TO:   Providers, Vendors and Clearinghouses

CORE Rules Implementation

Alabama Medicaid is implementing changes for the ACA CORE Rules Phase I & II on 10/26/2013.  The changes impact 270/271 Eligibility Request and Response. 

The changes being implemented consist of 3 CORE Rules.

·         Rules 154/260

Eligibility request and response will include generic or explicit service type information in addition to financial information.

·         Rule 258

Normalization of the Subscriber’s Last Name.

·         Rule 259

General Error Reporting

Additional information concerning the changes is available on the Alabama Medicaid website. The Companion Guide for HIPAA 5010 has been updated.

http://medicaid.alabama.gov/CONTENT/6.0_Providers/6.3_Companion_Guides.aspx

Provider Web Portal

Alabama Medicaid will implement changes to the Provider Web Portal on 10/26/2013 for the CORE Rules Phase I & II.

·         Eligibility Verification Request Panel - Updated

The format of this panel has changed and an additional search criterion has been added to allow Providers the ability to submit a request for specified services.  If no service type codes are selected a generic request and response will be returned which includes all of the CORE defined Generic Service Type Codes.

Generic Service Type Codes

·         Service Type Codes/Co-pay Panel - NEW

This new panel will be returned as part of the Eligibility response and will return the Service Type requested, Co-pay Min and Max, Co-Insurance, Deductible, Status of Covered/Non-Covered and a message if applicable.