TO:  All Delivering Healthcare Professionals (DHCPs)

The Alabama Medicaid Agency made the following changes to the ACHN DHCP referral process:

1.     Prior to July 7, 2020, OB/GYN telemedicine providers were required to obtain a DHCP referral from an ACHN for reimbursement of maternity services. Beginning July 8, 2020, Medicaid will allow physicians enrolled with the specialties OB/GYN (specialty type 328) and telemedicine (specialty type 931) to be reimbursed for maternity services with a referral from either an ACHN or the referring DHCP. The NPI of the ACHN, the DHCP, or the referring DHCP’s group must be on the claim for reimbursement. Refer to Chapter 40 of the Provider Billing Manual, section 40.43.2 (DHCP Selection Referral Number) for more detailed billing information.

2.     Telemedicine providers who render maternity-related services are required to sign a Non-Delivering Telemedicine DHCP Participation agreement with at least one of the ACHNs in order to receive reimbursement from Medicaid. Refer to Chapter 28 of the Provider Billing Manual to determine further requirements and procedure codes allowed for telemedicine services.

3.     In emergency circumstances, maternity claims submitted with an emergency indicator (Certified Emergency – Service Authorization Exception Code – 3) will no longer require a DHCP referral from an ACHN for reimbursement.

You may access the Provider Billing Manual with the following link: https://medicaid.alabama.gov/content/Gated/7.6.1G_Provider_Manuals.aspx

For questions related to the DHCP referral process and changes, e-mail ACHN@medicaid.alabama.gov.

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