Provider Update
Volume 16, Issue 4
August 1999
Y2K Readiness Update
As you are aware, the Department of Health and Hospitals and Unisys have been
working diligently to ensure that all Louisiana Medicaid systems are Year 2000
ready. As of June 30, 1999, the remediation and testing of code for Y2K
readiness (including mirroring, bridging, and expansion of critical date fields)
is complete, implemented, and currently in production. We are presently
conducting the final phase of our Y2K project which involves extensive
end-to-end testing of the system using future Year 2000 dates.
As part of our outreach initiative to ensure that recipients and providers
are not adversely affected by our Y2K changes, we would like to provide the
following information on key areas:
PERMANENT 13-DIGIT IDENTIFICATION NUMBER
The Medicaid recipient identification number previously assigned to recipients
is a 13-digit "intelligent" number that houses certain pieces of
information used in Medicaid billing. Use of this "intelligent" number
has caused billing difficulty for the provider community. In an effort to
resolve these issues, beginning July 1, 1999, a new permanent 13-digit number
was assigned to each Medicaid recipient. The most current 13-digit recipient ID
number was frozen and became the permanent person number for all individuals on
the Unisys recipient file on June 30, 1999. Recipients added to the file as of
July 1, 1999 and after are being assigned a new permanent 13-digit number, which
may look somewhat different to you. Information previously obtained from the
"intelligent" number is currently available and will be supplied as a
part of the response given when making eligibility inquiries through MEVS or
REVS. Providers must access and verify eligibility through REVS or MEVS
USE OF PREVIOUSLY ISSUED RECIPIENT IDENTIFICATION NUMBERS
This does not mean that other identification numbers previously issued to
recipients may not be used to bill claims for services rendered. Any 13-digit
number that was a valid number and is still on the recipient file may be used to
bill claims. In situations where services were pre-certified or prior authorized
using a number other than the permanent 13-digit person number, it is necessary
to bill using the number under which the pre-certification or prior
authorization was issued.
As of July, 1999, we encourage providers to make note of the identification
number confirmed or obtained from Unisys REVS or MEVS eligibility inquiries as
this number will be the PERMANENT number. For dates of service and
pre-certification and prior authorization after July 1, 1999, the permanent
13-digit person number will be used by all DHH and Unisys systems. PLEASE
REMEMBER THAT THIS 13-DIGIT PERSON NUMBER DOES NOT REPLACE THE 16-DIGIT CARD
CONTROL NUMBER (CCN) CONTAINING LEADING DIGITS OF "777."
PLASTIC IDENTIFICATION CARD/CARD CONTROL NUMBER
Medicaid recipients now have a plastic swipe ID card which is encoded with a
16-digit Card Control Number (CCN) containing the lead digits of
"777". This card number is used to access Medicaid eligibility,
benefit, and service limit information. The CCN should never be used for billing
with the exception of pharmacy POS. Claims submitted with this number will deny.
(Pharmacy POS providers may continue to use the 16-digit CCN number for POS
processing.)
ELIGIBILITY ACCESS
Both MEVS and REVS are Y2K ready and require entry of 8-digit dates (service
dates, dates of birth, etc.) when making eligibility inquiries through these
systems. Entry of anything other than 8-digit dates will prevent a valid
eligibility response. The provider will receive a prompt to enter an 8-digit
date, accompanied by an example, to allow continuation of the inquiry. Please be
sure to use 8-digit dates for all dates required when using MEVS or REVS. It is
imperative that the most current 13-digit recipient ID number or the newly
assigned permanent number be used to prevent any difficulty in obtaining
eligibility information through MEVS or REVS. Parties interested in MEVS may
obtain a list of participating telecommunications vendors through Unisys
Provider Relations at (800) 473-2783 or (225)924-5040. REVS may be accessed with
a touchtone phone by dialing 800-776-6323 or (225) 216-7387.
ELECTRONIC MEDIA CLAIMS (EMC)
As stated in the December, 1998 and April, 1999 Provider Update articles, no
changes will be made to the EMC submission process at this time. Once the
national standardized submission formats are finalized (Fall, 2001), EMC
processes will be modified to handle the new standards. Until then, DHH has
decided to maintain current submission standards and employ standard windowing
techniques for date conversions to handle Year 2000 dates.
TRANSITIONAL ISSUES
As we progress through our Y2K implementation, several transitional issues have
developed. As a part of the Y2K readiness effort, DHH is in the process of
undergoing a major conversion to the Medicaid Eligibility Determination System.
