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TO: All Physicians and enrolled Patient 1st Providers
RE: Patient 1st Referral Change
The Alabama Medicaid Agency made changes to the Patient 1st Referral process on June 1, 2014, that no longer allowed a specialist or Primary Medical Physician to bill/refer using a Group NPI number. The effective date of this change has been extended to allow more time to implement this change.
In the interim, the Group’s NPI number on the referral /claim/prior authorization as the Referring Provider will be accepted. However, Medicaid requests that specialists and PMP’s continue to write referrals and bill Medicaid utilizing the individual NPI number whenever possible.
The reasons Medicaid is requesting providers continue to bill/refer utilizing the individual NPI include:
• Reinforce Medical Home Concept
• Ensure referrals are managed by the PMP
• Ensure PMP is responsible for recipient’s total care
• Properly track caseload assignment for PMP’s
• Obtain accurate profiler reports for case management
Medicaid will notify providers through an ALERT, prior to implementing a new effective date, when the change will resume. Please contact Latonda Cunningham, Associate Director of the Patient 1st Program via e-mail at latonda.cunningham@medicaid.alabama.gov or via phone at (334) 353-4122 for any questions.