Ala. Admin. Code r. 560-X-45-.07

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

Section 560-X-45-.07 - NFP Records

(1) The NFP provider shall make available to the Alabama Medicaid Agency, at no charge, all information describing services provided to eligible recipients and shall permit access to all records and facilities for the purpose of claims audit, program monitoring, and utilization review by duly authorized representatives of Federal and State agencies. Complete and accurate records (including, but not limited to, medical, psychiatric, and fiscal records) which fully disclose the extent of the service shall be maintained by the NFP. Said records shall be retained for the period of time required by State and Federal laws.

(2) In addition to all NSO mandated data elements, NFP records must contain documentation of:

(a) name of recipient;

(b) a recipient Medicaid ID;

(c) the NFP Client ID;

(d) dates of services;

(e) name of provider agency and person providing services;

(f) nature, start and end time, extent or units of services provided;

(g) place(s) of service; and

(h) weeks of gestation or weeks postpartum at time of visit.

Ala. Admin. Code r. 560-X-45-.07

Repealed and New Rule: Filed February 19, 1999; effective March 26, 1999; operative May 1, 1999. Amended: Filed June 11, 2003; effective July 16, 2003. Amended: Filed October 12, 2005; effective November 16, 2005.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 10, July 31, 2018, eff. 8/26/2018.

Repealed by Alabama Administrative Monthly Volume XXXVIII, Issue No. 03, December 31, 2019, eff. 2/14/2020.

Amended by Alabama Administrative Monthly Volume XL, Issue No. 09, June 30, 2022, eff. 8/14/2022.

Previous Rule 560-X-45-.07 was renumbered to Rule 560-X-45-.08 as per certification filed October 12, 2005; effective November 16, 2005.

Author: John Majors, Associate Director, Maternity and Family Planning

Statutory Authority: Title XIX, Social Security Act; 42 C.F.R. Section 440.169(b); and State Plan.