During this conversion, it was necessary to freeze all eligibility files;
therefore, coverage for newly eligible recipients or changes to existing
recipient files could not be executed. This freeze has caused a temporary
inconvenience in verifying recipient eligibility. Every effort is being made to
minimize the delay in reflecting current recipient eligibility on the Medicaid
files.
POS processing problems experienced in early August were Y2K and eligibility
file related. We were made aware of this problem immediately, gave it top
priority, and corrected the problem by the close of business the following day. We apologize for any inconvenience you may have
experienced because of these Y2K efforts. Although we do not anticipate further
obstacles, please be patient should additional issues arise as we finalize our
Y2K readiness. Please watch for
updates to the Year 2000 conversion process of the MMIS system in future
Provider Update articles. Unisys and DHH personnel continue to work diligently
to see that the Medicaid System is Y2K ready, ensuring that recipients are
serviced and all provider claims are processed correctly after December 31,
1999.
Regional LADUR Committee Accepting Nominations
The Department of Health and Hositals is currently accepting physician
nominations for the Region 3 Drug Utilization Review Committee. The committtee
consists of three pharmacists and one physician who meet monthly to review
profiles of drug usage from a therapeutic perspective and to clarify or send
information to the medical community. Currently one physician opening is
available. We are requesting that the nominations be Lousiana Medicaid providers
and practice in at least one of the following parishes:
| Acadia |
Allen |
Avoyelles |
| Beauregard |
Calcasieu |
Cameron |
| Catahoula |
Concordia |
Evangeline |
| Grant |
Jeff. Davis |
Lafayette |
| LaSalle |
Rapides |
Vermillion |
| Vernon |
Prospective committee members must have time available to meet monthly for
one to three hours and must meet the following requirements:
�Doctor of medicine degree from an accredited U.S. medical school
�Licensed to practice in Louisiana as a medical doctor
�Board certification in their specialty
�No previous sanctions from the State of Louisiana
Please print or type your nominations on this form in the space
provided below and return the form (brief resume appreciated) as soon as
possible to :
Unisys: Louisiana Medicaid
8591 United Plaza Blvd., Suite 300
Baton Rouge, LA. 70809
ATTN:S. Delaville
LMMIS REGION THREE DRUG UTILIZATION REVIEW COMMITTEE
NAME:___________________________________PHONE:_______________________________
ADDRESS:______________________________________________________________________
PARISH:___________________________________________________I am nominating
the above mentioned for consideration as a member of the LMMIS REGION THREE DRUG
UTILIZATION REVIEW COMMITTEE.
SIGNATURE:___________________________________
PARISH:_________________________
Accessing the Medicaid Web Site
For your information, the Medicaid web site can be accessed through the
Department's web site at: http://www.dhh.state.la.us
or by going to the following address: http://www.dhh.state.la.us/Medicaid
We will continue to expand and improve the site and appreciate any comments
and suggestions; please direct these to Louis Lyles.
BHSF to Resolve Outstanding Crossovers
(RA Message - 6/1/1999, 6/8/1999, 6/15/1999)
The Bureau of Health Services Financing is working with all HMO Medicare
replacement plans to resolve outstanding and future Medicare HMO crossover
claims.
BHSF and the Medicare HMOs are in the process of resolving payments for old
outstanding claims for dates of service through 12-31-98. All payments, both
past and future, will be made directly to the Medicare HMO. Questions and
concerns should be addressed to the Medicare HMO involved.
Attention Eyeglass Providers: Eyeglass Frames Reimbursement Rate Increase
and Policy Change
(RA Message 7/13/1999, 7/20/1999, 7/27/1999)
Medicaid reimbursement rates for eyeglass frames were increased effective
July 1, 1999. This increase occurred for procedure codes X6370 through X6376.
The new reimbursement rates, along with a cover letter explaining the changes,
were distributed to all eyeglass providers in June 1999.
A change in eyeglass frame policy was implemented with this increase.
Effective July 1, 1999, Medicaid recipients must be offered a choice between
metal or plastic eyeglass frames. The frames should be sturdy and nonflammable.
Both the metal and nonmetal frames should carry at least a one-year
manufacturer's warranty. Other eyeglass policy remains unchanged.
Should you have any questions, you may contact Unisys Provider Relations by
calling 1-800-473-2783.
Health Standards Section - New Address and Phone Number
All Communications regarding enrollment, surveys (inspections), insurance
tracking, and complaint investigations for the Non Emergency Medical
Transportation (NEMT) program should be directed as follows:
Health Standards - NEMT Program Desk
Post Office Box 3767
Baton Rouge, Louisiana, 70821-3767
Physical address:
655 North 5th Street, 3rd Floor
Baton Rouge, Louisiana, 70802-5313
Telephone: 225-342-0138
Fax: 225-342-5292
Thank you for your cooperation in this matter.
