Form

Please remember that the 158-A Extension of Outpatient Physicians Visits Form is to be used to request an extension of OUTPATIENT PHYSICIAN VISITS ONLY.

Providers have been using this form to request extensions on other types of limited services.  This is an inappropriate use of the 158-A form.  If an approval is inadvertently given when the form is inappropriately used, the approval does not override the policy limitations and the claim will not pay.  Please use this form only as it is designed to be used.  

Louisiana Drug Utilization Review (LADUR) Education

Smoking Cessation in the Primary Care Setting

By Tracy S. Hunter, Ph.D., and Philip J. Medon, Ph.D.

Issues . . .

  • Smoking cigarettes involves three primary addictive risks.

  • Smoking cessation efforts and programs must address all three risks.

  • The AHCR recommends that smokers are routinely identified and intervention takes place with tobacco users are every office visits.

The health and economic consequences of cigarette smoking are widely reported and known to health care workers and the public.  Many smokers attempt to quit three or four times before they are successful.  Primary care clinicians and pharmacists are in a position to influence the health of the residents of the State of Louisiana by providing clear cut, simple advice to patients who currently smoke to stop.

The Health Consequences of Smoking
The tobacco addiction entails behavioral and physiologic dependence on nicotine.  Smoking cigarettes involves three primary addictive risks.  Smoking cessation efforts and programs must address all three addictive risks:

      -       A habit-forming substance that stimulates repeat behavior:

-       A pleasure-causing chemical that produces a positive reinforcement; and

-       A drug that is self-administered on impulse, with dosage control by the user.

Psychoactive Effects
Nicotine is the psychoactive agent that is the physically addictive component of cigarette tobacco.  The pharmacologic actions of nicotine are quite complex and potent, and often unpredictable.  It can cause various physiologic effects; it acts as both a stimulant and a central nervous system depressant.  Nicotine, in appropriate doses, acts on the central nervous system to cause EEG changes, tremors, convulsions, nausea, vomiting, and dizziness.  Nicotine effects the central nervous system in the locus ceruleus and mesolimbic-dopaminergic.  It increases activity in the locus ceruleus (which is critical in regulating vigilance and arousal, stress reactions, and psychosomatic reactions).  The result is an increase in arousal and concentration skills, and a decreased stress response.  On the mesolimbic-dopaminergic system - the pleasure center of the brain - nicotine acts like other drugs such as cocaine.  Drugs that stimulate this system often result in drug seeking behavior to recreate the pleasure sensation.

Cardiovascular Effects
Nicotine has a profound effect on cardiovascular health.  It elicits a discharge of epinephrine from the adrenal medulla, thus increasing heart rate and blood pressure.  Contributing to the sympathomimetic response is activation of chemoreceptors of the aortic and carotid bodies, resulting in vasoconstriction, tachycardia, and elevated blood pressure.  Additionally there is a concomitant increase in oxygen consumption and a decreased oxygen-carrying capacity.  The health consequences are exacerbation of angina, myocardial infarction, hypertension, peripheral vascular disease, and stroke.

Nicotine Tolerance
Tolerance develops to several of nicotine's effects including the nausea, vomiting, and dizziness seen in first time smokers.  But even chronic smokers experience increased blood pressure, heart rate, hand tremors, a decreased skin temperature, an increase in certain hormonal levels, and a lowering of the body weight set-point.  As tolerance develops, there is a concomitant increase in withdrawal symptoms when nicotine is removed.  These symptoms include irritability, anxiety, restlessness, difficulty concentrating, drowsiness, headaches, increased appetite, and sleep disturbances.  Women report more distress during withdrawal symptoms than do men.

Basic Primary Care Practice Standards
The Agency for Health Care Policy and Research (AHCPR) publishes a guide for clinicians, "The Clinical Practice Guidelines on Smoking Cessation," Number 18.  The following procedures were abstracted from this document which reflects a thorough review of medical evidence from clinical studies from 1978 to 1994.

They recommend that office systems routinely identify and intervene with all tobacco users at every office visit.  The system they recommend and have found to be effective can be summarized as:  Ask, Advise, and Assist.

The first step in the suggested protocol is for the clinician to ask about tobacco-use of every patient, at every office visit.  Tobacco usage should be routinely obtained with other vital signs data and recorded in the patient's chart.  Tobacco-use stickers prominently displayed on all patient charts flag smoking status or change in status and keep the issue active.  If computer based records are kept, a date field should be dedicated to tobacco-use status.

