In 2012, 60 million people were enrolled in medicaid. Provider selfauditing is an administrative method that may be useful in a program integrity office setting. Questions on billing, claims, prior authorization and programs. Effective january 1, 2015, alabama medicaid will implement the rb modifier. Ar medicaid dur board edits approved at the april 18, 2012 meeting. If you need an older version of an administrative guide or care provider manual, please contact your provider advocate. Up to 12 additional days of leave per year may be approved in increments of no more than two. Medicaid is the largest provider of mental health services in the united states. Provider manuals are available for viewing online at the medicaid website. Medicaid is a wideranging health insurance program for lowincome individuals of all ages. D0120, d0145, d0150, d1120, d1201, d1203, d1205, and d1208 on a single date of service. License for use of current procedural terminology, fourth edition cpt and current dental terminology cdt.
The manual contains abccedp guidelines and operational references for clinics and health care providers. Outcomes of early preventive dental care among medicaid. Jointly funded by the state and federal government, it provides health coverage for diverse groups of alabama residents, including pregnant women, parents and caretaker relatives, adults with no dependent children, disabled individuals, and seniors. A provider is required to obtain informed consent from the patient. Medicaid provider manual becoming a medicaid provider chapter. The early and periodic screening, diagnostic and treatment epsdt benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in medicaid. The alabama medicaid provider billing manual is a practical guide to assist medicaid enrolled providers in receiving reimbursement. Sep 21, 2015 alabama medicaid participation requirements. May 20, 20 the purpose of this manual is to provide medicaid policy and billing providers participating in the new york state medicaid health home apg provider manual new york state department of health. Alabama suspended and ineligible provider list any provider participating or applying to participate in the medicaid program must search this list and the list of excluded individuals and entities leie on a monthly basis to determine if any existing employee or contractor has been excluded from participation in the medicaid program. Please be sure to include the prior authorization pa number in the body of the email. Previously known as the provider manual appendix j, these documents provide a listing of the.
Department policy material is updated periodically and it is the responsibility of the users to check and make sure that the policy they are researching or applying has the correct effective date for their circumstances. Al medicaid management information system provider manual, p. Medicaid is the primary source of health care for lowincome families with children, the lowincome elderly, and people with disabilities. Alabama state telehealth laws and reimbursement policies. General information for providers if information is found on the website, it has been removed from the manual, and a link to the source is provided. The provider will be required to send in paper documentation for applicable information. Epsdt is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services. Claimsauthorizations for dates of service on or after october 1, 2015 must use the applicable icd10 diagnosis code that reflects the policy intent. Welcome to the alabama medicaid interactive web site. Recordings of the presentations are on the medicaid provider information webpage. References in this manual to icd9 diagnosis codes only apply to. Refer to hospitals are assigned a provider type of 01 hospital.
Effective june 7, 2010, idaho medicaid contracted with dxc technology, formally known as molina medicaid solutions to be the mmis claims processing center as well as provide provider training, billing, and operational support for all medicaid providers. The alabama public health training network is providing a twohour satellite conference and live webcast called preconception care. Final eligibility and enrollment rule, part 2 november 30, 2016. American podiatric medical association state reference. Printing the manual material found at this website for longterm use is not advisable. A sample 2012 ada dental claim form and instructions for completing the form can be found in chapter 5 of the provider billing manual april 2017 edition. The policy provisions for podiatrists can be found in the alabama medicaid agency administrative code, chapter 11. Effective for claims submitted on or after january 1, 2012. The distant site may be located outside of alabama as long as the physician has an alabama license. The kfmam and medical keesm are two separate manuals and are accessed by selecting the appropriate link.
Alabama medicaid agency medical services division clinics and mental health programs unit karen m. 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. The manuals provide policy for the medicaid, kancare chip, medikan and other state medical assistance programs and are used by staff when issuing an eligibility determination for these programs. Alabama medicaid inpatient hospital quality assurance provider manual.
Unbundling is the billing of multiple procedure codes for. Provider manuals for fy 2020 fy 2020 provider manual for community behavioral. March 2016 federally qualified heath centers hawaii medicaid provider manual 4 revised march 2016 21. Cms1500 0212 sample claim with npi 022012 sample remittance advice. A provider who contracts with alabama medicaid as a physician is added to the medicaid system. Provider electronic solutions user manual versus the alabama medicaid provider. Dec 30, 2014 provider web portal application w9 tax form can be faxed with the alabama medicaid participation requirements revised january 2015. The provider must also submit the proper financial documents to myers and stauffer lc, the ihcp ratesetting contractor, to have a reimbursement rate determined for the fqhc. Alabama medicaid agency policy and procedure manual home and. All code values listed in the nubc ub04 reference manual for each form locator ub04 claim form medical. Dhcfp department of health care financing and policy medicaid services manual. Feeforservice provider billing manual correct coding means billing for procedures with the appropriate comprehensive code. Information and forms to enroll as an alabama medicaid provider. The manual is divided into two major components, a general information and administration chapter and individual program chapters.
