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39 39 Patient 1st st The Patient 1 Manual has been developed by the Alabama Medicaid st Agency to ex

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The Patient 1 Manual, developed by the Alabama Medicaid Agency, outlines the policies and procedures for the Patient 1 program aimed at providing patient-centered care through primary medical providers (PMPs). It details eligibility requirements for PMPs, enrollment processes, responsibilities of PMPs, billing procedures, and guidelines for patient care coordination. The program seeks to reduce unnecessary emergency department visits by linking Medicaid recipients with a designated PMP who coordinates their healthcare needs. The manual also includes information on case management fees, recipient education, complaint processes, and quality assurance activities.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who is the general counsel for Medicaid in Alabama?

EP modifiers are used when billing initial, periodic and interperiodic screenings. Once chronic problems have been identified, providers should bill the appropriate level of office visit code and bill the services as EPSDT referring.

What is the EP modifier for Medicaid in Alabama?

Claims-Related Mailing Addresses For CMS-1500 claims, Pharmacy, Dental UB 04 claims, Medicare claims and Prior Authorization (including Medical Records), Adjustments/Refunds, Inquiries, Provider Enrollment and Electronic Claims Submission disks mail to: P.O. Box 244032, Montgomery, AL 36124.

What does QMB only mean for Alabama Medicaid?

Alabama Medicaid has three programs for people who have Medicare coverage: The Qualified Medicare Beneficiary (QMB) program, the Specified Low-Income Medicare Beneficiary (SLMB) program, and the Qualifying Individual (QI-1) program. The services you get depend on how much income you have.

What is emergency Medicaid in Alabama?

Medicaid pays for emergency outpatient services when there is a certified emergency. A certified emergency is when a person has a serious health problem that he or she reasonably believes could cause serious damage to your health or your body if you do not get medical care right away.

What does Alabama Medicaid not cover?

Stephanie Azar While serving as Commissioner, Azar continues in her position of General Counsel with the Agency, a role in which she has served since March 2010.

What is the KX modifier for Medicaid?

The KX modifier is a code used in medical billing to indicate that specific therapy services are medically necessary and exceed the annual threshold amounts set by Medicare.

What is the EP modifier for Medicaid?

Modifier EP indicates routine Healthy Kids/EPSDT screening. Modifiers may be appended to HCPCS/CPT codes only if the clinical circumstances justify the use of the modifier. A modifier should not be appended to a HCPCS/CPT code solely to bypass NCCI edits if the clinical circumstances do not justify its use.

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