The next step is to advise (in a clear, strong, personalized manner) the patient to stop tobacco use.  Simple statements such as, "I think it is important for you to quit smoking now and I will help you," have been found to be effective.  Of course, the more intense the treatment, the more effective it is in producing long term abstinence but even cessation treatments as brief as 3 minutes a visit help.  Strongly assert that "I need you to know that quitting smoking is the most important thing you can do to protect your current and future health."  Personalize your advice to the patient ("You've already had one heart attack," "Your diabetes is not under control, and you need to stop smoking").  

Mention the negative effects on the other members of the household ("Your new grandbaby has asthma, and your smoking makes it worse!").  If the patient does not wish to quit, clinicians should ask the patient to identify reasons to quit and barriers to quitting.  Reassure the patient that when he or she is ready to quit that you will be there to assist.

The next step is to advise the smoker to:  

  • Set a firm quit date, preferably within two weeks but at a time that is relatively low stress for the patient.

  • Inform friends, family, and co-workers of plans to quit and ask for their support

  • Remove cigarettes from home, car, and workplace, and avoid smoking in these places.

  • Review previous attempts to quit.  (What helped?  What circumstances led to relapse?)

  • Anticipate challenges, including nicotine withdrawal, situations such as weekend parties where resistance could be lowered.

Four additional tips to advise on successful quitting are:

  • Total abstinence is essential - not even a single puff - starting on the quit day.

  • Drinking alcohol is strongly associated with relapse.

  • Having other smokers in the household hinders successful quitting.

  • Offer educational materials that are culturally and educationally pertinent for your patients.

Medicinal Products in Aid to Smoking Cessation
Encourage nicotine replacement therapy.  Both the patch and gum are effective medications for smoking cessation.  Use of the patch may be easier for patients with regard to compliance, but use of the nicotine gum products are effective individualizing the delivery dose of nicotine.  A nasal spray has recently been approved.  (See Table 1 on Page 5.)

Follow Up
The clinician should schedule follow-up contacts with the patient, either in person or by telephone.  The first contact should generally be within two weeks (preferably during the first week) of the agreed upon "quit date."  A second contact should be attempted within the first month.  During these contacts, the clinician should congratulate successes, and if a lapse has occurred, solicit a recommitment to total abstinence.  Remind the patient that a lapse does not mean failure and can be a learning experience.  Review the events associated with the lapse and discuss alternative behaviors.

Prevent Relapse
To prevent relapse, offer the ex-smoker additional reinforcement.  Review the patient's success.

Congratulate, encourage, and discuss the importance of remaining abstinent.  Review the potential health and economic benefits of not smoking.  Inquire about problems encountered or anticipated in maintaining abstinence.

Allow the patients to present their own solutions.  Specific problems that can be anticipated include:  weight gain, depressed moods, prolonged nicotine withdrawal, or lack of social support for cessation from family, friends, or coworkers.

Weight gain, especially for female patients, is seen as an inevitable side effect of smoking cessation.  About 80% of smokers who quit smoking do gain weight.  The gain averages about 10 pounds and occurs within the first 6 months after smoking cessation.  The health effect of the weight gain is not significant compared to the benefits gained by not smoking, but still may be a major barrier to abstinence.  Efforts to prevent weight gain have been show to undermine cessation attempts, and it is recommended that weight control efforts not be started until at least 3 months after cessation of smoking.  Increased physical activity can be encouraged if appropriate for healthy patients.

For printed copies of the Clinical Practice Guideline, A Quick Reference Guide for Smoking Cessation Specialists, a consumer version (available in English and Spanish), telephone AHCPR at 800-358-9295 or write AHCPR Publication Clearinghouse, P. O. Box 8547, Silver Spring, MD  20907.  These smoking cessation guidelines are available through the Internet at  

Table 1:  Nicotine-Replacement Therapies



Brand Names and Strengths




Prescription Transdermal Systems




Habitrol (21, 14, or 7 mg/24 hours)

Healthy patients:  11 mg for 4-8 weeks, then taper to lower strengths every 2-4 weeks.



Prostep (22 or 11 mg/24 hours)

Patients greater than or equal to 100 l.:  22 mg patch for 4-8 weeks then taper.  Start patients less than 100 lb. On 11 mg patch for 4 weeks.



