Provider Qualifications & Requirements

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Provider Qualifications & Requirements"

Transcription

1 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Adult Care Home Ambulance Service Licensed by NC DHSR as a Family Care Home Home f the Aged and Disabled Group Home f Developmentally Disabled Adults Group Home f Mentally ill Adults Licensed by NC DHSR as an Emergency Medical Service Licensed as an Emergency Medical Service in Licensed as an Emergency Medical Service in Ambulaty Surgery Center Anesthesiologist Assistants Licensed by NC DHSR Licensed by the NC Medical Board as Anesthesiologist Assistant Licensed as Anesthesiologist Assistant in the applicant s state of practice Licensed as Anesthesiologist Assistant in the applicant s state of practice At-risk Case Management Behavial Health Managed Care Organization Birthing Center Certified as a Qualified Case Management Provider by NC Division of Aging and Adult Services DHHS approval letter Accredited by the Commission f Accreditation of Free-standing Birthing Centers Accredited by the Commission f Accreditation of Free-standing Birthing Centers Children's Developmental Services Agency Certified as an Infant-Toddler Program by the Division of Public Health Local ITP Service Plan/Agreement Amendment **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 1 of 30

2 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Cochlear Implant External Parts/Repairs NC Board of Pharmacy Permit Device and Medical Equipment (Dispensing) Permit NC Board of Pharmacy Permit Device and Medical Equipment (Dispensing) Permit NC Board of Pharmacy Permit Device and Medical Equipment (Dispensing) Permit Programs, CAP/C Case Management Home Mobility Aids Vehicle Modification Community Transition Funding Care Giver Training Medical Supplies Memo of endsement from DMA CAP/C supervis verifying agency designation f specific CAP services Approval from Head of DMA DME Program Programs, CAP/C Waiver Supplies Programs, CAP/C CAP/C Nursing Respite Care, Inhome (Nursing) Memo of endsement from DMA CAP/C supervis verifying agency designation f specific CAP services Documentation verifying the provider s with NC Medicaid as a Durable Medical Equipment provider Licensed by NC DHSR as a Home Care Service (Nursing Care must be indicated on the license) Documentation verifying the provider s with NC Medicaid as a Durable Medical Equipment provider **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 2 of 30

3 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Programs, CAP/C Personal Care Pediatric Nurse Aide Services Attendant Care Respite Care, Inhome (Aide) Licensed by NC DHSR as a Home Care Service (In-home Aide Care must be indicated on the license) Programs, CAP/C Respite Care, Institutional (Nursing Facility Hospital) Documentation verifying the facility's with NC Medicaid as a Nursing Facility Hospital Programs, CAP/C Palliative Care Documentation verifying the facility's with NC Medicaid as a Hospice Service **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 3 of 30

4 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Memo from DMA Facility and Community-based Services Unit verifying agency designation as a Lead Administrative Agency Programs, CAP/Choice Care Advis Financial Management Services Home Modifications and Mobility Aids Medical Supplies Participant Goods and Service Personal Assistant Services Training and Education Services Transition Codination (MFP) Transition Services Programs, CAP/Choice Assistive Technology Programs, CAP/Choice Waiver Supplies Documentation verifying the facility's with NC Medicaid as a Nursing Facility, Hospital Home Health Agency Memo from DMA Facility and Community-based Services Unit verifying agency designation as a Lead Administrative Agency Documentation verifying the provider s with NC Medicaid as a Durable Medical Equipment provider Documentation verifying the provider s with NC Medicaid as a Durable Medical Equipment provider **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 4 of 30

5 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Programs, CAP/Choice Personal Care Aide, In-Home Aide Level II Personal Care Aide, In-home Aide Level III Non-Institutional Respite Services Programs, CAP/Choice Institutional Respite Services Programs, CAP/Choice Adult Day Health Care Programs, CAP/Choice Meal Preparation and Delivery Licensed by NC DHSR as a Home Care Service (In-home Aide Care must be indicated on the license) Documentation verifying the facility's with NC Medicaid as a Nursing Facility Hospital Certification by NC Division of Aging and Adult Services as Adult Day Facility Memo from DMA Facility and Community-based Services Unit verifying agency designation as a Lead Administrative Agency Letter of approval from NC Division of Aging and Adult Services Copy of current review from NC Division of Aging and Adult Services **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 5 of 30

6 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Agency marketing materials (brochure) Programs, CAP/Choice Personal Copy of contract between provider agency and Emergency moniting station if the provider agency does not Response System directly provide the moniting service Copy of contract signed by the subscriber (recipient) Note: If the contract that is signed by the subscriber (recipient) indicates that the subscriber is responsible f monthly charges and/ states that subscriber is liable and responsible f the payment of any expenses costs incurred by any person responding to a call from the moniting center, an addendum must be submitted to indicate that these charges do not apply to the subscriber. Documentation on company letterhead indicating: who is responsible f 24-hour moniting where they are located who completes medical infmation who completes responder infmation who provides info to moniting staff verification that subscriber has not signed a contract because the provider does not use a contract Note: All documentation must confirm that the agency operates accepts responsibility f providing service 24/7. **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 6 of 30

