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TO: Physicians, Nurse Midwives, Plan First/Family Planning Providers, FQHC, IRHC, PBRHC, Hospitals, Nurse Practitioners and Maternity Care Primary Contractors
I. Changes in District Ten (Autauga, Bullock, Butler, Crenshaw, Elmore, Lowndes, Montgomery and Pike Counties).
An Alabama Medicaid ALERT dated November 16, 2015, informed providers that if recipients need assistance locating a maternity provider on or after January 1, 2016, they could call the following Help Lines:
|
Healthy Beginnings Help Line |
1-800-654-1385 |
|
INFO CONNECTION Help Line |
1-800-545-1098 |
or
contact the Alabama Department of Public Health Region V Perinatal Coordinator.
This process has changed. If a recipient needs assistance locating a provider on or after January 1, 2016, please direct recipients to call Medicaid toll-free at 1-800-362-1504, not the numbers listed above.
Recipients with questions about their maternity services on or before December 31, 2015, may call Gift of Life Foundation, Inc., at 1-877-826-2229 or (334) 272-1820.
II. Claims Processing
Effective for dates of service as of 12:01 a.m., January 1, 2016, and thereafter, reimbursement for maternity care services in the following counties will be paid as fee-for-service claims:
• Autauga,
• Bullock,
• Butler,
• Crenshaw,
• Elmore,
• Lowndes,
• Montgomery, and
• Pike
Maternity providers will send their claims to Medicaid for reimbursement. If the delivery occurred as of 12:01 a.m., January 1, 2016, and thereafter, but ancillary services (such as ultrasounds) related to the pregnancy were provided prior to this date, the ancillary services that are not part of the delivery payment would be paid fee-for-service. In order for the ancillary services that are not part of the delivery payment to be paid fee-for-service, the provider must submit a paper claim to Medicaid for an override. Medicaid will NOT override an ancillary service until the delivery is paid by Medicaid. These paper claims should be sent to:
Alabama Medicaid Agency
Maternity Care Program
P.O. Box 5624
Montgomery, AL 36104
For questions about fee-for-service billing, contact Hewlett Packard Enterprise at:
· Provider Assistance Center 1-800-688-7989
· Electronic Media Claims Helpdesk 1-800-456-1242
Provider Representative Contact Information may be found at this link.