TO: Hospitals
and Prenatal Care Providers
The passage of
the Bipartisan Budget Act of 2018 requires states to “cost avoid” claims for
prenatal services when there is a known liable third party. Prior to this
change, states were federally required to “pay and chase” claims with a
designated prenatal procedure or diagnosis code. The federal “pay and chase”
provision enabled providers to bill Medicaid for prenatal care and receive payment
without having to bill the other third party. Medicaid was required to seek
reimbursement from the other liable third party.
Because of this
federal change, the Alabama Medicaid Agency will implement changes within its
claims processing system to require providers to bill other known insurance
coverage prior to receiving Medicaid payment for prenatal services. Effective
January 1, 2019, for prenatal services claims received for dates of services on
or after February 9, 2018, Alabama
Medicaid will deny claims when there is other insurance coverage, but no
payment or denial by the other insurance is indicated on the claim.
Once the
provider has billed the third-party carrier, if a denial is received or a
balance remains, the provider may then submit the claim to the Alabama Medicaid
Agency for consideration of payment.
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.