Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-61 - CHILDREN'S SPECIALTY CLINIC SERVICES
Section 560-X-61-.05 - Reimbursement
Universal Citation: AL Admin Code R 560-X-61-.05
Current through Register Vol. 42, No. 11, August 30, 2024
(1) Children's Specialty Clinics will be reimbursed by as follows:
(a) Governmental providers will be reimbursed
by an encounter rate based on reasonable allowable costs, as defined by OMB
Circular A-87, and established by the Medicaid Agency based on completion of
the required cost report documentation.
(b) Nongovernmental providers will be
reimbursed by a rate established by Medicaid based on usual, customary, and
reasonable charges.
(2) Only one clinic visit per date of service per recipient will be reimbursed. Exception: A dental encounter may be billed in conjunction with a clinic visit for the same date of service for the same recipient.
Author: Lynn Sharp, Associate Director, Policy Development, Medical Services Division
Statutory Authority: Title XIX, Social Security Act; State Plan; 42 C.F.R. §440.90.
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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