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NOTE:
THIS ALERT IS A CLARIFICATION
FOR THE ALERT DATED JANUARY 30, 2018
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 procedure code(s) for the service(s) 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 under the IRHC National Provider Identifier (NPI)
and on a separate claim?
•
Vaccines for Children
(VFC) 18 years and under
What services are billable and reimbursable
outside of the encounter rate under the non IRHC National Provider Identifier
(NPI) and on a separate claim?
•
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)
•
EPSDT Vision Screenings, Hearing Screenings,
Cognitive Assessments,
and Behavioral Assessments when applicable.
Medicaid is committed 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.
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.