CommercialAdministrativeHigh impact
Network News - 2nd Quarter 2019
Blue Cross and Blue Shield of Louisiana·LA·Provider News
Effective date
Jul 27, 2019
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Louisiana is implementing a new Optum claims-editing software system on July 27, 2019, which will change how claims are processed and may affect allowable charges. The system applies updated industry-standard coding edits, bundling rules, and modifier requirements that could impact reimbursement.
Action Required
By July 27, 2019: Billing team must access the new code-editing tool in iLinkBlue to understand new system logic. Update billing procedures for new patient visits (codes 99201-99205 will deny if patient seen by same provider within 3 years), ensure Modifier 50 billing uses only one unit per line, and verify NP/PA assistants use Modifier AS. Urgent care clinic nurse practitioners must append Modifier SA to all services. Review updated drug allowables effective September 1, 2019, and HCPCS/DME allowables effective July 1, 2019. Attend mandatory webinars July 9-10 or August 6-7.