7 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Programs, CAP/DA Case Management Home Modifications and Mobility Aids Participant Goods and Service Training and Education Services Transition Codination (MFP) Transition Services Programs, CAP/DA Assistive Technology Programs, CAP/DA Waiver Supplies Programs, CAP/DA Personal Care Aide, In-Home Aide Level II Personal Care Aide, In-home Aide Level III Non-Institutional Respite Services Programs, CAP/DA Institutional Respite Services Memo from DMA Facility and Community-based Services Unit verifying agency designation as a Lead Administrative Agency Documentation verifying the facility's with NC Medicaid as a Nursing Facility, Hospital Home Health Agency Memo from DMA Facility and Community-based Services Unit verifying agency designation as a Lead Administrative Agency Documentation verifying the provider s with NC Medicaid as a Durable Medical Equipment provider Licensed by NC DHSR as a Home Care Service (In-home Aide Care must be indicated on the license) Documentation verifying the facility's with NC Medicaid as a Nursing Facility Hospital Documentation verifying the provider s with NC Medicaid as a Durable Medical Equipment provider **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 7 of 30

8 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Programs, CAP/DA Adult Day Health Care Programs, CAP/DA Meal Preparation and Delivery Certification by NC Division of Aging and Adult Services as Adult Day Facility Memo from DMA Facility and Community-based Services Unit verifying agency designation as a Lead Administrative Agency Letter of approval from NC Division of Aging and Adult Services Copy of current review from NC Division of Aging and Adult Services **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 8 of 30

9 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Agency marketing materials (brochure) Programs, CAP/DA Personal Copy of contract between provider agency and Emergency moniting station if the provider agency does not Response System directly provide the moniting service Copy of contract signed by the subscriber (recipient) Note: If the contract that is signed by the subscriber (recipient) indicates that the subscriber is responsible f monthly charges and/ states that subscriber is liable and responsible f the payment of any expenses costs incurred by any person responding to a call from the moniting center, an addendum must be submitted to indicate that these charges do not apply to the subscriber. Documentation on company letterhead indicating: who is responsible f 24-hour moniting where they are located who completes medical infmation who completes responder infmation who provides info to moniting staff verification that subscriber has not signed a contract because the provider does not use a contract Programs, CAP/MR-DD Adult Day Health Care Programs, CAP/MR-DD Crisis Respite Note: All documentation must confirm that the agency operates accepts responsibility f providing service 24/7. Certification by NC Division of Aging And Adult Services Licensed by NC DHSR as a Respite Care facility Certification by the Local Management Entity (Notification of Endsement Action Letter) **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 9 of 30

10 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Documentation verifying the provider s Documentation verifying the provider s Programs, CAP/MR-DD with NC Medicaid as a Durable with NC Medicaid as a Durable Waiver Supplies Medical Equipment provider Medical Equipment provider Programs, CAP/MR-DD No requirements Specialized Equipment and Supplies Programs, CAP/MR-DD Transptation Enrollment f transptation services is limited to emergency (ambulance) service providers only F additional infmation: NC DMA: Transptation Services **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 10 of 30

11 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Programs, CAP/MR-DD Augmentative Communication Behavial Consultant Crisis Services Home and Community Suppt Home Modification Home Suppt Individual/Caregiver Training and Education Long-term Vocational Suppts Personal Care Services Respite Care, Noninstitutional Specialized Consultative Services Suppted Employment Vehicle Adaptation Certification by the Local Management Entity (Notification of Endsement Action Letter) **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 11 of 30

12 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Programs, CAP/MR-DD Certification by the Local Management Entity (Notification of Endsement Action Letter) Residential Suppts Note: Services can be delivered in the community in a licensed facility not owned by the provider. However, if the service is rendered in a licensed facility that is owned by the provider, the facility must be licensed (accding to 10A NCAC 27G.5600) by NC DHSR as one of the following: (F) Supervised Living/Alternative Family Living Facility (C) Supervised Living f DD Adults (B) Supervised Living f DD Mins **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 12 of 30

13 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Agency marketing materials (brochure) Programs, CAP/MR-DD Personal Copy of contract between provider agency and Emergency moniting station if the provider agency does not Response System directly provide the moniting service Copy of contract signed by the subscriber (recipient) Note: If the contract that is signed by the subscriber (recipient) indicates that the subscriber is responsible f monthly charges and/ states that subscriber is liable and responsible f the payment of any expenses costs incurred by any person responding to a call from the moniting center, an addendum must be submitted to indicate that these charges do not apply to the subscriber. Documentation on company letterhead indicating: who is responsible f 24-hour moniting where they are located who completes medical infmation who completes responder infmation who provides info to moniting staff verification that subscriber has not signed a contract because the provider does not use a contract Note: All documentation must confirm that the agency operates accepts responsibility f providing service 24/7. **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 13 of 30

14 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Programs, CAP/MR-DD Certification by the Local Management Entity (Notification of Endsement Action Letter) Day Suppts Licensed by NC DHSR as one of the following: Adult Day Developmental Vocational Program (in accdance with 10A NCAC 27G.2300) Sheltered Wkshop (in accdance with 10A NCAC 27G.5500) Day Activity (in accdance with 10A NCAC 27G.5400) Developmental Day Programs (in accdance with 10A NCAC 27G.2400) Programs, CAP/MR-DD Respite Care, Institutional (ICF/MR) Programs, CAP/MR-DD Respite Nursing Note: Services can be delivered by a licensed Adult Day Health Care Facility that is enrolled to provide CAP/MR-DD Adult Day Health Care Services, no additional certification, licensure, endsement is required to provide day suppt services. Letter of approval verifying the facility's with NC Medicaid Certification by the Local Management Entity (Notification of Endsement Action Letter) Licensed by NC DHSR as a Home Care Service (Nursing Care must be indicated on the license) **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 14 of 30

