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TO: Independent Rural
Health Clinics (IRHC) Providers
Effective for date of
service April 1, 2018 or later, Alabama
Medicaid (Medicaid) will require IRHCs to bill the exact or closest procedure
code for the service being performed. During claims processing, submitted procedure
codes will systematically roll into a T1015 procedure code to generate an
encounter rate.
How can
an IRHC help ensure they receive payment?
·
Itemize
the billing to services they are performing
·
Utilize
the Current Procedure Terminology (CPT) Code Book
·
Document
medical support in the recipient chart to justify level of care billing
·
Submit
a clean claim (refer to Provider Manual Chapter 5)
Note*
Billing for services within the encounter must be under the IRHC National
Provider Identifier (NPI).
What services
are billable and reimbursable outside of the encounter rate?
·
Vaccines
for Children (VFC) 18 years and under
·
Deliveries
·
Surgeries
with place of service 21 or 22
·
Labs
·
Technical
component for:
o Electrocardiograms
(EKG’s)
o Radiology
·
Intrauterine
Devices (IUDs)
·
Smoking
cessation products (under family planning)
Note* Billing
for services outside the encounter must be under the non IRHC National Provider
Identifier (NPI)
and on a separate claim.
Medicaid commits to ensuring a smooth transition:
·
Medicaid
welcomes providers with interest in testing.
For questions or assistance regarding testing, please email the Medicaid
Fiscal Agent at AlabamaIRHCTest@groups.ext.hpe.com.
·
Dates
for testing will be March 1-16, 2018, for claims with dates of service December
1, 2017, or later.
For questions regarding the
IRHC reimbursement, please contact the Medicaid Fiscal Agent, Provider
Assistance Center at 1-800-688-7989.