Category: Medicaid
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Alabama’s ACHNs Go Live Oct. 1
The end date for the Patient 1st Program is approaching, and providers will be required to have completed agreements with both Medicaid and the ACHN. Primary Care Physicians (PCPs) will no longer receive Patient 1st capitation payments beginning in October 2019. The ACHN program will be implemented on October 1, 2019, and providers will need…
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Alabama Medicaid Updates: Don’t Miss This Information!
Promoting Interoperability with Prescription Drug Monitoring Program (PDMP) The Alabama Department of Public Health Meaningful Use team recently added new functionality where Eligible Providers who are currently participating in the PI Program can access the PDMP registry and run reports to show that they are actively engaged with this Specialized Registry during the reporting period.…
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Alabama Medicaid Cumulative MME Edit Coming Early 2019
UPDATE April 26, 2019: Effective May 1, 2019 the Alabama Medicaid Agency will begin implementing cumulative daily MME edits for opioid experienced recipients. Higher doses of opioids are associated with higher risk of overdose and death – even relatively low dosages (20-50 MME per day) may increase risk.1 Therefore, Alabama Medicaid will limit the amount of…
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New Requirements for Fee-For-Service Delivery Claims
Effective for dates of services on or after Feb. 1, 2018, fee-for-service delivery claims for recipients who reside in a county not served by an Alabama Medicaid (Medicaid) Maternity Care Program must contain the date of last menstrual period and the date of first prenatal visit. This information is not required for hospital claims. Counties…
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Medicaid to Host Regional Meetings With Primary Care Providers
Patient First primary medical providers and other primary care providers are invited to attend one of seven upcoming meetings to learn more about Medicaid’s proposed Alabama Coordinated Health Networks (ACHNs). ACHNs are designed to create a single care coordination delivery system that effectively links patients, providers and community resources within each of seven regions. In coordination…
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MEDICAID ALERT: Federal Rule Change for Prenatal Claims
The passage of the Bipartisan Budget Act of 2018 requires states to “cost avoid” claims for prenatal services when there is a known liable third party. Prior to this change, states were federally required to “pay and chase” claims with a designated prenatal procedure or diagnosis code. The federal “pay and chase” provision enabled providers…
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Alabama Medicaid Alert: Short-Acting Opioid Naïve Limits
Effective Nov: 1, 2018, the Alabama Medicaid Agency will begin implementing limits on short-acting opiates for opioid naïve recipients. The Agency defines “opioid naïve” as a recipient with no opioid claim in the past 180 days. Edit Details: A 7-day supply limit for adults age 19 and older A 5-day supply limit for children age 18…
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Alabama Medicaid Agency Updates
Short-Acting Opioid Naïve Limits — Effective Nov. 1 Effective Nov. 1, 2018, the Alabama Medicaid Agency will begin implementing limits on short-acting opiates for opioid naïve recipients. The Agency defines “opioid naïve” as a recipient with no opioid claim in the past 180 days. Edit Details: A 7-day supply limit for adults age 19 and older…
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Alabama Medicaid Seeks Public Comments
Alabama Medicaid is seeking public comment on an amendment to the Alabama Home and Community-Based Intellectual Disabilities Waiver. Medicaid Intellectual Disabilities Waiver Amendment | Comments Submitted by October 8, 2017 The Alabama Medicaid Agency is seeking public comment on its proposal to amend the Alabama Home and Community-Based Intellectual Disabilities Waiver (ID Waiver). The waiver…
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Alabama Medicaid to Pursue an Alternative to RCOs
MONTGOMERY – Alabama Medicaid Commissioner Stephanie Azar announced Thursday that in light of known federal administration changes and potential congressional adjustments, the Alabama Medicaid Agency will pursue an alternative to the Regional Care Organization initiative to transform the Medicaid delivery system. The state will work with the Centers for Medicare and Medicaid Services to create…