Opr provider verification ihcp providers should verify enrollment of the ordering, prescribing, or referring opr provider before services or supplies are rendered. The new expiration date is may 30, 2020, or at the conclusion of the covid19 national emergency, whichever occurs first. March 2016 federally qualified heath centers hawaii medicaid provider manual 1 revised march 2016 21. Medicaid american association for marriage and family. Medicaid rehabilitation option mro provider manual library reference number. These are subject to all limitations of the alabama. Myers and stauffer forwards the rate document to the provider enrollment unit so the encounter rate can be loaded into the core medicaid. Dec 4, 2018 identify the section in the provider manual related to ub04 claim form completion icd10cm diagnosis codes and icd10 pcs codes on a claim to ensure payment at the nubc ub04 data specifications manual. The manuals are updated quarterly throughout each fiscal year july june, and are posted one month prior to the effective date. The following documents comprise the michigan medicaid provider. The alabama medicaid agency fiscal agent enrolls physicians and issues provider contracts to applicants who meet the licensure andor certification requirements of the state of alabama, the code of federal regulations, the. The ama contracts with a fiscal agent to process and pay all claims submitted by. Pediatrician kids children specialist obstetrician gynecologist obgyn orthopedic surgeon. The distant site may be located outside of alabama as long as the physician has an alabama license and is enrolled as an alabama medicaid provider.
Medicaid referral form form 362 or other medical documentation. For additional details, refer to the alabama medicaid provider manual appendix c. Medicaid rehabilitation option services overview medicaid rehabilitation option mro services are designed to assist in the rehabilitation of the. 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. Medicaid application alabama 2012 medicare pdf list. Alabama medicaid submitted their initial transition plan to cms on 6 2012. Missouri medicaid audit and compliance po box 6500, jefferson city, mo 651026500 phone.
Earlier this year, south dakota medicaid shared information about its health home program, and alabama medicaid presented on its coordinated health networks program. Alabama medicaid agency, alabama medicaid provider manual, 2847 july 2014. Free advice for your oral health needs during covid. Free electronic billing software for medicaid providers. Alabama medicaid provider enrollment list the physicians medicaid numbers for satellite locations that are i have read and understand the patient 1st provider manual, the agreement for provider insider alabama medicaid alabama. Telemedicine is the use of electronic information and communication methods to provide direct patient care, generally when the patient and attending physician are not located at the same facility. A written informed consent is required prior to an initial telemedicine service. Medicaid vision coverage by state making eye health a. It is financed through social security taxes and premiums. The agency has once again extended all previously published expiration dates related to the coronavirus covid19 emergency. Medicare is a health insurance program primarily for elderly persons, regardless of income. The intent of the service provider manual is to present useful information and guidance to providers participating in the louisiana medicaid program.
Findings are categorized into three broad categories. Medicaid was created in 1965 by congress along with a soundalike sister program, medicare. Health homes provider manual, billing policy and guidance. Eligible women must be referred and receive services by a participating. Limit on federal financial participation for durable medical equipment in medicaid. Jan 2, 2017 smoking cessation products are covered by alabama. Title xix of the social security act ssa is a program that provides. Alabama medicaid agency administrative code, and the. It is best applied to investigations of overpayments which do not involve fraud and abuse. The purpose of the provider manual is to provide standardized guidelines for breast and cervical cancer screening services for eligible alabama breast and cervical cancer early detection program abccedp participants. Jan 6, 20 the same recipient, by the same billing provider, same rendering provider. Al medicaid management information system provider manual, 2817, oct. Medicaid is jointly financed by the state and federal governments and.
Dbhdd publishes its expectations, requirements, and standards for community providers via policies and the respective behavioral health or developmental disabilities provider manuals. Pen and ink updatesbrief changes will be sent as pen and ink updates. This site is intended for providers, clerks, and trading partners. Medicaid bed hold policies by state september 2012 state hospital transfer therapeutic leave amount paid by medicaid alabama medicaid residents may not be charged for reservation of a bed for the first four days. November, 2014 policies and procedures as of june 1, 2014 version. The provider search tool enables you to locate providers enrolled with the ihcp to provide services to medicaid members. Do not attempt to use the backforward buttons in the browser.
Alerts, publications and information for medicaid providers. 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. Magellan medicaid administration is providing these services for the pharmacy program. California medicaid residents may not be charged for reservation of a bed for the first seven days. Medicaid covered services and member eligibility end of update log chapter. The webinar materials, including an audio recording and transcript where available, can be accessed below. We identified preventive dental visits through oral examination claims containing any of the following current dental terminology codes as specified by the alabama medicaid agency provider manual and consistent with prior studies. Instead, use the navigation section within the application. Durable medical equipment dme in response to the coronavirus disease 2019 covid19, the alabama medicaid agency has compiled a summary of changes and allowances made by the agency as they apply to dme providers. Jul 19, 2016 code, and the alabama medicaid provider manual.