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Alabama Medicaid

(VM040)
Monday, June 27, 2022
ATTENTION PROVIDERS:
Effective June 21st, a minor update will be made to the Medicaid Interactive Portal. As part of this update, the label for the 'First Prenatal Visit' will change to 'Initial Treatment Date' to better reflect the usage of this field. Maternity Fee for Service providers will continue submitting the First Prenatal Visit date in this field. In addition, a 'Referral #' field will be added to the Professional Claim panel below the Referring Physician field.
Providers with questions concerning the upcoming change can submit them via the following email address: interChange_testing@gainwelltechnologies.com

Attention All Providers: The Alabama Medicaid Agency received approval from CMS for statewide coverage of Nurse Family Partnership (NFP) related services effective January 1, 2022. NFP provides prenatal, postpartum and infant home visiting services until the child reaches age two for Medicaid eligible women who meet certain eligibility criteria. Please refer to the Provider ALERT dated 4/4/2022 for more information on the NFP program including: goals of the program, provider enrollment and reimbursement information.

All previously published expiration dates related to the Coronavirus (COVID-19) emergency are once again extended by the Alabama Medicaid Agency. The new expiration date is the earlier of July 31, 2022, the conclusion of the COVID-19 National emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT. A listing of previous Provider ALERTs and notices related to the health emergency is available by selecting the Agency's COVID-19 page in the bottom section: https://medicaid.alabama.gov/news_detail.aspx?ID=13729
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Provider Electronic Solution (PES) Software

PLEASE REVIEW PRIOR TO SELECTING AN OPTION FOR SOFTWARE DOWNLOAD Provider Electronic Solutions Software version 3.12 is now available.
  • Software version 3.12 includes the addition of Quantity Prescribed on the Pharmacy claim form and updates to the Gainwell logo.
  • Software version 3.11 includes the addition of the PWK Segment (Electronic Attachments) to all 837 claim forms and the incentive amount field to the Pharmacy claim form.
  • Software version 3.10 includes updates to NCDCP Pharmacy form to include conflict code ingredient duplication and update 837 Professional claim form to include new maternity date fields.
  • Software version 3.09 includes changing "RCO" references to "MCO" on eligibility response file and removing message regarding RCO from claim status response. Change field label on 837 claim forms crossover tab and eligibility response to display Medicare ID field label instead of HIC Number.
  • Software version 3.08 includes updates to DXC logos and defaults ICD version to ICD 10.
  • Software version 3.07 includes updates to allow up to 3 birthweights, and new inpatient admit source codes.
Please refer to Appendix C Change Log in the software User Manual for a full list of the changes included in the new Provider Electronic Solution software version.

ICD-10 RELATED NOTES:
  • Software version 3.02 and all subsequent software versions will include changes for ICD-10.
  • ICD-10 codes should not be submitted until the CMS mandated date of October 1, 2015.
  • The ICD version on new Claims and Prior Authorizations will default to blank.
  • The Procedure/HCPCS and Diagnosis list are split based on ICD version.
  • Users may begin building ICD-10 lists now.
Users must perform an upgrade through each software version to successfully upgrade an older version of a database.

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