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RE: New Requirements for Fee-For-Service Delivery Claims
Effective for claims received on or after February 1, 2018,
fee-for-service delivery claims for recipients who reside in a county not
served by an Alabama Medicaid (Medicaid) Maternity Care Program must contain
the date of last menstrual period and the date of first prenatal visit. This
information is not required for hospital claims.
Counties not included in a Medicaid Maternity Care Program:
District 10: Autauga, Bullock, Butler, Crenshaw, Elmore, Lowndes,
Montgomery and Pike
District 12: Baldwin, Clarke, Conecuh, Covington, Escambia, Monroe and
Washington
Soft Denial:
Claims without the date of last menstrual period and the date of first prenatal
visit will receive a “soft” denial. This means the claim will process,
but the provider will receive an alert to remind them to include the
information.
Hard Denial:
On August 1, 2018, claims that do not include the date of last menstrual
period and the date of first prenatal visit will be denied.
Some examples of what a provider can expect to see on the denied claim
include:
Edit 330-DTP SEGMENT DATE IS INVALID
Edit 331-DATE LAST MENSTRUAL PERIOD MISSING OR IN FUTURE
Edit 332-DATE FIRST PRENATAL VISIT MISSING OR IN FUTURE
Claims with the procedure codes below must include date of last menstrual
period and date of the first prenatal visit:
- 59400-59410 Vaginal
delivery
- 59510-59515 Cesarean
delivery
- 59610-59622 Delivery after
previous cesarean delivery
How can a fee-for-service provider
submit a claim?
- For claims submitted through 5010 X12 837P:
1.
Enter the date of the patient’s last menstrual period in a DTP segment in
loop 2300
with a qualifier of
484
2. Enter the date of the patient’s first
prenatal visit in a DTP segment in loop 2300 with
a qualifier of 454 - For claims submitted on the Medicaid Interactive Web
Portal:
1. Enter the date of the patient’s last menstrual
period in the field labeled “last
menstrual period
date”
2. Enter the date of the patient’s first prenatal
visit in the field labeled “first prenatal
visit date” - For paper claims submitted on a CMS form 1500:
1. Enter the patients last
menstrual period in block 14
2. Enter QUAL the value “484”
to identify the information in block 14 as the date of the
last
menstrual period
3. Enter QUAL the value “454”,
which identifies the information entered as the date of
the
first prenatal visit in block 15
4. Enter the date of the
patient’s first prenatal visit in block 15
5. If no prenatal care was
received, the date entered in block 15 should be the date of
first
contact during the pregnancy.
*Reminder: Medicaid requires all claims be filed electronically
unless they are required to be submitted on paper. - PES does not currently allow claims to be submitted
with this information, but a software upgrade will be available prior to
claims denying for not containing the information.
Note:
Providers within the Maternity Care Program must continue to follow
guidelines outlined in the April 13, 2017, ALERT. Please visit http://medicaid.alabama.gov/alert_detail.aspx?ID=12209
for a copy of the ALERT.
Please direct questions to the Fiscal Agent, Provider Assistance Center at
(800) 688-7989.
The Current Procedural
Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright
© 2018
American Medical Association and © 2018 American Dental Association (or such other date
publication of CPT and CDT). All rights reserved.
Applicable FARS/DFARS apply.