15 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Community Intervention Services Assertive Community Treatment Team Mobile Crisis Management Medically Supervised ADATC Detox/Crisis Stabilization Diagnostic Assessment Multisystemic Therapy Community Intervention Services Early Intervention Services Certification by the Local Management Entity (Notification of Endsement Action Letter) Letter of approval from the Children's Developmental Services Agency **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 15 of 30

16 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Certification by the Local Management Entity (Notification of Endsement Action Letter) Community Intervention Services Professional Treatment Services in Facility-based Crisis Program - Adult Professional Treatment Services in Facility-based Crisis Program - Child Partial Hospitalization Ambulaty Detox Substance Abuse Comprehensive Outpatient Treatment Non-hospital Medical Detox Substance Abuse Non-medical Community Residential Treatment Substance Abuse Medically Monited Community Residential Treatment Substance Abuse Intensive Outpatient Program Psychosocial Rehab Opioid Treatment Licensed by NC DHSR as a Mental Health Facility **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 16 of 30

17 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Certified Registered Nurse Anesthetist, Individual Licensed by NC Board of Nursing as a Registered Nurse Certified by Council on Certification of Nurse Anesthetists Council on Recertification of Nurse Anesthetists Licensed as a Registered Nurse by the licensure board in Certified by Council on Certification of Nurse Anesthetists Council on Recertification of Nurse Anesthetists Licensed as a Registered Nurse by the licensure board in Certified by Council on Certification of Nurse Anesthetists Council on Recertification of Nurse Anesthetists Certified Registered Nurse Anesthetist, Group Critical Access Behavial Health Agency Community Suppt Team Child and Adolescent Day Treatment Intensive In-home state of practice state of practice No requirements No requirements Letter of Certification as a Critical Access Behavial Health Agency from DHHS from DMH/DD/SAS Certification by the Local Management Entity (Notification of Endsement Action Letter) Dialysis Center Licensed by NC DHSR **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 17 of 30

18 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Durable Medical Equipment NC Pharmacy Board Permit Device and Medical Equipment (Dispensing) Permit A letter on the applicant s letterhead signed by the authizing agent attesting to the provision of thotics and prosthetics only NC Pharmacy Board Permit Device and Medical Equipment (Dispensing) Permit A letter on the applicant s letterhead signed by the authizing agent attesting to the provision of thotics and prosthetics only NC Pharmacy Board Permit Device and Medical Equipment (Dispensing) Permit A letter on the applicant s letterhead signed by the authizing agent attesting to the provision of thotics and prosthetics only Current National Clearinghouse Supplier letter from CMS verifying Medicare (cannot be me than 3 yrs from the date of approval indicated on the letter) Current National Clearinghouse Supplier letter from CMS verifying Medicare (cannot be me than 3 yrs from the date of approval indicated on the letter) Current National Clearinghouse Supplier letter from CMS verifying Medicare (cannot be me than 3 yrs from the date of approval indicated on the letter) Federally Qualified Health Center Ce Services Approval from Head of DMA DME Program Medicaid Agency s Notice of Rate Health Department No Requirements Hearing Aid Provider Licensed by the NC State Hearing Aid Dealers Licensed by the NC State Hearing Aid Dealers and Fitters Board and Fitters Board by the licensure board in the applicant's state of practice HIV Case Management Certified as a Qualified Case Management Provider by the Carolinas Center f Medical Excellence Home Health Service Licensed by NC DHSR as a Home Care Service **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 18 of 30

19 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Home Infusion Therapy Hospice Licensed by NC DHSR as a Home Care Service (Infusion Nursing Service must be indicated on the license) Licensed by NC DHSR as a Home Care Service Hospital Hospital, Critical Access Licensed by NC DHSR Hospital, (Specialty) Long Term Acute Care (LTACH) Licensed by NC DHSR Licensed by NC DHSR Hospital, Swing Bed Licensed by NC DHSR Hospital, Psych/Rehab Unit ICF/MR, Privately Owned Licensed by NC DHSR Licensed by NC DHSR ICF/MR, State-owned No requirements **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 19 of 30

20 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Independent Diagnostic Testing Facility Accredited through the American Registry of Diagnostic Medical Sonographers Cardiovascular Credentialing International American Registry of Radiologic Technologists Independent Labaty CLIA certification CLIA certification CLIA certification Independent Practitioner, Individual Occupational Therapist Independent Practitioners, Individual Physical Therapist Independent Practitioner, Individual Respiraty Therapist Licensed by the NC Board of Occupational Therapy Licensed by the NC Board of Physical Therapy Licensed by the Respiraty Care Board Licensed by the Board of Occupation Therapy in the applicant s state of practice Licensed by the Board of Physical Therapy in the applicant s state of practice Licensed by the Respiraty Care Board in the applicant s state of practice **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 20 of 30

