We have created a provider manual for inpatient hospital quality assurance. The alabama medicaid provider billing manual is a practical guide to assist medicaidenrolled providers in receiving reimbursement. Provider manual claims for these ancillary services are subject to medical policy and fragmented coding edits in place at the blue plan to which they are filed. Jul 19, 2016 code, and the alabama medicaid provider manual. The alabama medicaid provider billing manual is a practical guide to assist medicaid enrolled providers in receiving reimbursement. This will take you to a table of contents for that particular manual.
Click on the title of the chapter you wish to view or print. December 26, 2014 department of examiners of public accounts 50 north ripley street, room 3201 p. Dec 30, 2014 provider web portal application w9 tax form can be faxed with the alabama medicaid participation requirements revised january 2015. For complete details of the rules and regulations, you may reference the alabama medicaid agency website. Alabama medicaid agency and qualis health hospital quality assurance provider manual 2014. Feb 1, 2014 al medicaid management information system provider manual, p. Providerone billing and to most medicaid providers. Alabama medicaid agency, alabama medicaid provider manual, 2847 july 2014. Medicaid covered services and member eligibility end of update log chapter. Jan, 2020 the alabama hospital association aha estimates that an additional 340,000 people in alabama would gain access to health coverage if the state were to adopt medicaid expansion.
The ancillary claim filing rules apply regardless of the providers contracting status with any blue plan. Jan 2, 2017 smoking cessation products are covered by alabama. Rn can bill epsdt services and the following family planning services. This will load that chapter into the acrobat adobe reader. Medicaid rehabilitation option mro provider manual library reference number. A federal government website managed and paid for by the u. Alabama medicaid agency alabama medicaid reimburses for live video for the medical assistance provider billing manuals for ambulatory. State of alabama recovery audit state agencies and departments october 1, 2008 through september 30, 2011 conducted by recovery audit specialists, llc filed. Can you explain this new alert requirement to add the left or right modifier for procedures when only performed unilaterally. Campaign adph and the alabama department of mental health launch a statewide campaign, stop judging. In alabama, adult day care adc and adult day health adh services are provided under multiple state programs, including two medicaid 1915c waiver programs.
November 25, 2014 introduction the alabama medicaid plan first program began october 1, 2000. State of alabama alabama medicaid agency alabama plan first. State of alabama alabama medicaid agency alabama plan oct 29, 2014 the alabama medicaid agency will continue the plan first waiver in the the state of alabama requests the renewal of this waiver for three faqs from manufacturers alabama medicaid alabama. Alabama medicaid management alabama medicaid agency. All hospitals, prospective rcos and other interested stakeholders. Update from alabama medicaid coronavirus disease 2019 covid19 may 15, 2020 the alabama medicaid agency medicaid continues to work with the alabama department of public health adph and other state and federal agencies to stay uptodate the spread of covid19 in alabama. A onepage overview of schoolbased medicaid administrative claiming. The public was notified that they could attend the. Alabama medicaid was granted an automatic extension of its 1115 waiver by cms, to run through december 31, 2014. Jan 1, 2014 statement, a report that lists claim and payment activity for a provider secondary identifier when filing claims for a specific service location. A diagnosis of asd now includes several conditions that used to be diagnosed separately. Alabama medicaid applied for a three year renewal of the waiver and was granted an extension to continue family planning services for three years, beginning january 1, 2015, through. State of alabama request for information alabama department of.
The proposal called for medicaid funds to be distributed on a perpatient basis to regional care organizations rcos, most of which would be affiliated with local hospitals. Cross over claims will continue to be reimbursed as a continuous rental when submitted as a rental. Ahcccs medical policy manual ampm information regarding covid19 in response to medicaidrelated questions from providers and contractors arising from the covid19 pandemic, ahcccs has developed a list of frequently asked questions faqs regarding coronavirus disease 2019 covid19 which is updated regularly. A description of the state plan services offered through the ama is found in the appendix a section of this manual or on the medicaid website. State efforts to exclude 340b drugs from medicaid managed. Sep 7, 2017 medicaid eligibility and posteligibility if applicable requirements, and procedures for the evaluation as indicated in section 1 of this appendix, the waiver is not operated by another divisionunit within. Jan 1, 2014 acceptance of crossover claims from medicare that began with. Alabama medicaid inpatient hospital quality assurance.
Aug 16, 2018 in may 2014, alabama submitted a section 1115 demonstration waiver proposal to cms, called alabama medicaid transformation. Alabama, june 2014 cpt code diagnostic code community health center medicare state medicaid comments 1 billable encounter per day. Refer to hospitals are assigned a provider type of 01 hospital. On december 29, 2014, cms granted alabama medicaid an extension of its 1115 family planning demonstration waiver to continue family planning services through december 31, 2017. Only unresolved problems or provider dissatisfaction with the response of the fiscal agent should be. The secure site gives providers, clerks and billing agents the opportunity to view claim and prior authorization status as well as eligibility verification inquiries and to upload and download standard x12 and ncpdp transactions. Indiana mac time study participant manual updated july 2016. Free electronic billing software for medicaid providers. Alabama plan first medicaid family planning fiscal quarter 1. Alabama medicaid agency and qualis health hospital quality assurance provider manual 2014 4 this document is intended as a reference guide only. August 29, 2014 introduction the alabama medicaid plan first program began october 1, 2000. During this time, eligibility inquiries are available through our telephone system at 1 866 6864272.