Wheelchair Seating Evaluations for Medicaid Recipients in
Nursing Facilities
Since Medicaid policy for the prior authorization of customized wheelchairs
requires DME providers to submit a wheelchair seating evaluation from a
rehabilitation therapist, several DME providers have recently requested that
BHSF clarify Medicaid policy with regard to the methods by which they may obtain
such evaluations in nursing facilities. Three methods that may be utilized by
DME providers to obtain seating evaluations for nursing home recipients:
First, Medicaid does reimburse home health agencies for the provision of
physical or occupational therapists to perfrom wheelchair seating evaluations
for Medicaid recipients in nursing facilities. If therapy services are available
from a home health agency for a facility resident, a DME provider may work with
that home health agency to have a therapist perform a seating evaluation.
(Please note, however, that Medicaid does not reimburse rehabilitation centers
for the provision of therapists for wheelchair seating evaluations in nursing
facilities).
Second, since nursing facilities are required to provide rehabilitation
services for skilled care Medicaid recipients residing in their facilities, they
often employ physical and occupational therapists on staff to render
rehabilitation services to these recipients. A DME provider, therefore, may work
with a therapist, who is employed by a facility to obtain a wheelchair seating
evaluation for a facility resident.
Third, some DME providers, at their own expense, reimburse therapists to
perform seating evaluations for nursing home recipients when no other method is
available for their reimbursement. Medicaid policy does not specifically address
this as an option for DME providers, but since policy does not prohibit it, and
since policy does require a seating evaluation by a therapists as a prerequisite
for prior authorization of a customized wheelchair, BHSF recognizes that DME
provider reimbursement for a therapist�s evaluation of a nursing home
recipient may be necessary in those circumstances where there is no other method
of reimbursement. DME providers, however, should document in their records that
no facility contracted therapist, home health agency therapist, or other funding
source is available for an evaluation for that individual recipient. (Please
note, also, that Medicaid regulations do not permit a DME provider to pay a
therapist for seating evaluation services for a recipient when that therapist is
already employed by a home health agency, a nursing home, or a rehabilitation
center to provide rehabilitation services for that recipient.)
Filling Out Home Health Services Claims
When filing claims for home health services, Block 19, "Patient
Status," on the Home Health Services claim form must be completed.
There must be a date in either Block A - Date of Discharge , Block B - Date
of Death, or Block C - Visits Exhausted or an X must be placed in Block D -
Still Receives. Failure to fill in one of these blocks will cause the claim to
be denied.
Previous Provider Update Correction
The June/July 1999 issue of the Provider Update included an article for Home
Health Agencies entitled, "RN Qualifications for Psychiatric Home Health
Visits."
The last paragraph of this article incorrectly stated that the services must
be prior authorized. The correct wording of the paragraph is "Additionally,
the services must be medically necessary and provided only to recipients who
meet Medicaid�s homebound criteria."
We apologize for any inconvenience this may have caused.
To EPSDT School Board Providers and Billing Agents
As some of you may know, the computer system (WIS) DHH uses to gather data for
the Medicaid eligibles listing you receive each month is going through a major
conversion. Until the conversion is complete, the Medicaid eligibles listing
will be gathered from the Medicaid Management Information System (MMIS).
However, there is no mechanism in MMIS to link the recipients to other family
members. Therefore, starting in July, the fields on the Medicaid eligibles
listing relating to the case number will be blank. We don't anticipate this to
cause any billing problems since all necessary information regarding the actual
recipient receiving services will still be included.
CPT Code 82962
(RA Message 6/8/1999)
Currently Medicaid pays for one unit of CPT code 82962 (Glucose test). In
order for a lab to receive payment for the complete glucose test, the billable
units have been increased from 1 to 3. Providers who have been paid for only one
unit may submit adjustment forms to be reimbursed for additional units.
LADUR Education Article
A Look at the Louisiana Medicaid Lock-in Program: Its
Effect on Health Services Utilization
By Sandra G. Blake, Ph.D.Northeast Louisiana University
School of Pharmacy
Issues...
- The lock-in program can improve the relationship between patient and provider.
- The use of the lock-in program has been shown to produce significant
reductions in utilization and expenditures.
- The goal of the lock-in program is to substitute self-directed utilization for
physician-directed utilization.
