4S Ochsner Med School 2 19,20 OPH Registered Dietitian 1 AU 4U Waiver Services 1 42 4W 4X Waiver-Only Transportation 1 42 4Y EHR Managed Care (Medical) 2 IP PCS-LTC 1 24 5A 5B PCS-EPSDT 1 24 5C PAS 1 24 PCS-LTC, PCS-EPSDT 1 24 5D 5E PCS-LTC, PAS 1 24 5F PCS-EPSDT, PAS 1 24 5G PCS-LTC, PCS-EPSDT, PAS 1 24 Community Mental Health Center 18 5H 5I Statewide Management Organization (SMO) 1 AB 5J Youth Support 1 AC Family Support 1 AC 5K 5L Both Youth and Family Support 1 AC 5M Multi-Systemic Therapy 12 Substance Abuse and Alcohol Abuse Center 1 68 5N 5P PACE 1 50 5Q CCN-P (Coordinated Care Network, Pre-paid) 1 05 CCN-S (Coordinated Care Network, Shared 1 52 5R Savings) 5S Tulane Med School 2 19,20 5T Community Choices Waiver (CCW) 1 Individual 1 AD 5U 5V Agency/Business 1 AD 5W Community Choices Waiver - Personal Assistance 2 87 44 Service 5X Therapeutic Group Homes 1 AT 5Y PRCS Addiction Disorder 1 Therapeutic Group Home Disorder 1 5Z Psychologist -Clinical 1 31 6A 6B Psychologist-Counseling 1 31 6C Psychologist - School 1 31 Psychologist - Developmental 1 31 6D 6E Psychologist - Non-Declared 1 31 6F Psychologist - All Other 1 31 Medical Psychologist 1 31 6G LaPOP 1 01 6H 6N Endodontist 1 27 Periodontist 1 27 6P E Jefferson Fam Practice Ctr - Residency Program 2 19,20 6S 6T Community Choices Waiver - Physical Therapy 2 65, 87, 75 35, 44, 65 6U Applied Behavioral Analyst 1 AX Licensed Mid-Wife 1 MW 6W Type: Related Related Specialty 1=Specialty, Specialty (if Provider Code Description 2=Subspecialty Subspecialty) Types
4S Ochsner Med School 2 19,20 4U OPH Registered Dietitian 1 AU 4W Waiver Services 1 42 4X Waiver-Only Transportation 1 42 4Y EHR Managed Care (Medical) 2 IP 5A PCS-LTC 1 24 5B PCS-EPSDT 1 24 5C PAS 1 24 5D PCS-LTC, PCS-EPSDT 1 24 5E PCS-LTC, PAS 1 24 5F PCS-EPSDT, PAS 1 24 5G PCS-LTC, PCS-EPSDT, PAS 1 24 5H Community Mental Health Center 18 5I Statewide Management Organization (SMO) 1 AB 5J Youth Support 1 AC 5K Family Support 1 AC 5L Both Youth and Family Support 1 AC 5M Multi-Systemic Therapy 12 5N Substance Abuse and Alcohol Abuse Center 1 68 5P PACE 1 50 5Q CCN-P (Coordinated Care Network, Pre-paid) 1 05 5R CCN-S (Coordinated Care Network, Shared Savings) 1 52 5S Tulane Med School 2 19,20 5T Community Choices Waiver (CCW) 1 5U Individual 1 AD 5V Agency/Business 1 AD 5W Community Choices Waiver - Personal Assistance Service 2 87 44 5X Therapeutic Group Homes 1 AT 5Y PRCS Addiction Disorder 1 5Z Therapeutic Group Home Disorder 1 6A Psychologist -Clinical 1 31 6B Psychologist-Counseling 1 31 6C Psychologist - School 1 31 6D Psychologist - Developmental 1 31 6E Psychologist - Non-Declared 1 31 6F Psychologist - All Other 1 31 6G Medical Psychologist 1 31 6H LaPOP 1 01 6N Endodontist 1 27 6P Periodontist 1 27 6S E Jefferson Fam Practice Ctr - Residency Program 2 19,20 6T Community Choices Waiver - Physical Therapy 2 65, 87, 75 35, 44, 65 6U Applied Behavioral Analyst 1 AX 6W Licensed Mid-Wife 1 MW Specialty Code Description Type: 1=Specialty, 2=Subspecialty Related Specialty (if Subspecialty) Related Provider Types
PIHP_CSoC_SystemsCompanionGuide-Sept2018_V12.docx