21 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Independent Practitioner, Individual Licensed by the NC Board of Examiners f Speech and Language Pathologists and Licensed by the Board of Examiners f Speech and Language Pathologists and Audiologists in Speech Language Therapist Audiologists the applicant s state of practice Proof of ASHA Certificate of Clinical Competence (CCC) in Speech/Language Pathology Documentation indicating the completion of: requirements and wk experience necessary f the ASHA CCC in Speech/Language Pathology academic Master's degree program and is acquiring the supervised wk experience to qualify f the ASHA CCC in Speech/Language Pathology Proof of ASHA Certificate of Clinical Competence (CCC) in Speech/Language Pathology Documentation indicating the completion of: requirements and wk experience necessary f the ASHA CCC in Speech/Language Pathology academic Master's degree program and is acquiring the supervised wk experience to qualify f the ASHA CCC in Speech/Language Pathology Independent Practitioner, Individual Audiologist Licensed by the NC Board of Examiners f Speech and Language Pathologists and Audiologists Licensed by the Board of Examiners f Speech and Language Pathologists and Audiologists in the applicant s state of practice Independent Practitioner, Group Local Education Agency (Public Schools) Local Management Entity No Requirements No Requirements No Requirements Note: Only a State-constituted public board of education other public authity running a school system, elementary secondary school, public nonprofit charter school recognized by the State is eligible to participate as an LEA. No Requirements **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 21 of 30

22 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Nurse Midwife, Individual Licensed by the NC Board of Nursing Certification from the Midwifery Joint Committee of NC Licensed by the Board of Nursing in the applicant's state of practice Certification from the Midwifery Joint Committee of NC the entity responsible f certification in Licensed by the Board of Nursing in the applicant's state of practice Certification from the Midwifery Joint Committee of NC the entity responsible f certification in Nurse Midwife, Group No Requirements Nurse Practitioner, Licensed by the NC Board of Nursing Licensed by the NC Board of Nursing the Individual entity responsible f licensure in the applicant's state of practice Licensed by the NC Board of Nursing the entity responsible f licensure in the applicant's state of practice Certification as a Nurse Practitioner by one of the following national credentialing bodies American Nurses Credentialing Center American Academy of Nurse Practitioners National Certification Cpation of the Obstetric and Gynecological and Neonatal Nursing Specialists Pediatric Nursing Certification Board NOTE: Per 21 NCAC (a) A nurse practitioner with first-time approval to practice after January 1, 2000, shall provide evidence of certification recertification as a nurse practitioner by a national credentialing body. NPs licensed pri to January 1, 2000 did not have to be certified by a national credentialing body. Copy of Statement of Approval Letter issued by the medical board other licensing entity with both the approval date and the name of the supervising physician Certification as a Nurse Practitioner by one of the following national credentialing bodies American Nurses Credentialing Center American Academy of Nurse Practitioners National Certification Cpation of the Obstetric and Gynecological and Neonatal Nursing Specialists Pediatric Nursing Certification Board NOTE: Per 21 NCAC (a) A nurse practitioner with first-time approval to practice after January 1, 2000, shall provide evidence of certification recertification as a nurse practitioner by a national credentialing body. NPs licensed pri to January 1, 2000 did not have to be certified by a national credentialing body. Copy of Statement of Approval Letter issued by the medical board other licensing entity with both the approval date and the name of the supervising physician Certification as a Nurse Practitioner by one of the following national credentialing bodies American Nurses Credentialing Center American Academy of Nurse Practitioners National Certification Cpation of the Obstetric and Gynecological and Neonatal Nursing Specialists Pediatric Nursing Certification Board NOTE: Per 21 NCAC (a) A nurse practitioner with first-time approval to practice after January 1, 2000, shall provide evidence of certification recertification as a nurse practitioner by a national credentialing body. NPs licensed pri to January 1, 2000 did not have to be certified by a national credentialing body. Copy of Statement of Approval Letter issued by the medical board other licensing entity with both the approval date and the name of the supervising physician **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 22 of 30

23 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Nurse Practitioner, Group Nursing Facility No Requirements Licensed by NC DHSR Copy of the state Medicaid agency's official notice of rate Copy of the state Medicaid agency's official notice of rate Nursing Facility, Vent Bed Approval from Head of DMA Nursing Facility Program Nursing Facility, Head Bed Licensed by NC DHSR Licensed by NC DHSR Optical Supplier Licensed by the NC Board of Opticians Licensed by the NC Board of Opticians the licensure board in **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 23 of 30

24 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Orthotics and Prosthetics Certified Ocularist Certified Fitter of Therapeutic Shoes Certified/Registered Mastectomy Fitter Certified Orthotist Certified/Registered Orthotic Fitter Certified Prosthetist Certified Pedthist Register Fitter Orthotics Mastectomy Certified Orthotist/Prosthetist Certified accredited by American Board f Certification in Orthotics and Prosthetics Board of Orthotist/Prosthetist Certification National Examining Board of Ocularists Board f Certification in Pedthics Board of Certification in Clinical Anaplastology The Compliance Team, Inc. Certified accredited by American Board f Certification in Orthotics and Prosthetics Board of Orthotist/Prosthetist Certification National Examining Board of Ocularists Board f Certification in Pedthics Board of Certification in Clinical Anaplastology The Compliance Team, Inc. Outpatient Behavial Health Provider, Individual Advanced Practice Psychiatric Clinical Nurse Specialist Licensed by the NC Board of Nursing Certification from the American Nurse Credentialing Center Advanced Psychiatric Nurse Association Licensed by the NC Board of Nursing the licensure board in Certification from the American Nurse Credentialing Center Advanced Psychiatric Nurse Association **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 24 of 30