Effective for dates of service on or after april 1, 2014, alabama medicaid will reimburse e0570 nebulizer as purchase only, excluding crossover claims. Instead, use the navigation section within the application. The ama contracts with a fiscal agent to process and pay all claims submitted by. You can see the status of an application, change personal information, change providers, request a new card or see when you are eligible. Alabama medicaid authorizes telemedicine for prenatal visits during covid19 emergency additional extension for covid19 emergency expiration date hospice claims reprocessed due to increased per diem rate for nursing facilities related to covid19 health emergency. You can also find it on the provider resources page. The idaho medicaid website is down each week from 4 pm on saturday to 10 am on sunday for regular maintenance. Print book function for robohelps webhelp is licensed from. Alabama plan first medicaid family planning demonstration. The new expiration date is may 30, 2020, or at the conclusion of the covid19 national emergency, whichever occurs first.
It represents a collaborative effort between the alabama medicaid agency and the alabama department of public health to increase the availability of family planning services to all women of childbearing age 1955 with incomes at or. All kids will extend coverage for up to sixty days during the renewal months of april, may and june for children who are not eligible due to nonpayment, nonresponse or are over the income level. Provider manual blue cross and blue shield of alabama. Visit national correct coding initiative edits for information about, and edits for, the medicare ncci program. Chapter 1 general zip chapter 2 state organization zip chapter 3 eligibility zip chapter 4 services zip chapter 5 early and periodic screening zip. Autism spectrum disorder asd is a developmental disability that can cause significant social, communication and behavioral challenges. These manuals require javascript and cookies enabled. Sep 14, 2014 the district of columbias medicaid manual currently does not indicate. Title xix medical assistance state plan for alabama medicaid provides claim adjustment reason codes and remittance advice remark jan 4, 2017 claim adjustment reason codes and remittance advice remark codes. Medicaid coverage groups 8 continuity of care 9 provider information 10 providers designated as primary care physicians pcps 10 the role of the primary care physician pcp 10 the role of the specialist physician 10 administrative, medical andor reimbursement policy changes 11 communication among providers 11 provider marketing guidelines 11. Welcome to the alabama medicaid interactive web site.
Theresa richburg, director, medical services division statutory authority. All psychologists during the past year, a workgroup consisting of alabama medicaid agency staff and representatives from the alabama psychological association has collaborated to identify changes that enable the agency to maintain a basic package of services while preserving the health. Information and forms to enroll as an alabama medicaid provider. Any changes to this standard maintenance window will be communicated via an announcement on this website. Medicaid pays for 14 doctor visits per calendar year. Agency provider manual, appendix c located on alabama medicaid s website. Secure site the agency has once again extended all previously published expiration dates related to the coronavirus covid19 emergency. For example, the definition of 69436 tympanostomy, requiring. Summary of proposed demonstration the plan first program is designed to reduce pregnancies and improve the wellbeing of children and families in alabama by extending medicaid eligibility for family planning services to. Currently, the center for disease control and prevention estimates. Questions on billing, claims, prior authorization and programs. Such manual is guidance for providers in filing and preparing claims. Jul 29, 2014 gao found, based on a questionnaire sent to state medicaid agencies, that states financed.
Oct 29, 2014 that are offered through the alabama medicaid agency, including. Plus and wisconsin medicaid 2015, badgercare plus and wisconsin medicaid policy manual, chapter 300. The alabama medicaid agency the agency will be converting hospital inpatient pricing for feeforservice recipients from a per diem calculation to a per discharge calculation based on all patient refined diagnosis related groups aprdrgs effective october 1, 2016. Southern states with medicaid expansion saw improved overall. Do not attempt to use the backforward buttons in the browser. According to a july 2014 report from the pew charitable trusts, in 2010 there were 1,015,576 alabama residents enrolled in medicaid. The first public hearing was held on july 9, at the alabama medicaid agency in montgomery, al. By 20, medicaid covered 17 percent of alabama residents. The second public hearing was held at the alabama medicaid agency district office in birmingham, al on july 10.
A 2018 study also found that hospitals in states with medicaid expansion are about six times, or 84%, less likely to close than states with did not adopt expansion. Home substance use disorder prevention synar reports synar reports 15. Feb 28, 2012 office of the alabama health insurance exchange hix related to screening. States current medicaid and chip programs outside of eligibility, benefits, cost sharing or delivery systems. Alerts, publications and information for medicaid providers. Sep 21, 2015 alabama medicaid participation requirements. Fee scheduleprovider manuals license for use of current procedural terminology, fourth edition cpt and current dental terminology cdt you must indicate your agreement and acceptance of the following license agreements by clicking below on the button labeled i accept. Medicaid billing guidebook updated december 2017 the guidebook is a highlevel overview of medicaid claiming for schoolbased health services and related administrative activities in indiana. The wechsler intelligence scale for childrenfifth edition wiscv. Cross over claims will continue to be reimbursed as a continuous rental when submitted as a. This site is intended for providers, clerks, and trading partners. This website is for alabama medicaid recipients or people who have applied for alabama medicaid services.
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