Attention:  All Psychologists

Effective July 1, 2012, psychologists and the allied mental health professional(s) working with/for them must have an Alabama Medicaid Agency Supervision Contract on file with the Agency.   This requirement is in addition to the Minimum Qualifications for Psychology Providers Professional Staff outlined in Section 34.1 of the Alabama Medicaid Provider Manual.

Any claims submitted on or after dates of service July 1, 2012, that do not have a corresponding Supervision Contract on file will be subject to recoupment on post payment review.

The Supervision Contract must be completed for each allied mental health professional billing for services under a psychologist’s NPI. 

A fillable or printable version of this form can be downloaded at the following link: http://medicaid.alabama.gov/CONTENT/4.0_Programs/4.4.0_Medical_Services/4.4.9.2_Clinical_Psychologists.aspx

Please submit the completed contract to Brenda Fincher via e-mail at: contracts@medicaid.alabama.gov or via fax at: (334) 353-2296.

If additional information is needed, please contact Karen Smith at: karen.watkins-smith@medicaid.alabama.gov or (334) 353-4945.

Chapter 34 of the Alabama Medicaid Provider Manual is available online at: http://medicaid.alabama.gov/CONTENT/6.0_Providers/6.7_Manuals/6.7.6_Provider_Manuals_2012/6.7.6_Provider_Manuals_2012.aspx