25 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Outpatient Behavial Health Provider, Licensed by the NC Board of Nursing Licensed by the NC Board of Nursing the licensure board in Individual Certification from the Advanced Practice American Nurse Credentialing Center Certification from the Psychiatric Nurse American Nurse Credentialing Center Practitioner another specialty with 2 years of documented mental health experience another specialty with 2 years of documented mental health experience Outpatient Behavial Health Provider, Individual Licensed Clinical Social Wker Licensed by the NC Social Wk Certification and Licensure Board Master's degree in social wk from a school of social wk accredited by the Council on Social Wk Education Licensed by the Social Wk Certification and Licensure Board the licensure board in the applicant s state of practice Master's degree in social wk from a school of social wk accredited by the Council on Social Wk Education Outpatient Behavial Health Provider, Individual Licensed Professional Counsel Outpatient Behavial Health Provider, Individual Licensed Clinical Addiction Specialist Outpatient Behavial Health Provider, Individual Certified Clinical Supervis Licensed by the NC Board of Licensed Professional Counsels Licensed by the NC Substance Abuse Professional Practice Board Certified by the NC Substance Abuse Professional Practice Board Licensed by the Board of Licensed Professional Counsels the licensure board in the applicant s state of practice Licensed by the Substance Abuse Professional Practice Board the licensure board in the applicant s state of practice Certified by the Substance Abuse Professional Practice Board the licensure board in the applicant s state of practice **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 25 of 30

26 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Outpatient Behavial Health Provider, Individual Licensed by the NC Marriage and Family Therapy Licensure Board Licensed by the Marriage and Family Therapy Licensure Board the licensure board in the applicant s state of practice Licensed Marriage and Family Therapist Outpatient Behavial Health Provider, Individual Licensed Psychologist Outpatient Behavial Health Provider, Individual Licensed Psychological Associate Outpatient Behavial Health Provider, Group PACE Licensed by the NC Psychology Board Licensed psychologists must be doctate level Licensed by the NC Psychology Board No Requirements Certification from the NC Division of Aging and Adult Services Licensed by the Psychology Board the licensure board in the applicant s state of practice Licensed psychologists must be doctate level Licensed by the Psychology Board the licensure board in the applicant s state of practice Copy of PACE Program Agreement from CMS Personal Care Service Licensed by NC DHSR as a Home Care Service (In-home Aide Care must be indicated on the license) Pharmacy Permit from the NC Board of Pharmacy Permit from the Board of Pharmacy in the applicant's state of practice Permit from the Board of Pharmacy in the applicant's state of practice Physician, Individual Medical docts Physician, Individual Osteopaths Licensed by NC Medical Board Licensed by NC Medical Board Licensed by Medical Board in the applicant's state of practice Licensed by Medical Board in the applicant's state of practice Approval from Head of DMA Pharmacy Program Licensed by Medical Board in the applicant's state of practice Licensed by Medical Board in the applicant's state of practice **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 26 of 30

27 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Physician, Individual Licensed by the NC Board of Chiropractic Licensed by the Board of Chiropractic Examiners Licensed by the Board of Chiropractic Examiners Chiropracts Examiners in in Physician, Individual Licensed by the NC Board of Examiners in Licensed by the Board of Examiners in Licensed by the Board of Examiners in Optometrists Optometry Optometry in Optometry in Physician, Individual Licensed by the NC Board of Podiatry Examiners Licensed by the Board of Podiatry Examiners in Licensed by the Board of Podiatry Examiners in Podiatrists Physician, Individual Licensed by the NC Board of State Dental Licensed by the Board of State Dental Examiners Licensed by the Board of State Dental Examiners Dentists Examiners in in Physician, Group No requirements No requirements No requirements Physician Assistant, Individual Physician Assistant, Group Successful completion of an accredited educational program accredited by the Committee on Allied Health Education and Accreditation (CAHEA) its predecess success entities Successful completion of Physician Assistant National Certifying Examination if licensed after June 1, Maintain a current and active license from State Medical Board (license renewed annually) and maintain an active registration with State Medical Board to practice in Nth Carolina Current Copy of Intent to Practice Acknowledgement Letter issued by the medical board other licensing entity No Requirements Licensed by State Medical Board (license renewed annually) and active registration with State Medical Board Successful completion of an accredited educational program accredited by CAHEA its predecess success entities Successful completion of Physician Assistant National Certifying Examination if licensed after June 1, 1994 Current Copy of Intent to Practice Acknowledgement Letter issued by the medical board other licensing entity Licensed by State Medical Board (license renewed annually) and active registration with State Medical Board Successful completion of an accredited educational program accredited by CAHEA its predecess success entities Successful completion of Physician Assistant National Certifying Examination if licensed after June 1, 1994 Current Copy of Intent to Practice Acknowledgement Letter issued by the medical board other licensing entity Not Eligible Planned Parenthood Agency Ptable X-ray Service Private Duty Nursing Certification from the Planned Parenthood Federation of America, Inc. Licensed by NC DHSR as a Home Care Service (Nursing Care must be indicated o the license) **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 27 of 30