The Louisiana Medicaid Lock-in Program began in the 1970s with minimal
enrollment. With program costs increasing drastically, the Bureau of Health
Services Financing, the state agency responsible for administering the lock-in
program, increased enrollment substantially in the summer and fall of 1995.
Each regional Drug Utilization Review (DUR) Board selects lock-in recipients
based on recipient utilization profiles developed by Unisys Corporation, the
fiscal intermediary for the Medicaid program. Enrollment at this time is
approximately 2,500 recipients. Recipients may be locked-in to a primary care
physician, a specialist, and/or a pharmacy, but the vast majority of recipients
are locked-in to only a pharmacy provider. The pharmacy-only lock-in allows
recipients the same freedom of access to generalist and specialist physician and
emergency room care that they had prior to the lock-in but requires that they
obtain all non-emergency medications from their lock-in pharmacies. The lock-in
program is a recipient education program used to improve the quality of health
care for the patient. Although frequently viewed as a punitive action toward
system abusers, the lock-in, by directing patients more often to the same
providers, can facilitate a stronger provider patient relationship resulting in
improved patient care.
Previous research that compared the utilization in one year prior to lock-in
and one year post lock-in showed significant reductions in utilization and,
therefore, expenditures. This study also examined utilization three years after
lock-in to determine if the reductions have been sustained.
Data Source
Claims data were obtained from the Louisiana Department of Health and
Hospitals through Unisys Corporation. Three six-month periods were selected for
comparison, one pre-lock-in period (January-June 1995) , one period soon after
the lock-in (January-June 1996) and one period several years later (January-June
1998). The time periods for analysis were selected to utilize existing data sets
while, at the same time, comparing the same months in each year thus controlling
for seasonal variation.
Study Group
In selecting recipients to be included in the present study, criteria
were developed with the intent of isolating, as much as possible, the effect of
the lock-in from effects of other programs or changes in eligibility. Therefore,
recipients who had been in long term care and/or who had participated in the
CommunityCare program (gatekeeper program) were eliminated from the study group.
Recipients were also required to have been continuously eligible, defined as
having had at least one claim in each year of the study period. Of the 2,255
recipients for whom claims data had been supplied, 621 were not considered
continuously eligible according to the above definition. Another 86 had
participated in the CommunityCare program, 64 had been in long term care and 2
had been in both. This resulted in a final study group of 1,482 recipients.
Table 1. Demographics of the Lock-in Study Group.
| Sex |
Male |
375 |
25.3% |
| |
Female |
1, 107 |
74.7% |
| |
|
|
|
| Race |
White |
731 |
49.3% |
| |
Black |
493 |
33.3% |
| |
Asian-American |
258 |
17.4% |
| |
|
|
|
| Age Group |
0-10 |
2 |
0.1% |
| |
11-20 |
4 |
0.1% |
| |
21-30 |
66 |
4.5% |
| |
31-40 |
302 |
20.4% |
| |
41-50 |
414 |
27.9% |
| |
51-60 |
331 |
22.3% |
| |
61-70 |
241 |
16.3% |
| |
71-80 |
99 |
6.7% |
| |
Over 80 |
25 |
1.7% |
| |
|
|
|
| Average Age |
= 50.8 |
|
|
| |
|
|
|
| Aid Category |
Old Age Assistance |
243 |
16.4% |
| |
Aid to Families with Dependent Children |
105 |
7.1% |
| |
Disability Assistance |
1098 |
74.1% |
| |
Other |
36 |
2.4% |
| |
|
|
|
| Region Of Residence |
New Orleans |
524 |
35.4% |
| |
Baton Rouge |
444 |
30.0% |
| |
|
317 |
21.4% |
| |
|
197 |
13.3% |
Results
Demographical data were obtained from the most recent claim of each
recipient in the study group. Table 1 contains a summary of the demographics.
Health services utilized by this group of recipients were then examined. The
measures of utilization selected for this analysis were: physician outpatient
services, number of outpatient pathology and laboratory tests, emergency
department visits, number of pharmacy claims, inpatient days, and inpatient
admissions. For all measures, average utilization per recipient during each
six-month period (Jan-Jun 1995, Jan-Jun 1996, Jan-Jun 1998) was compared.
Outpatient Physician Services--Figure 1
Physician and hospital outpatient claims were used to determine the number of
outpatient physician services. When one of these claims contained a Physician's
Current Procedural Terminology (CPT) code of 99201-99215 (office, outpatient
services), 99241-99245 (office, outpatient consultations) or 99321-99333
(medical care at a domiciliary facility), that claim was categorized as an
outpatient physician service claim. Prior to the lock-in, each recipient
received, on average, 7.63 physician outpatient services for the six-month
period. In the first six-month period after the lock-in, utilization declined to
4.43 physician outpatient services per recipient and declined further to 4.29
services per recipient in the second post-lock-in period.
