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TO: All Medicaid Enrolled Providers
Alabama Coordinated Health Networks (ACHNs) began
operation on October 1, 2019, and recipients were attributed to providers enrolled
with Medicaid on that date. Referrals to specialists will continue to be
required in the ACHN Program. Below are several key items related to the
referral process that specialists need to be aware of during the transition to
the ACHN Program:
· Referrals dated prior to 10/1/2019
continue to be valid until the expiration date of the referral.
· The recipient’s PCP should be
contacted for a referral, if one is needed on or after 10/1/2019.
· If the recipient does not have a PCP,
then the specialist may contact the ACHN for a billing referral until a PCP can
be identified for the recipient.
· Specialists (including Oncologists
and Hematologists) should not request PCP referrals from health departments,
other specialists, or Children’s Rehabilitation Services (CRS).
v Exception: Mobile and Jefferson
County Health Departments are considered PCP Groups and should be available to
provide a PCP referral to a specialist.
·
For
details on provider types, specialties and services that require referrals, see
Chapter 40 of the Provider Billing Manual. Chapter 40 is available on the
following link: https://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals/7.6.1.4G_Oct2019/Oct19_40.pdf
For Teaching
Facilities Only:
· Specialists linked to a teaching
facility will not require referrals and may also make referrals to other
specialists. Medicaid considers all providers linked to teaching facilities as part
of a PCP Group.
Webinar Specifically
for Specialists
Medicaid provided
a webinar for specialists on 10/9/2019. Visit https://medicaid.alabama.gov/content/5.0_Managed_Care/5.1_ACHN/5.1.3_ACHN_Providers.aspx
to view a recording of the webinar and
to find other important information about the ACHN.
Questions about the ACHN program may
be emailed to ACHN@medicaid.alabama.gov.