April 29, 2014

State of Alabama
Press Release: Medicaid

Change to use of Group NPI and Non-enrolled Physicians in Patient 1st Program

  TO:     All Physicians and Enrolled Patient 1st Providers

 

The Alabama Medicaid Agency is making changes to the Patient 1st program on June 1, 2014, to more precisely track referrals, and to improve patient care management and provider payment accuracy.  These changes will also allow Medicaid to track performance measures of a Primary Medical Provider (PMP) in a more efficient manner.

 

The new changes are:

 

1.    The group NPI number will no longer be recognized for referrals. 

This means the referring provider number on the claim must be the NPI of the referring physician, not the NPI of the group.  A group NPI number will cause the claim to deny.

2.    Physicians who are not enrolled as a Patient 1st provider will no longer be able to make referrals for or on behalf of an enrolled PMP and can only provide services if the patient was referred to them by a Patient 1st enrolled provider.

 

3.    A self- referral will no longer be required for PMP’s who see patients at different locations. 

 

ACTION NEEDED:

Enrollment in the PMP program will ensure payment.  Physicians not enrolled with Patient 1st are encouraged to complete the online application as soon as possible.

 

Individual Providers:

The application is available on Medicaid’s website at:  www.medicaid.alabama.gov under Providers>Provider Enrollment>Forms for Provider Enrollment>under Administrative Forms >Patient 1st Provider Enrollment.  Questions concerning the application process should be directed to the Provider Enrollment Unit at:  1-888-223-3630. 

 

Individual Providers in a Group:

Individual providers within a PMP enrolled group may update the Group/Clinic Patient 1st Update Form and fax to Provider Enrollment at 334-215-4298.  This form is located on the following link: http://medicaid.alabama.gov/documents/5.0_Resources/5.4_Forms_Library/5.4.4_Medical_Services_Program_Forms/5.4.4.7_Patient1st/5.4.4.7_Group_Clinic_Patient1st_Update_Form_Revised_5-14-14.pdf.  This will ensure a smooth enrollment of an individual PMP within a group.   

 

For more information regarding these changes, please contact Latonda Cunningham via e-mail at Latonda.cunningham@medicaid.alabama.gov. 

 

 



  • For more information, visit http://medicaid.alabama.gov
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