Outpatient Pathology and Laboratory Tests--Figure 2
CPT codes were also used to identify an outpatient pathology and laboratory
test. Any hospital outpatient or professional claim that contained a CPT code
from 80000 to 89999 (Pathology and Laboratory) was included in the number of
outpatient pathology and laboratory tests. As can be seen in Figure 2, the
number of tests declined after the lock-in and this decline was sustained over
the following few years. The pre-lock-in six-month average per recipient was
14.30. After the lock-in, average six-month test utilization was 10.75 and 10.04
for the first and second post-lock-in periods, respectfully.
Emergency Department Visits-Figure 3
A hospital outpatient claim containing a code indicating an emergency room
charge (Revenue Code HR450-HR459) was used to determine the number of emergency
department (ED) visits. As Figure 3 illustrates, usage of the ED declined after
the lock-in for this group of recipients. Prior to the lock-in, ED visits were
approximately 4.06 per recipient for the six-month period. In the first year
after the lock-in, usage declined to 3.45 per recipient for that six-month
period. In year three post-lock-in, ED usage increased slightly to 3.66 per
recipient for the six month period; however, utilization continued to remain
lower than that in the pre-lock-in period.
Pharmacy Claims--Figure 4
As a proxy for prescription drug utilization, number of pharmacy claims per
recipient (includes prescription drugs, non-prescription medications covered by
Medicaid and other pharmacy-related items such as syringes, etc.) were examined
to determine the impact of the lock-in. Figure 4 shows that the lock-in had a
substantial impact on pharmacy utilization. In the six-month pre-lock-in period,
72.82 pharmacy claims were paid for each recipient in the study group. In the
first and second post-lock-in periods, the number of pharmacy claims declined to
52.80 and 52.04, respectfully.
Inpatient Days--Figure 5
Hospital inpatient claims were used to determine the impact of the lock-in on
inpatient days (this analysis does not include inpatient utilization where
Medicare was the primary payor). Number of "covered days" paid by
Medicaid was summed to determine the average number of inpatient days per
six-month period. In January through June prior to the lock-in, each recipient
in the study group used 2.48 inpatient days. After the lock-in, inpatient days
used per recipient declined to 1.88 for January through June of 1996 and
declined again to 1.63 for January through June of 1998.
Inpatient Admissions--Figure 6
The "admit date" in the hospital inpatient claims was used to
determine the average number of inpatient admissions for each of the three
six-month periods (This also does not include admission where Medicaid was the
primary payor). As Figure 6 shows, inpatient admissions declined from the
pre-lock-in level. In the six-month pre-lock-in period, each recipient in the
study group had 0.40 admissions. After the lock-in, admissions declined to 0.33,
first post-lock-in period, and then declined further to 0.32, second
post-lock-in period.
Conclusions
The goal of any lock-in program is, of course, to reduce utilization and
expenditures. However, it is also the goal of a lock-in program to achieve these
reductions by substituting physician-directed utilization for self-directed
utilization, thus assuring that inappropriate utilization has been reduced or
eliminated but access to appropriate utilization maintained. Based on the
results of this study, it appears that these goals have been achieved.
Reductions in outpatient utilization have been achieved without an increase in
inpatient days, inpatient admissions, or ED usage that could have resulted from
lack of appropriate outpatient care.
Limitations
As in any study conducted using claims data, it should be recognized that the
data were collected for the purpose of provider reimbursement and not for the
purpose of clinical studies. Thus, positive clinical outcomes (compared with
negative clinical outcomes) can only be inferred by the absence of an increase
in inpatient hospital and/or ED utilization. Additionally, this was a
longitudinal study with a single group, e.g., no control group. Thus, it was not
possible to control for other factors that may have affected utilization other
than the lock-in, such as the national trend toward outpatient utilization over
inpatient utilization, reimbursement rates, other DHH policies, etc. However,
analysis of claims data is a cost-effective method to examine health services
utilization, so long as the limitations of such analyses are recognized.
It should be noted that when utilization is used as evidence of eligibility,
there may be a bias toward high users. However, in this instance, the effect of
any such bias, if there is one, should be minimal as high utilization is a
pre-requisite to lock-in selection. It should also be noted that mortality data
were not available and this study does not examine or control for mortality.