Nonprescription Transdermal Systems




Nicoderm CQ (21, 14, 6 mg patches/16 or 24 hours

Light smokersA: one 14 mg/24 hour patch for 16 hours per day for 6 weeks, then one 7 mg/24 hour patch for 16 to 24 hours per day for 2 weeks.

Heavy smokers B: one 21 mg/24 hour patch for 16 hours daily for 6 weeks, taper in two week increments.



Nicotrol (15 mg/day/16 hours)

Heavy smokers B: 15 mg/day for 6 weeks.



Nonprescription Chewing Gum




Nicorette (2 or 4 mg)

2 mg (for patients who smoke 24 or fewer cigarettes/day) or 4 mg for more.  Chewed and placed in check intermittently over 30 minutes every hour for 6 weeks, then taper to every 2-4 hours for 4 weeks, then to every 4-8 hours for 3 weeks.  Do not exceed 24 pieces daily or for longer than 12 weeks.



Prescription Nasal Spray




Nicotrol NS (10 mg/ml)

One or two 1 mg dose (each dose is two 0.5 mg, one in each nostril) per hour initially, increased if needed but not to exceed 5 doses per hour (or 40 daily) for up to 8 weeks, then taper over 4-6 weeks.



LightA = Less than or equal to 10 cigarettes/day

HeavyB = More than 10 cigarettes/day



Attention DME Providers:  Procedure Code Changes

Durable Medical Equipment providers should note the following changes that have been made to the procedure code file for DME items.


A4335 - Incontinence supply; miscellaneous
A4455 - Adhesive remover or solvent (for tape, cement, or other adhesive)
A4628 - Oropharyngeal suction catheter, each
A4629 - Tracheostomy care kit for established tracheostomy
K0101 - One arm attachment
K0102 - Crutch and cane holder
K0103 - Transfer Board (25")
K0104 - Cylinder Tank Carrier
K0132 - Male external catheter with or without adhesive, with or without anti-reflux device, each
K0133 - Intermittent urinary catheter, disposable, straight tip
K0134 - Intermittent urinary catheter, disposable, coude (curved) tip
K0135 - Intermittent urinary catheter, reusable, straight tip
K0136 - Intermittent urinary catheter, reusable, coude (curved) tip
K0280 - Extension drainage tubing, any type, any length, with connector/adaptor, for use with urinary leg bag or urostomy pouch, each
K0281 - Lubricant, individual sterile packet, each
K0407 - Urinary catheter anchoring device, adhesive skin attachment
K0408 - Urinary catheter anchoring device, leg strap
K0409 - Sterile water irrigation solution, 1000 ml.
K0410 - Male external catheter, with adhesive coating, each
K0411 - Male external catheter, with adhesive strip, each
XX004 - Administration set, small volume nonfiltered pneumatic nebulizer, disposable
K0169 - Small volume nonfiltered pneumatic nebulizer, disposable
K0170 - Administration set, small volume nonfiltered pneumatic nebulizer, non-disposable
K0171 - Administration set, small volume nonfiltered pneumatic nebulizer
K0172 - Large volume nebulizer, disposable, unfilled, used with aerosol compressor
K0173 - Large volume nebulizer, disposable, prefilled, used with aerosol compressor
K0174 - Reservoir bottle, non-disposable, used with large volume ultrasonic nebulizer
K0175 - Corrugated tubing, disposable, used with large volume nebulizer, 100 feet
K0176 - Corrugated tubing, non-disposable, used with large volume nebulizer, 100 feet
K0177 - Filter, non-disposable, used with aerosol or ultrasonic
K0180 - Aerosol mask, used with DME nebulizer
K0183 - Nasal application device, used with CPAP device
K0184 - Nasal pillow/seals, replacement for nasal application device, pair
K0184 - Headgear, used with CPAP device
K0186 - Chin strap, used with CPAP device
K0187 - Tubing, used with CPAP device
K0188 - Filter, non-disposable, used with CPAP device
K0189 - Filter, non-disposable, used with CPAP device
K0192 - Tubing, used with suction pump
K0193 - Continuous Positive Airway Pressure (CPAP) device, with humidifier
K0194 - Intermittent Assist Device with Continuous Positive Airway Pressure (CPAP), with humidifier
K0268 - Humidifier, used with CPAP device
K0277 - Skin barrier; solid 4x4, or equivalent, with built-in convexity, each
K0278 - Skin barrier; with flange (solid, flexible, or accordion) with built-in convexity, any size, each
K0279 - Skin barrier; extended wear
E0791 - Parenteral infusion pump, stationary, single, or multichannel
E0192 - Low pressure and equalization pad
K0284 - External infusion pump, mechanical, reusable, for extended drug infusion
L1885 - KO, single or double upright, thigh and calf, with functional active resistance control
L5617 - Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each
L5845 - Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable
L5846 - Addition, endoskeletal, knee-shin system, microprocessor control feature, swing phase only
L5930 - Additional, endoskeletal system, high activity knee control frame
L5985 - All endoskeletal lower extremity prostheses, dynamic prosthetic pylon
L2860 - Addition to lower extremity joint, knee, or ankle, concentric adjustable torsion style mechanism, each
L3890 - Addition to upper extremity joint, wrist, elbow, concentric adjustable torsion style mechanism, each
XX058 - Category IV enteral product, 100 calories = 1 unit, Vivonex T. E. N.
XX073 - Category IV enteral product, 100 calories = 1 unit, Advera
XX074 - Category IV enteral product, 100 calories = 1 unit, Crucial
XX075 - Category IV enteral product, 100 calories = 1 unit, Diabetisource
XX076 - Category IV enteral product, 100 calories = 1 unit, Isosource
XX077 - Category IV enteral product, 100 calories = 1 unit, Vivonex Plus
XX078 - Category IV enteral product, 100 calories = 1 unit, Sandosource Peptide
XX079 - Category IV enteral product, 100 calories = 1 unit, L-Elemental Plus
XX080 - Category IV enteral product, 100 calories = 1 unit, Pro-Peptide
XX081 - Category IV enteral product, 100 calories = 1 unit, Peptamen VHP
XX082 - Category IV enteral product, 100 calories = 1 unit, Impact 1.5
XX083 - Category IV enteral product, 100 calories = 1 unit, Renacal
XX084 - Category IV enteral product, 100 calories = 1 unit, Pro-Peptide VHN