28 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Psychiatric Hospital, State Owned (only f recipients under 21 and 65 years and older) Psychiatric Residential Treatment Facility, state-owned Psychiatric Hospital, privately owned, (only f recipients under 21 and 65 years and older) Accreditation from Joint Commission on Accreditation of Healthcare Organizations Council on Accreditation Commission on Accreditation of Rehabilitation Facilities Licensed by the NC DHSR F Individuals under 21, Accreditation from Joint Commission on Accreditation of Healthcare Organizations Council on Accreditation Commission on Accreditation of Rehabilitation Facilities Licensed by the hospital s state agency charged with licensure in F Individuals under 21,Accreditation from Joint Commission on Accreditation of Healthcare Organizations Council on Accreditation Commission on Accreditation of Rehabilitation Facilities Licensed by the hospital s state agency charged with licensure in F Individuals under 21, Accreditation from Joint Commission on Accreditation of Healthcare Organizations Council on Accreditation Commission on Accreditation of Rehabilitation Facilities **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 28 of 30

29 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** Psychiatric Residential Treatment Facility, privately owned Rural Health Clinic Ce Services School Based Health Center Sponsed by a Physician Group, a Nurse Practitioner Group, a Health Department School Based Health Center Sponsed by a Federally Qualified Health Center Licensed by NC DHSR as a Mental Health Treatment Facility Accreditation from Joint Commission on Accreditation of Healthcare Organizations Council on Accreditation Commission on Accreditation of Rehabilitation Facilities Letter of Suppt from the Local Management Entity Copy of completed NC School-based Health Center Verification of Credentialed Status Fm from the N.C. Division of Public Health Copy of completed NC School-based Health Center Verification of Credentialed Status Fm from the N.C. Division of Public Health Health Resources and Services Administration (HRSA) Notice of Grant Award including Fm 5 Part B/Services Sites Licensed as a Mental Health Facility in the applicant s state of practice and location Accreditation from Joint Commission on Accreditation of Healthcare Organizations Council on Accreditation Commission on Accreditation of Rehabilitation Facilities Be enrolled as a Medicaid provider in the state in which it is located. Licensed as a Mental Health Facility in the applicant's state of practice and location Accreditation from Joint Commission on Accreditation of Healthcare Organizations Council on Accreditation Commission on Accreditation of Rehabilitation Facilities Approval from Head of DMA Behavial Health Program Be enrolled as a Medicaid provider in the state in which it is located. Medicaid Agency s Notice of Rate **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 29 of 30

30 Nth Carolina Medicaid Management As of May 22, 2012 Infmation System (MMIS) Provider Type In-State Bder Out-of-State** F new applicants: Notice of Endsement from the Local Management Entity Targeted Case Management f Developmental Disabilities Targeted Case Management f Mental Health and Substance Abuse Therapeutic Family Services F providers currently billing f this service through the Local Management Entity: Notice of Endsement from the Local Management Entity and Letter of Attestation f TCM-DD from the Local Management Entity Letter of Certification as a Critical Access Behavial Health Agency from DHHS from DMH/DD/SAS Licensed by NC DSS as a Child Placing Agency Notice of Endsement from the Local Management Entity **Out-of-state providers are eligible f enrollment only f the reimbursement of services rendered to a N.C. Medicaid recipient in response to an emergency if travel back to the State would endanger the health of the eligible recipient; f reimbursement of a priapproved non-emergency service; f reimbursement of medical equipment and devices that are not available through an enrolled provider located within the State of Nth Carolina in the 40-mile bder area. Page 30 of 30

4123-6-02.2 Provider access to the HPP - provider credentialing criteria.

4123-6-02.2 Provider access to the HPP - provider credentialing criteria. 4123-6-02.2 Provider access to the HPP - provider credentialing criteria. (A) The bureau shall establish minimum credentialing criteria for provider certification. Providers must meet all licensing, certification,

More information

CHAPTER 600 PROVIDER QUALIFICATIONS AND PROVIDER REQUIREMENTS 600 CHAPTER OVERVIEW... 600-1 610 AHCCCS PROVIDER QUALIFICATIONS...

CHAPTER 600 PROVIDER QUALIFICATIONS AND PROVIDER REQUIREMENTS 600 CHAPTER OVERVIEW... 600-1 610 AHCCCS PROVIDER QUALIFICATIONS... 600 CHAPTER OVERVIEW... 600-1 REFERENCES... 600-2 610 AHCCCS PROVIDER QUALIFICATIONS... 610-1 EXHIBIT 610-1 AHCCCS PROVIDER TYPES 620 AHCCCS FFS MINIMUM NETWORK REQUIREMENTS... 620-1 630 MEDICAL RECORD

More information

IHCP Provider Enrollment Provider Type and Specialty Matrix

IHCP Provider Enrollment Provider Type and Specialty Matrix Type and Specialty Matrix Specialty Codes In-State Out-of-State (OOS) 01 Hospital 010 Acute Care 011 Psychiatric (distinct part or unit) 012 Rehabilitation (distinct part or unit) 01 Hospital 011 Psychiatric

More information

ICD-10 Implementation Billing Guide

ICD-10 Implementation Billing Guide ICD-10 BILLING INSTRUCTIONS: SERVICES Split Claims s who submit claims for the following services are required to split the claim so that claims for dates of service through September 30, 2015, contain

