March 8, 2018

State of Alabama
Press Release: Medicaid

Changes to Billing Effective April 1, 2018

PDF Version
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.


 




  • For more information, visit http://medicaid.alabama.gov
  • For more state-wide press releases, click here