Diabetic Shoes Code Changes

The following is a list of codes which have been made non-payable and the codes which have replaced them.  The descriptions remain the same for each code replacement.  

Deleted Codes  Replaced By  
Q0117 A5500  
Q0118 A5501  
Q0119 A5502  
Q0120   A5503  
Q0121 A5504  
Q0122 A5505  
Q0123    A5506  
Q0133   A5507  

For All DME Providers

Effective for dates of service on and after February 26, 1997, the Bureau of Health Services Financing will reimburse DME providers for customized wheelchairs (HCPC code E1220) at a rate of Manufacturer's Suggested Retail Price (MSRP) minus 15% for manual type customized wheelchairs, and MSRP minus 12% for motorized, customized wheelchairs.  An Emergency Rule was published in the February 20, 1997 issue and the Louisiana Register to implement this rate revision.  This rate revision is being made as a result of, and in response to, concerns expressed by some providers in the public hearing of October 19, 1996, and afterward, about the effects of the previous rate revision on MSRP minus 18%.

Reminder to Physician Providers:  Global Surgery Policy

In July, 1996, you received manual revisions which included the implementation of the Louisiana Medicaid Global Surgery Period Policy.  Information concerning this new policy was also printed in the Summer, 1996 edition of the Provider Update.  Please be sure you are aware of this policy when billing claims for services related to any surgeries covered by this policy.

You may obtain information concerning whether a particular surgery falls under this policy by calling Unisys Provider Relations at (800) 473-2783 or (504) 924-5040.

REMINDER:  This Global Surgery Period Policy may not be circumvented.  You may not elect to bill for office visits instead of billing for the procedure.  Please do not attempt to bill in this way.

Notice to Certified Midwives

Effective for dates of service on or after February 1, 1997, the following CPT codes were added to the list of codes reimbursable to Certified Nurse Midwives.  

