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TO: All Medicaid Enrolled Providers

Alabama Coordinated Health Networks (ACHNs) began operation on October 1, 2019, and recipients were attributed to providers enrolled with Medicaid on that date. Referrals to specialists will continue to be required in the ACHN Program. Below are several key items related to the referral process that specialists need to be aware of during the transition to the ACHN Program:

·   Referrals dated prior to 10/1/2019 continue to be valid until the expiration date of the referral.

·   The recipient’s PCP should be contacted for a referral, if one is needed on or after 10/1/2019.

·   If the recipient does not have a PCP, then the specialist may contact the ACHN for a billing referral until a PCP can be identified for the recipient.

·   Specialists (including Oncologists and Hematologists) should not request PCP referrals from health departments, other specialists, or Children’s Rehabilitation Services (CRS).

v  Exception: Mobile and Jefferson County Health Departments are considered PCP Groups and should be available to provide a PCP referral to a specialist.

·   For details on provider types, specialties and services that require referrals, see Chapter 40 of the Provider Billing Manual. Chapter 40 is available on the following link: https://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals/7.6.1.4G_Oct2019/Oct19_40.pdf

For Teaching Facilities Only:

·   Specialists linked to a teaching facility will not require referrals and may also make referrals to other specialists. Medicaid considers all providers linked to teaching facilities as part of a PCP Group.

Webinar Specifically for Specialists

Medicaid provided a webinar for specialists on 10/9/2019. Visit https://medicaid.alabama.gov/content/5.0_Managed_Care/5.1_ACHN/5.1.3_ACHN_Providers.aspx  to view a recording of the webinar and to find other important information about the ACHN. 

Questions about the ACHN program may be emailed to ACHN@medicaid.alabama.gov.