Additional Information
For additional information or detailed operational definitions and data
analysis methodologies, contact Sandra G. Blake, Ph.D., Northeast Louisiana
University, School of Pharmacy, Monroe, LA 71209.
References
Physicians' Current Procedural Terminology. (1998). Chicago: American Medical
Association.
Blake SB. (1997) The Impact of the Louisiana Medicaid Lock-in Program on the
Process and Clinical and Economic Outcomes of Recipient Care. (Doctoral
Dissertation).
Hospital Services Manual. (1994) Department of Health and Hospitals Bureau of
Health Services Financing.
1999 Unisys Provider Workshops
|
CITY
|
DAY,
DATE, TIME, AND SESSION
|
|
|
|
Baton
Rouge
|
Tuesday,
September 28
|
Wednesday,
September 29
|
|
|
Room
1
|
Room
2
|
Room
1
|
Room
2
|
|
LA
State Police Training Academy
7901 Independence Blvd.
Baton Rouge, LA
(225) 925-6121
|
8:30 - 9:30 - Long Term Care
10:00 - 12:00 - Basic
1:00- 3:00 - Basic
3:30 - 4:30 - Home Health/Rehab
4:45 - 5:45 - DME
|
8:30 - 9:30 - Case
Management
9:45 - 11:00 - Waiver
11:15 - 12:15 - Dental
1:30 - 2:30 - EPSDT
2:45 - 3:45 - Ambulance
4:00 - 5:00 - NEMT
|
8:30 - 9:30 - Mental Health
Rehab
10:00 - 12:00 - Basic
1:00 - 3:00 - Basic
3:30 - 4:30 -RHC/FQHC
|
8:30 - 9:30 - KIDMED
10:00 - 12:00 - Professional
1:30 - 2:30 - Hospital
|
|
Mandeville
|
Thursday,
September 30
|
|
|
|
|
Castine
Center at Pelican Park
63350 Pelican Dr. (off US
Hwy. 190)