99218  76818   80019   84702 86901  
99219   80012   80439   84703   87070
99220   80016   80440   85013   87072  
99231   80018   81005 85014   87086  
99238   81002   81007   85018   87087
99281   81015   82962   85023   87088  
99282   81025   83001   85024 87110  
99283   57061 (w/protocol)   83002 85025 87178  
99432   59414   84443  


99440   80002   86302 86403 86664
11977   80003   86311 86580   86665
57170   80004   86430   86689 86674  
58300  80005   86431   86701  


58301   80006   82465   86702   86688
59020   80007   82947   86762   86694
59025   80008   83020 86781   86695  
59050   80009   83718   86850 86777  
59300   80010   83719 86900 86778  
76810   80011 83721   87211   86787  


Codes 59020 and 59025 are payable in an office setting to providers who have verified, in writing to the state, that they have the capability of performing this procedure in their office and have registered the equipment necessary to perform these tests.

If the place of service is inpatient or outpatient hospital, or the billing provider is rendering the "interpretation" only in his office, modifier 26 must be appended to the procedure code.

The register equipment please contact Provider Enrollment at (504) 342-9454.

Notice to Providers:  Reimbursement for the Removal of Keloids  

Reimbursement for the removal of keloids shall not be made if the Medical Review Unit determines that the removal was for cosmetic reasons only.

This policy shall apply to the removal of all keloids, regardless of size, if the only reason for which they were removed was cosmetic.

Notice to Physicians and Providers:  CPT Codes Placed in Non-Pay Status

The CPT codes which were deleted in the 1997 issuance of the Physician's Current Procedural Technology have been placed in non-pay status effective for dates of service April 1, 1997.

Please program your billing systems immediately to bill current codes if you have not already done so.

Notice to All Providers Whose Services Require Prior Authorization or Pre-Certification

Many services covered under the Louisiana Medicaid Program require some form of prior authorization, pre-certification, or extension request.  Please remember that authorization of services does not override any other Medicaid Program policy and does not guarantee payment of the claim.  This includes, but is not limited to, the following examples:

1.     If a recipient is not eligible for services on the specified date of service, an authorization does not override ineligibility and the claim will not be paid.

2.     If a recipient is Medicare eligible, an authorization does not override the fact that the claim must be submitted to Medicare for consideration prior to being submitted to Medicaid.

Please be aware of this fact when submitting your claims for processing.

Notice to Providers:  Funding of Needle Aspiration Services

The Bureau of Health Services Financing is pleased to inform you of the funding of fine needle aspiration procedures, CPT codes 88170 and 88171, effective for dates of service March 1, 1997.  The description and fees are as follows:





Fine needle aspiration with or without preparation of smears; superficial tissue (e.g., thyroid, breast, prostate)




Deep tissue under radiologic guidance


Each of these codes has a UVS of "2".  The professional component fee is 40% of the full service fee stated above.

Providers:  Where to Get POS Brochures

The Department has received numerous requests for additional copies of our disease management materials on H. Pylori and GERD.  Our initial order for the brochure, entitled "About Your Stomach," targeted the Medicaid population identified through paid claims with an appropriate ICD.9 diagnosis; therefore, our supply of these brochures is exhausted.

Providers have our permission to copy the "About Your Stomach" brochure.  In addition, if providers choose, Printing Tech can be contacted for additional color brochures which can be ordered at the providers' expense in any specified quantity.  Mr. David Kleinpeter is the contact person, and he can be reached at the following address:

Printing Tech  
College Drive
Baton Rouge, LA
(504) 928-5920

Unisys Provider Relations Reminders to Providers

Provider Relations Telephone Inquiry Unit

The Unisys Provider Relations Department has recently made changes to the provider inquiry lines reached by calling (800) 473-2783 or (504) 924-5040.  Please listen to the new message to determine which line to choose prior to pressing a line number.  When calling these numbers, you now have the option of choosing one of the following:

Types of Calls


Option 1

Recipient or provider eligibility, third party insurance inquiries, or recipient service limits verification ONLY.


Recipient dates of coverage, enrollment with CommunityCARE and Primary Care Physician, lock-in status and lock-in provider, TPL/Medicare coverage and effective dates, TPL carrier code and address, service limits remaining, and provider check amount.

Option 2

Orders for printer materials ONLY.


Orders for provider manuals, training packets, enrollment packets, Unisys claims forms, fee schedules, TPL carrier code lists, and provider newsletter reprints.

Option 3

Claim and policy questions and inquiries.


Claim status, precertification status, reimbursement inquiries, claim denial clarification, problem claim resolution, requests for field analyst visits, and Medicaid policy inquiries.

