Attention Independent Rural Health Clinic (IRHC) Alabama Providers:
Effective January 1, 2018, Alabama Medicaid will no longer allow IRHC providers to bill a small range of services for the encounter rate. IRHCs will need to bill the actual procedure code for the services performed instead of billing a limited range of codes, such as 99211-SE and 99231-SE. IRHCs will need to refer to the CPT code book and bill the most appropriate code to reflect the services provided and the appropriate medical documentation must be documented in the patient’s chart to support the level of care billed. When the claim is received for processing, DXC will add the T1015 procedure code to the claim and you will be reimbursed the encounter rate for services.
Services payable outside of the encounter rate will not be affected by this change, and will continue to be paid outside the encounter rate, under the non RHC NPI. These services include Vaccines for Children, deliveries, surgeries with place of service 21 or 22, lab, technical component for Electrocardiograms (EKG’s) and radiology, and smoking cessation products (under family planning). Do not submit services outside of the encounter rate on the same claim as services within the encounter or the claim will deny. Because such services are paid separately they must be billed separately from the services that are part of the encounter. IRHCs should not mix the two types of services on claims – those that are part of the encounter and those outside of the encounter.
If you have any questions, please contact the Provider Assistance Center at 1-800-688-7989.
*Information obtained from the Alabama Medicaid Agency Alert System