TO:     All Providers

Effective October 21, 2013, the Alabama Medicaid Agency will begin use of two new Explanation of Benefit (EOB) codes.

The new EOB codes will be:

·         EOB 3323 Procedure restriction – Required modifier not present

o   A procedure code was submitted without the required modifier.

·         EOB 3324 Procedure restriction – modifier not allowed

o   A procedure code was submitted with a modifier that is not allowed.

Between October 21, 2013, and November 21, 2013, these codes will be returned as informational messages only.  Effective November 22, 2013, claims will be denied when submitted without the correct procedure and modifier combinations. 

For prior authorization requests entered on the provider web portal, an error message will be returned to the user on the line item panel if the modifier entered for the procedure code is not allowed. In that case, the following online error message will be displayed: “Procedure code and modifier combination entered is invalid for the requested effective dates.” 

A user must correct the prior authorization record by removing or changing the modifier that is not allowed while on the line item panel prior to selecting NEXT to move to the next page. 

The provider manual has additional information concerning billing modifiers for certain services.

http://medicaid.alabama.gov/CONTENT/6.0_Providers/6.7_Manuals.aspx

Questions concerning this change may be directed to the Provider Assistance Center at 1-800-688-7989 or your Provider Representative at 1-855-523-9170.