Attention all providers: Due to the COVID-19 pandemic, the Alabama Medicaid Agency has suspended all EPSDT and Specialist Referrals at this time. Please view the provider Alert posted on the Alabama Medicaid Agency website: www.Medicaid.Alabama.gov.
Why MY CARE ALABAMA East?
The goal of My Care Alabama is to create a team of community and healthcare partners who are dedicated to providing Medicaid recipients with the highest quality of care possible. And for all of us at My Care, that starts with building effective relationships with our healthcare providers, healthcare administrators, community leaders, and care coordination experts. These relationships are focused on a single and important goals. . . meeting the needs of our recipients.
My Care Alabama sets the standard for quality administration, and we love nothing more than finding physicians, practices and providers who match our standards for efficiency with even higher standards of care. Because, when we combine high quality, compassionate health services with our ability to “wrap around” other issues for Medicaid recipients, we can get closer to achieving our goal of improving health outcomes in east Alabama. And it allows us to be truly innovative in our approaches.
Participating Providers for services:
- List of Medicaid-enrolled Delivering Healthcare Professionals (DHCPs)
- List of Medicaid-enrolled Primary Care Physicians (PCPs)
- List of Urologists
Medical Management Meeting Schedule:
For any contract questions or to submit provider agreements, email Join_Now@mycarealabama.org.
Do you have more questions about the ACHN Program?
Please see Medicaid Agency’s FAQs.
For any contract questions or to join the My Care Alabama Provider Network?
Please email us at: Join_Now@mycarealabama.org, or call us: if you are in the Northwest Region, please call our Provider Help Line: 855-500-9470; if you are in the Central Region, please call our Provider Help Line: 855-288-8361; or if you are in the East Region, please call our Provider Help Line: 855-288-8366.
How does this affect me as a Delivering Health Care Professional?
- Claims for maternity services will be reimbursed FFS directly by Medicaid
- DHCPs will have the opportunity to receive two bonus payments in addition to your FFS payment:
- A bonus payment for an initial prenatal visit made in the first trimester
- A bonus payment for a postpartum visit (if provided 21-56 days postpartum)
- If you are an actively Participating DHCP Medicaid will pay $100.00 for each bonus payment and the following procedure codes must be submitted on a separate claim:
- Initial Prenatal Visit – H1000 (made during the first trimester)
- Postpartum visit – G9357 (between 21 and 56 days of delivery)
What is the Provider’s role?
As a participating provider in the ACHN Program, you will be asked to work with My Care Alabama to review utilization data of your patients to help achieve ACHN goals. You will work with our Care Managers to provide holistic care to our patients. You will participate in our Medical Management Committee, which meets quarterly to develop and implement quality and outcome-based improvements for our patients.
How will My Care Alabama help me as a Provider?
Our Care Managers work with you and a full scope of other service providers to ensure a holistic care approach for your patients. We will help patients coordinate their care, assisting in referrals to other specialists or gaining access to needed services. We conduct home visits to help patients follow your orders and make sure they understand their care plan.
Our Behavioral Health Care Managers assist patients in managing their mental health conditions by linking patients with appropriate community mental health services and ensuring appointment follow-up and medication compliance.
Our Transitional Nurse Care Managers help transition patients from inpatient facilities to their home or to a medical home. Our Nurses provide personalized service and care management to the members before discharge, and then again at home within 72 hours of discharge. Our Pharmacists work with you to answer questions about medication and assist in medication reconciliation. They provide consultation services and assist with pharmacy-related initiatives.
What are the participation requirements for a Primary Care Physician?
Physician groups must meet the following criteria for participation:
- Actively work with the ACHN entity to review recipient care plans
- Participate as needed in ACHN Multi-Disciplinary Care Team (MCT)
- Participate in ACHN initiatives centered around quality measures
- Participate in at least two quarterly Medical Management Meetings and one webinar/facilitation exercise with the regional ACHN medical director over a 12 month period (NPs and PAs may attend for PCP)
- Review data provided by the ACHN to help achieve regional and state Medicaid goals
How does this affect me as a Primary Care Physician?
- New opportunity to earn bonus payments for achieving quality related goals in addition to FFS payments
- If you earned “bump” payments previously, you can earn increased amounts by participating with Medicaid and a regional ACHN entity
- You will not have a patient panel to manage, but will work in partnership with licensed social workers and nurses who will help manage your complex or non-compliant patients
- You can see patients regardless of where they live
- Referrals are not needed for primary care
- Referrals will be required only for certain medical specialties
- EPSDT referrals will continue to be required