Mandeville, LA
70448
(504) 626-7997
|
8:30 - 10:30 - Professional
11:00 - 1:00 - Basic
1:30 - 2:30 - Hospital
3:00 - 4:00 - Case
Management
4:15 - 5:15 - Waiver
|
|
|
|
|
Shreveport
|
Monday,
October 4
|
Tuesday,
October 5
|
|
|
Room
1
|
Room
2
|
Room
1
|
Room
2
|
|
Bossier
Civic Center
620 Benton Rd.
Bossier City, LA
(318) 741-8900
|
8:30 - 9:30 - Long Term Care
10:00 - 12:00 - Basic
1:00- 3:00 - Basic
3:30 - 4:30 - Home Health/Rehab
4:45 - 5:45 - DME
|
8:30 - 9:30 - Case
Management
9:45 - 11:00 - Waiver
11:15 - 12:15 - Dental
1:30 - 2:30 - EPSDT
2:45 - 3:45 - Ambulance
4:00 - 5:00 - NEMT
|
8:30 - 9:30 - Mental Health
Rehab
10:00 - 12:00 - Basic
1:30 - 2:30 - Hospital
3:00 - 4:30 -
Precertification
|
8:30 - 9:30 - KIDMED
10:00 - 12:00 - Professional
1:00 - 3:00 - Basic
3:30
- 4:30 -RHC/FQHC
|
|
Monroe
|
Wednesday,
October 6
|
Thursday,
October 7
|
|
|
Room
1
|
Room
2
|
Room
1
|
Room
2
|
|
Holiday
Inn - Holidome
1051 US Hwy. 165 Bypass
Monroe, LA
(318) 387-5100
|
8:30 - 9:30 - Long Term Care
10:00 - 12:00 - Basic
1:00- 3:00 - Basic
3:30 - 4:30 - Home Health/Rehab
4:45 - 5:45 - DME
|
8:30 - 9:30 - Case
Management
9:45 - 11:00 - Waiver
11:15 - 12:15 - Dental
1:30 - 2:30 - EPSDT
2:45 - 3:45 - Ambulance
4:00 - 5:00 - NEMT
|
8:30 - 9:30 - Mental Health
Rehab
10:00 - 12:00 - Professional
1:00 - 3:00 - Basic
3:30
- 4:30 -RHC/FQHC
|
8:30 - 9:30 - KIDMED
10:00 - 12:00 - Basic
1:30 - 2:30 - Hospital
|
|
Lake
Charles
|
Wednesday,
October 13
|
Thursday,
October 14
|
|
|
Room
1
|
Room
2
|
Room
1
|
Room
2
|
|
Lake
Charles Civic Center
900 Lakeshore Dr.
Lake Charles, LA
(318) 491-1256
|
8:30 - 9:30 - Long Term Care
10:00 - 12:00 - Basic
1:00- 3:00 - Basic
3:30 - 4:30 - Home Health/Rehab
4:45 - 5:45 - DME
|
8:30 - 9:30 - Case
Management
9:45 - 11:00 - Waiver
11:15 - 12:15 - Dental
1:30 - 2:30 - EPSDT
2:45 - 3:45 - Ambulance
4:00 - 5:00 - NEMT
|
8:30 - 9:30 - Mental Health
Rehab
10:00 - 12:00 - Basic
1:00 - 3:00 - Basic
3:30
- 4:30 -RHC/FQHC
|
8:30 - 9:30 - KIDMED
10:00 - 12:00 - Professional
1:30 - 2:30 - Hospital
|
|
Alexandria
|
Tuesday,
October 19
|
Wednesday,
October 20
|
|
|
Room
1
|
Room
2
|
Room
1
|
Room
2
|
|
Hotel
Bentley
200 DeSoto
Alexandria, LA
(318) 448-9600
|
8:30 - 9:30 - Long Term Care
10:00 - 12:00 - Basic
1:00- 3:00 - Basic
3:30 - 4:30 - Home Health/Rehab
4:45 - 5:45 - DME
|
8:30 - 9:30 - Case
Management
9:45 - 11:00 - Waiver
11:15 - 12:15 - Dental
1:30 - 2:30 - EPSDT
2:45 - 3:45 - Ambulance
4:00 - 5:00 - NEMT
|
10:00 - 12:00 - Basic
1:00 - 3:00 - Basic
3:30
- 4:30 -RHC/FQHC
|
8:30 - 9:30 - KIDMED
10:00 - 12:00 - Professional
1:30 - 2:30 - Hospital
3:00 - 4:30 - Precertification
|
|
Lafayette
|
Monday,
October 25
|
Tuesday,
October 26
|
Wednesday,
October 27
|
|
|
Room
1
|
Room
2
|
|
|
|
Holiday
Inn - Holidome
2032 NE Evangeline Thruway
Lafayette, LA
(318) 233-6815
NOTE:
Workshops will be held on three
days in Lafayette.
|
8:30 - 9:30 - Long Term Care
10:00 - 12:00 - Basic
1:00- 3:00 - Basic
3:30 - 4:30 - Home Health/Rehab
4:45 - 5:45 - DME
|
8:30 - 9:30 - Case
Management
9:45 - 11:00 - Waiver
11:15 - 12:15 - Dental
1:30 - 2:30 - EPSDT
2:45 - 3:45 - Ambulance
4:00 - 5:00 - NEMT
|
9:00 - 11:00 - Professional
1:00 - 3:00 - Basic
3:30
- 4:30 - KIDMED
|
8:30 - 9:30 - Hospital
10:00 - 12:00 - Basic
1:30 - 2:30 - RHC, FQHC
|
|
New
Orleans
|
Monday,
November 1
|
Tuesday,
November 2
|
|
|
Room
1
|
Room
2
|
Room
1
|
Room
2
|
|
Hilton
Riverside
Poydras at the Mississippi
River
New Orleans, LA
(504) 561-0500
NOTE:
A discounted event rate of $6.00 per day parking fee is charged by
the Hilton.
|
8:30 - 9:30 - Long Term Care
10:00 - 12:00 - Basic
1:00- 3:00 - Basic
3:30 - 4:30 - Home Health/Rehab
4:45 - 5:45 - DME
|
8:30 - 9:30 - Case
Management
9:45 - 11:00 - Waiver
11:15 - 12:15 - Dental
1:30 - 2:30 - EPSDT
2:45 - 3:45 - Ambulance
4:00 - 5:00 - NEMT
|
8:30 - 9:30 - Mental Health
Rehab
10:00 - 12:00 - Basic
1:00 - 3:00 - Basic
3:30
- 4:30 -RHC/FQHC
|
8:30 - 9:30 - KIDMED
10:00 - 12:00 - Professional
1:30 - 2:30 - Hospital
3:00 - 4:30 - Precertification
|
- Please note workshops in all
locations will be held on 2 consecutive days with the exception of Lafayette
which will be held on 3 consecutive days.
