Ala. Admin. Code r. 560-X-18-.06

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

Section 560-X-18-.06 - Payment For Services

(1) The transportation provider is responsible for completion of the HCFA 1500 claim form. All claims submitted will be required to include the diagnosis code, modifiers, and indicators as appropriate.

(2) Payment for ambulance services shall be based on the lesser of the submitted charge or Alabama Medicaid's statewide ambulance service rate. These payments shall not exceed combined payments for providing comparable services under comparable circumstances under Medicare and/or more than the prevailing charges in the locality for comparable services under comparable circumstances.

(3) Air transportation for adults 21 years of age and older will be reimbursed at the emergency ground rate.

(4) Ambulance services billed will be commensurate with services actually performed. Services rendered are independent of the type of call received or the type staff/equipped ambulance service responding.

(5) An Alabama Medicaid Provider may bill an Alabama Medicaid recipient when the recipient has exhausted all of his/her allowed Medicaid benefits for the calendar year, or when the service rendered by the provider is a non-covered benefit as outlined in the Alabama Medicaid Agency Administrative Code.

Author: Ginger Collum, Program Manager, Clinic/Ancillary Services

Ala. Admin. Code r. 560-X-18-.06

Rule effective October 1, 1982. Amended: July 9, 1984. Amended effective July 9, 1984; January 1, 1987; July 13, 1989. Amended: Filed July 7, 1994; effective August 12, 1994. Amended: Filed May 10, 2002; effective June 14, 2002.

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