Ala. Admin. Code r. 560-X-21-.04

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-21-.04 - Reimbursement

(1) Nurse midwives may submit claims and be reimbursed only for those procedure codes authorized by Medicaid policy. Claims should be submitted on a Health Insurance (HCFA 1500) Claim Form.

(2) The nurse midwife agrees when billing Medicaid for a service that the midwife will accept as payment in full, the amount paid by Medicaid for the services and that no additional charges will be made.

(3) Conditional collections from patients, made before Medicaid pays, to be refunded after Medicaid reimbursement for the service, are not permissible.

(4) A hospital-based nurse midwife who is employed by and paid by a hospital may not bill Medicaid for services performed therein and for which the hospital is reimbursed. A nurse midwife who is not employed by and paid by a hospital may bill Medicaid using a Health Insurance (HCFA 1500) Claim Form. To prevent double payment, the nurse midwife having a Medicaid provider number(s) shall inform the Alabama Medicaid Agency of the name of the hospital(s) with whom employed, regardless of regularity and frequency.

Author: Glen A. Smythe

Ala. Admin. Code r. 560-X-21-.04

Rule effective October 1, 1982. Amended effective July 10, 1987; February 9, 1989. Emergency amendment June 14, 1993. Amended August 12, 1993. Amended: Filed February 7, 1994; effective March 15, 1994.

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§440.165, 440.210, 440.220, 441.21; Code of Ala. 1975, §§ 34-19-2, etseq.