1999 Unisys Provider Workshops
In this issue is the schedule for the 1999 Unisys Provider Workshops. Our
training format has been revised to accommodate numerous requests to separate
basic information from specific program information. The basic Medicaid
information workshops will cover general Medicaid policy such as standards for
participation, recipient eligibility and ID cards, third party liability, how to
obtain assistance from Unisys, etc. This information will be presented ONLY in
the basic sessions and will not be repeated in specific program workshops.
In
each specific program workshop, Unisys staff will discuss (for that specific
Medicaid program) recent policy or procedure changes and will address frequent
claim denial causes and resolutions. Basic information such as eligibility,
third party liability, etc. WILL NOT be presented in the specific program
workshops.
All basic Medicaid information workshop sessions will be identical in
content. Providers may choose to attend any of the basic sessions in addition to
their specific program, or they may choose to attend only the specific program
session for their provider type.
Hospital training and precertification training
are being held as separate sessions this year. Personnel from the Utilization
Review Department of each hospital and those involved in precertification for
inpatient admissions should attend the precertification workshop, which will
contain information specifically for precertification. The hospital workshop
will focus on hospital policy in general and on billing policies and procedures.
Hemodialysis facility billing will not be included.
Pharmacy training and hemodialysis facility training will not be held with
the other Medicaid workshops this year. Pharmacy providers will be notified of
other arrangements for training as that information becomes available. Pharmacy
providers who are also DME providers should attend the DME workshop, however.
Due to space limitations in all workshops, only personnel involved in billing
should be in attendance (with the exception of the precertification workshop).
Attendees should arrive 15 - 20 minutes early to register. Remember,
-each person MUST have
his or her provider name and Medicaid provider ID number in order to register and attend, and
-providers are required to have a valid Medicaid provider ID number for each
specific program workshop attended (except where noted below).
Medicaid Programs for discussion at the workshops include:
1. Basic Medicaid Information (Basic): All providers may attend. Basic
Medicaid information will be presented, including standards for participation,
recipient eligibility and ID cards, third party liability, remittance advice
review, how to obtain assistance from Unisys, Provider Relations information,
common denial reasons and methods of correction, etc. Also included in this
session will be information on policy and participation in the Community Care
Program. This information will not be repeated in any of the specific program
workshops.
2. Professional: Physicians, Labs, Optometrists, Chiropractors,
Ambulatory Surgery Centers, Optical Suppliers, Nurse Practitioners,
Audiologists, Nurse Midwives, CRNAs, Hemodialysis (supervision ONLY), Mental
Health Clinics, and Substance Abuse Clinics.
3. Hospital: Acute, Rehabilitation, Long Term, Free-standing Psych, and
Distinct Part Psych hospitals. Hospital policy and billing issues will be
presented. Hemodialysis facility billing will not be included.
4. Precertification: Hospital Utilization Review or other personnel
involved in obtaining precertification. Precertification workshops will be held
in Alexandria, Shreveport, and New Orleans ONLY and will include policy and
procedures specific to precertification (not billing).
5. Long Term Care: Nursing and ICF/MR Facilities and Hospice Services.
6. Mental Health Rehabilitation Agencies: Workshops will NOT be held in
Alexandria or Lafayette.
7. Home Health Agencies and Rehabilitation Centers: Home Health providers
who are also DME providers should attend both the Home Health and DME sessions.
8. Durable Medical Equipment (DME) Suppliers: Pharmacists who are also
DME providers should attend this workshop also.
9. Dental: EPSDT and Adult and Oral Surgery.
10. Ambulance Transportation: Ambulance providers only--does not include
non-emergency non-ambulance transportation.
11. Non-emergency Medical Transportation (NEMT): Non-emergency
non-ambulance providers only--does not include ambulance transportation.
12. EPSDT: EPSDT Health Services (school boards and Early Intervention
Centers) ONLY. Billing for EPSDT PCS services will not be discussed. PCA
providers who bill for EPSDT PCS services should attend the Waiver workshop
indicated below.
13. Rural Health Clinics and Federally Qualified Health Centers (RHC/FQHC)
14. KIDMED
15. Case Management:
Contract case management providers and targeted case
management providers. Waiver providers may also attend this session for
informational purposes.
16. Waiver: MR/DD, PCA, and Elderly waiver providers.
EPSDT PCS providers and Adult Day Habilitation Center providers should also
attend. Case management providers may also attend this session for informational
purposes.
Please refer to the schedule for dates and times at each workshop
location. Note that there may be more than one session held at the same time.
There is no pre-registration required. Please direct any questions concerning
the workshops to Unisys Provider Relations at 800/473-2783 or 225/924-5040.
Meeting sites should be contacted for directions or sleeping accommodations
ONLY!