Alerts

New Procedures Added to All-Inclusive Encounter Rate

5/9/2018

PDF Version

TO:  IRHC Providers 


Effective May 16, 2018, Medicaid will enforce Alabama Medicaid Administrative Code RuleNo. 560-X-8-.03 Reimbursement.  As a result, the following procedure codes may no longer be billed and paid outside the IRHC provider encounter rate. Providers should continue listing these procedure codes when filing claims for reimbursement.

 

·         92551 PURE TONE HEARING TEST AIR

·         99173 VISUAL ACUITY SCREEN

·         96110 DEVELOPMENTAL SCREEN W/SCORE

·         96127 BRIEF EMOTIONAL OR BEHAVIORAL ASSESSMENT (smoking cessation)

 

Claims that are billed using the non-IRHC number for reimbursement will be monitored on a post payment review process. Claims that are filed and paid with these procedures outside of the encounter rate will be subject to recoupment.

 

Contact the Provider Assistance Center at 1-800-688-7989 if you have received denials for the four codes listed above when billing and using the non-IRHC number.  A call center associate will review your file and advise you on how to proceed with refiling the claim.

 

Any other questions should be directed to Calvin Binion at calvin.binion@medicaid.alabama.gov.



The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2018 American Medical Association and © 2018 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.