Ala. Admin. Code r. 560-X-17-.01

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

Section 560-X-17-.01 - Eye Care Services - General

The information contained herein sets forth policies and procedures for providing eye care services under the Alabama Medicaid Program.

(1) Participation. Only in-state and borderline out-of-state eye care services providers (within a 30-mile radius of the state line) who meet enrollment requirements are eligible to participate in the Alabama Medicaid Program. The following information must be included in a written enrollment request to Medicaid's Fiscal Agent, Provider Enrollment Division:

(a) Name

(b) Address

(c) Specialty Provider Type

(d) Social Security Number

(e) Tax Identification Number

(f) Medical or Business License Number, as applicable

(2) Patient Identification. It is most important that a provider verify a Medicaid recipient's identity and eligibility, since claims submitted on ineligible persons cannot be paid by the Alabama Medicaid Agency (Medicaid). Refer to Chapter 1, General, of this Code for information about identification of Medicaid recipients.

(3) Prior Authorization.

(a) Certain services require prior authorization.

Refer to Chapter 15 of the Alabama Medicaid Provider Manual.

Ala. Admin. Code r. 560-X-17-.01

Rule effective October 1, 1982. Amended: effective May 9, 1984; January 13, 1988; effective January 13, 1993; March 13, 1993. Amended: Filed January 17, 2012; Refiled February 17, 2012; effective February 21, 2012.

Amended by Alabama Administrative Monthly Volume XL, Issue No. 11, August 31, 2022, eff. 8/26/2018.

Author: Calvin Binion, Associate Director, State Agency, Vision, & Clinic Services

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. § 401, et seq.