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TO:     All Providers

RE:     Patient 1st Referral Form (Form 362) and Mid-Level Extenders

Alabama Medicaid has made some changes to the Patient 1st Referral form process to help resolve any completion problems that may have occurred. This change will allow the Primary Medical Physician (PMP) to bill/refer using his/her individual NPI number that will ensure payment accuracy and more precise tracking of the patient’s care management. Also included is revised policy that will allow additional Mid-Level extenders to extend the PMP caseloads.

Important Patient 1st Referral Information:

Group NPI numbers will no longer be accepted on referrals.

·  All Cascading referrals should identify the individual referring Primary Medical Physician’s (PMP) name and NPI number beginning April 1, 2015.

·  All Certified Registered Nurse Practitioners (CRNP) and Physician Assistants (PA) must use the individual PMP’s (the collaborating physician) NPI number as the Referring provider on all claims.  When a referral is made to other providers outside of a group, the name and NPI number of the PMP and CRNP/PA, if applicable must be on the referral form.  (See example below)
 

·  For hard copy referrals, the printed, typed, or stamped name of the PMP with an original signature of the physician or designee next to the printed, typed, or stamped name is required.

·  The Referring provider who is filling in for the PMP must be enrolled as a Patient 1st provider and makes sure that his/her Individual NPI is on the referral form. The PMP’s number should not be on the referral since the PMP did not make the referral.

·  In order for any specialist’s claim to process, the NPI of the PMP must be on the claim.

·  A referral from a Group written prior to April 1, 2015, is valid for one year or until the referral expires; whichever comes first. A new referral is not necessary. 

·  A referral from an individual PMP that has been end-dated on Medicaid’s file will be valid for one year after the end-date OR until the referral expires; whichever comes first.

Mid-Level Extenders

·  Effective March 1, 2015, Medicaid aligned with the requirements of the Alabama Board of   Medical Examiner’s Administrative Code to allow three (3)  certified registered nurse practitioners (CRNP) /   physician assistants (PA) to  extend the PMP’s caseload  up to 400 additional patients, per extender. A  total of 2,400 patients will make the maximum panel size. The provider caseloads are determined by the total number of Full Time Equivalent (FTE) hours the physicians and the physician extenders work. 

For more information regarding these changes, please contact Latonda Cunningham via email at: latonda.cunningham@medicaid.alabama.gov