Rural Health Clinic Cost Report - Useful
information to help new providers establish the rate for
ACA Primary Care Physician
The Primary Care
Physician Rate Increase under The Affordable Care Act (ACA)
ends December 31, 2014.
Medicaid-enrolled primary care physicians who qualify for
Primary Care Enhanced Physician Rates may continue to
receive enhanced payments after the federal program ends on
December 31, 2014.To qualify, eligible providers must
accurately self-attest by filing required 2015 forms.
You must self-attest and submit board certification proof to
continue payments for 2015 Primary Care Enhanced Physician
Complete a 2015 self-attestation form
• Attach proof of board certification (WEB VERIFICATION), if
• Mail original self-attestation form to the address below:
HPES, PO Box 241685,
Montgomery, Alabama 36124
must be complete and easy to read. Please retain copy for
Qualification for the payment increase will end the earliest
of either September 30, 2015 or the expiration date of the
board certification. Therefore, physicians whose board
certifications expire before September 30, 2015, must
self-attest for the program; services provided during any
lapses in time between board certification expiration and
self-attestation will not be eligible for the rate increase.
The physician must notify HPES within 10 days if the board
certification is lost.”
Payment for Primary Care Enhanced Physician Rates:
• An eligible provider with 2015 self-attestation form on
file at HPES by January 31,
2015, will receive payment at the enhanced rates retroactive to January
Federal requirements mandate providers
re-enroll periodically with the Alabama Medicaid program. Providers will be
notified when they are scheduled to re-enroll. Failure to re-enroll
and provide appropriate documentation to complete enrollment will result in
an end-date being placed on the provider file. Once a provider file has been
closed for failure to timely re-enroll, providers will have to submit a new
application for enrollment.
"List of Providers Scheduled to Re-Enroll."
The listing of providers selected to re-enroll for the current month
is listed under
Re-Enrollment Forms entitled
Ordering, Prescribing and Referring Providers:
Federal law requires all physicians and other practitioners who prescribe or
order services for Medicaid recipients, or who refer Medicaid recipients to
other providers, must be enrolled as a Medicaid provider. Claims will deny
beginning January 1, 2013, if provider is not enrolled.