More information

TYPE AND SPECIALTY LIST AND DOCUMENTATION REQUIREMENTS FOR PROVIDER PARTICIPATION AGREEMENTS

TYPE AND SPECIALTY LIST AND DOCUMENTATION REQUIREMENTS FOR PROVIDER PARTICIPATION AGREEMENTS New Mexico Medicaid Project 1720-A Randolph Road SE Albuquerque, NM 87106 505-246-9988 505-246-8485 (fax) TYPE AND SPECIALTY LIST AND DOCUMENTATION REQUIREMENTS FOR PROVIDER PARTICIPATION AGREEMENTS Please

More information

PROVIDER TYPE CODE DESCRIPTION OF PROVIDER TYPE SPECIALITY CODE DESCRIPTION OF PROVIDER SPECIALITY 01 INPATIENT FACILITY 010 ACUTE CARE HOSPITAL 01

PROVIDER TYPE CODE DESCRIPTION OF PROVIDER TYPE SPECIALITY CODE DESCRIPTION OF PROVIDER SPECIALITY 01 INPATIENT FACILITY 010 ACUTE CARE HOSPITAL 01 PROVIDER TYPE CODE DESCRIPTION OF PROVIDER TYPE SPECIALITY CODE DESCRIPTION OF PROVIDER SPECIALITY 01 INPATIENT FACILITY 010 ACUTE CARE HOSPITAL 01 011 PRIVATE PSYCHIATRIC HOSPITAL 01 012 INPATIENT MEDICAL

More information

Ohio Medicaid Web Portal Enrolling Provider Checklists by Request Type

Ohio Medicaid Web Portal Enrolling Provider Checklists by Request Type Ohio Medicaid Web Portal Enrolling Provider Checklists by Request Type Ohio Department of Job and Family Services TABLE OF CONTENTS General Instructions...3 Provider Enrollment Application Checklist: Individual

More information

ForwardHealth-Required Taxonomy Codes

ForwardHealth-Required Taxonomy Codes ForwardHealth-Required s Provider Type Ambulance Air Ambulance 3416A0800X Air Transport Ambulance Land Ambulance 3416L0300X Land Transport Federally Qualified Health Ambulance Water Ambulance 3416S0300X

More information

Introduction to One Care. MassHealth plus Medicare. www.mass.gov/masshealth/onecare

Introduction to One Care. MassHealth plus Medicare. www.mass.gov/masshealth/onecare Introduction to One Care MassHealth plus Medicare www.mass.gov/masshealth/onecare Overview of One Care Starting in fall 2013, MassHealth and Medicare will join together with health plans in Massachusetts

More information

INTEGRATED PROVIDER NETWORK SERVICE DESCRIPTION LIST (Medicaid Services)

INTEGRATED PROVIDER NETWORK SERVICE DESCRIPTION LIST (Medicaid Services) INTEGRATED PROVIDER NETWORK SERVICE DESCRIPTION LIST (Medicaid Services) Service 5121 H0005 AODA Group Counseling Alcohol and/ drug svcs; grp couns. AODA Group counseling provided in a Community Substance

More information

The following table lists provider type and specialty codes with the enrollment requirements and provider classification information

The following table lists provider type and specialty codes with the enrollment requirements and provider classification information Indiana Health Coverage Programs P R O V I D E R T Y P E A N D S P E C I A L T Y M A T R I X V E R S I O N 4. 0 A U G U S T 2 0 0 4 The following table lists provider type and specialty codes with the

More information

AN ACT RELATING TO HEALTH INSURANCE; AMENDING A SECTION OF THE NEW MEXICO INSURANCE CODE TO PROVIDE FOR FREEDOM OF CHOICE OF

AN ACT RELATING TO HEALTH INSURANCE; AMENDING A SECTION OF THE NEW MEXICO INSURANCE CODE TO PROVIDE FOR FREEDOM OF CHOICE OF AN ACT RELATING TO HEALTH INSURANCE; AMENDING A SECTION OF THE NEW MEXICO INSURANCE CODE TO PROVIDE FOR FREEDOM OF CHOICE OF HOSPITAL AND PRACTITIONER TO INCLUDE LICENSED PROFESSIONAL MENTAL HEALTH COUNSELORS

More information

CABHAs and non-cabha agencies may provide Comprehensive Clinical Assessments, Medication Management, and Outpatient Therapy.

CABHAs and non-cabha agencies may provide Comprehensive Clinical Assessments, Medication Management, and Outpatient Therapy. Page 7c.1b 4.b Early and periodic screening, diagnostic and treatment services for individuals under 21 years of age, and treatment of conditions found. (continued) Critical Access Behavioral Health Agency

More information

Medicaid 101. The basics of publicly funded healthcare.

Medicaid 101. The basics of publicly funded healthcare. Medicaid 101 The basics of publicly funded healthcare. Medicare Vs Medicaid Medicare: Over 65, or Disabled Federally Managed program Medicaid Resource & Need Based State Federal Partnership Social Security

More information

Oregon Health Care Regulatory Agencies

Oregon Health Care Regulatory Agencies Citizen s Guide to Oregon Health Care Regulatory Agencies Prepared by: Oregon State Board of Nursing This is a guide to Oregon health care regulatory agencies. The boards and agencies listed here protect

More information

FLORIDA BLUE HOSPITAL, ANCILLARY FACILITY AND SUPPLIER BUSINESS APPLICATION. Facility Name: Legal Name (if different from above):