Pharmacy providers calling concerning pharmacy claims are instructed to contact the Unisys POS Unit at (800) 648-0790 for assistance.  Pharmacy providers with inquiries regarding DME claims should still contact Provider Relations.  Once you reach Provider Relations, if you have reached the wrong service line you may be asked to redial or you may be transferred to another service group.  Thus far this arrangement is working to expedite provider calls and to make the inquiry process more efficient.  As you contact our service lines, please let us know if you find this arrangement to be a positive change.

Incidentally, the Unisys Recipient Eligibility Verification System, or REVS line, is still available.  Reached by dialing (800) 776-6323, this automated system allows providers with a touch tone phone to check recipient eligibility and service limits 24 hours a day, 7 days a week.  NOTE:  Provider Relations lines are NOT available for recipient use, and Provider Relations staff cannot assist recipients.  Please do not issue the Provider Relations telephone numbers to Medicaid recipients, as recipient inquiries directly reduce the number of incoming provider calls that can be answered.  If recipients have problems with eligibility, it is appropriate to refer them to their eligibility worker at the parish office.

Provider Relations Correspondence Unit
May providers submit "clean" claims to the Provider Relations Department hoping to expedite processing of these claims.  However, this actually delays claim processing, as the claims must pass through additional hands before reaching the appropriate processing area.  In addition, it diverts productivity that would otherwise be devoted to researching and responding to provider requests for assistance with legitimate claim problems.  Providers are asked to send "clean" claims directly to the appropriate post office box as listed on the back page of the May/June 1996 issue of the Louisiana Medicaid Provider Update.  You may also find a listing of appropriate post office boxes in the 1996 provider training packet for your provider type.

Providers who wish to submit claims for research and a written response are encouraged to submit them to the Unisys Provider Relations Correspondence Unit, P. O. Box 91024, Baton Rouge, LA  70821.  The Provider Relations Correspondence Unit is available to research and respond in writing to questions involving problem claims and requests to update recipient files with correct eligibility and third party liability information.  Incidentally, Provider Relations staff do not have direct access to eligibility files.  Requests to update recipient files are forwarded to the Bureau of Health Services Financing by the Correspondence Unit, so these may take additional time for final resolution.  Any inquiry requiring research or special handling (including claim problems, requests to update recipient eligibility or third party liability information, requests to override the one-year timely filing limitation, requests to override the yearly outpatient visit limitation, and ambulance "second trip, same day" claims) MUST include a separate cover letter on top of the claims or claims which indicates what the provider is requesting.  CLAIMS RECEIVED WITHOUT A COVER LETTER, INCLUDING THOSE WITH ONLY NOTES WRITTEN ON THE FACE OF THE CLAIM, WILL BE CONSIDERED "CLEAN" CLAIMS AND WILL BE SENT TO PROCESSING WITH NO RESEARCH OR SPECIAL HANDLING.  

Claim Special Handling Reminders
1.     Other than cover letters, attachments should be included behind the claim form itself.  Attaching information other than the cover letter on top of the claim form will delay handling of the claim.

2.     Requests for override of the one-year filing limitation must have required documentation attached to each claim (usually a copy of the remittance advice page showing the claim was processed with one year from the date of service).  One copy of timely filing verification for several separate claim forms is unacceptable.

3.     Requests for override of the yearly outpatient visit maximum must be accompanied by a 158-C form showing the visit was approved by Unisys.  Only one copy of the 158-C form should be sent along with each visit claim form - the "physician copy" should be kept by the provider for his/her records.

4.     Requests to update recipient files with correct eligibility and third party liability information must include a copy of the documentation verifying the eligibility or TPL information (e.g., a copy of the recipient's Medicaid card showing eligibility for the date of service in a question or a letter from the recipient's other insurance indicating coverage has terminated).

5.     Any request for research regarding a denied claim should include as much documentation as possible to assist in thorough analysis of the problem.

 Provider Relations Field Analysts
Provider Relations Field Analysts are available to visit providers on-site and to provide training to new providers and their office staff.  Providers are encouraged to request their assistance for training staff in billing Medicaid claims and in resolving complicated billing issues.  However, calls regarding eligibility or to request Unisys claim forms, manuals, or other policy documentation should NOT be directed to the Field Analysts.  Provider Relations Field Analysts may be reached through the Telephone Inquiry Unit phone number mentioned earlier.