- (1) Nurse midwives may submit claims and be reimbursed only for those procedure codes authorized by Medicaid policy. Claims should be submitted on a Health Insurance (HCFA 1500) Claim Form.
- (2) The nurse midwife agrees when billing Medicaid for a service that the midwife will accept as payment in full, the amount paid by Medicaid for the services and that no additional charges will be made.
- (3) Conditional collections from patients, made before Medicaid pays, to be refunded after Medicaid reimbursement for the service, are not permissible.
- (4) A hospital-based nurse midwife who is employed by and paid by a hospital may not bill Medicaid for services performed therein and for which the hospital is reimbursed. A nurse midwife who is not employed by and paid by a hospital may bill Medicaid using a Health Insurance (HCFA1500) Claim Form. To prevent double payment, the nurse midwife having a Medicaid provider number(s) shall inform the Alabama Medicaid Agency of the name of the hospital(s) with whom employed, regardless of regularity and frequency.
Author: Glen A. Smythe
Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§440.165, 440.210, 440.220, 441.21; Code of Ala. 1975, §§34-19-2, et seq.
History: Rule effective October 1, 1982. Amended effective July 10, 1987; February 9, 1989. Emergency amendment June 14, 1993.Amended August 12, 1993. Amended: Filed February 7, 1994; effective March 15, 1994.