FLORIDA BLUE HOSPITAL, ANCILLARY FACILITY AND SUPPLIER BUSINESS APPLICATION. Facility Name: Legal Name (if different from above): FLORIDA BLUE HOSPITAL, ANCILLARY FACILITY AND SUPPLIER BUSINESS APPLICATION Florida Blue Provider Number: Facility Name: Legal Name (if different from above): Facility Physical Address: City: State: Zip

More information

Therapy Services Table of Contents

Therapy Services Table of Contents Therapy Services Table of Contents John R. Kasich, Governor John B. McCarthy, Director Ohio Department of Medicaid The Electronic Publishing Unit makes every attempt to publish accurate and current information,

More information

(A) Information needed to identify and classify the hospital, include the following: (b) The hospital number assigned by the department;

(A) Information needed to identify and classify the hospital, include the following: (b) The hospital number assigned by the department; 3701-59-05 Hospital registration and reporting requirements. Every hospital, public or private, shall, by the first of March of each year, register with and report to the department of health the following

More information

Appendix A. Glossary

Appendix A. Glossary Glossary The following provides brief definitions and descriptions of terms, abbreviations, and acronyms often used in the conjunction with the Medicaid program. AI is an indicator in the CAP block on

More information

An Overview of Medicaid in North Carolina *

An Overview of Medicaid in North Carolina * An Overview of Medicaid in North Carolina * Lisa J. Berlin Center for Child and Family Policy Duke University Abstract: In North Carolina, as in other states, Medicaid cost containment is an increasingly

More information

NJ FamilyCare ABP. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services

NJ FamilyCare ABP. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services NJ FamilyCare ABP BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see

More information

Medicaid Enrollment for Provision of Outpatient: Occupational Therapy Physical Therapy Speech-Language Pathology Audiology

Medicaid Enrollment for Provision of Outpatient: Occupational Therapy Physical Therapy Speech-Language Pathology Audiology Bulletin Michigan Department of Community Health Distribution: Hearing Aid Dealer 04-02 Hearing and Speech Center 04-02 Hospital 04-17 Medical Supplier 04-08 Practitioner 04-10 Outpatient Therapies 04-01

More information

Medicaid Application Fee Requirement by Provider Type

Medicaid Application Fee Requirement by Provider Type Medicaid Application Fee Requirement by Provider Type The following table shows which Medicaid provider types are required to pay the application fee upon initial enrollment, re-enrollment, and enrollment

More information

ATTACHMENT 3 REQUIREMENTS FOR PROFESSIONAL AND ASSOCIATE LEVEL EARLY INTERVENTION CREDENTIALING AND ENROLLMENT TO BILL

ATTACHMENT 3 REQUIREMENTS FOR PROFESSIONAL AND ASSOCIATE LEVEL EARLY INTERVENTION CREDENTIALING AND ENROLLMENT TO BILL ATTACHMENT 3 REQUIREMENTS FOR PROFESSIONAL AND ASSOCIATE LEVEL EARLY INTERVENTION CREDENTIALING AND ENROLLMENT TO BILL Please monitor the EI website at www.dhs.state.il.us/ei for changes to Credentialing

More information

NJ FamilyCare B. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services

NJ FamilyCare B. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services NJ FamilyCare B BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see

More information

1. To be eligible for Non-Physician Health Care Provider Board Certified Pay (NPBCP), a Nurse Corps officer must:

1. To be eligible for Non-Physician Health Care Provider Board Certified Pay (NPBCP), a Nurse Corps officer must: 1. Chapter 4 of OPNAV 7220.17 is amended by replacing the current section 430 with the following: 430. DEFINITION AND ELIGIBILITY 1. To be eligible for Non-Physician Health Care Provider Board Certified

More information

NJ FamilyCare A. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services

NJ FamilyCare A. Covered by Horizon NJ Health for spontaneous abortions/miscarriages. Abortions & Related Services NJ FamilyCare A BENEFIT Abortions & Related Services COVERAGE by Horizon NJ Health for spontaneous abortions/miscarriages. by Fee-for-Service for elective/induced abortions. Acupuncture Audiology (see

More information

APPENDIX C Description of CHIP Benefits

APPENDIX C Description of CHIP Benefits Inpatient General Acute and Inpatient Rehabilitation Hospital Unlimited. Includes: Hospital-provided physician services Semi-private room and board (or private if medically necessary as certified by attending)

More information

North Carolina Medicaid Special Bulletin

North Carolina Medicaid Special Bulletin North Carolina Medicaid Special Bulletin An Information Service of the Division of Medical Assistance Please visit our Web site at www.ncdhhs.gov/dma JULY 2006 Attention: All Mental Health/Substance Abuse

More information

DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW

DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW DEPARTMENT OF HEALTH & HUMAN SERVICES MEDICAID PROGRAM OVERVIEW North Carolina General Assembly Fiscal Research Division February 2005 Overview Purpose of Medicaid Impact of Medicaid - On the State Economy

More information

HOUSE OF REPRESENTATIVES FINAL BILL ANALYSIS SUMMARY ANALYSIS

HOUSE OF REPRESENTATIVES FINAL BILL ANALYSIS SUMMARY ANALYSIS HOUSE OF REPRESENTATIVES FINAL BILL ANALYSIS BILL #: CS/HB 639 FINAL HOUSE FLOOR ACTION: SPONSOR(S): Health Quality Subcommittee; Harrell and others 117 Y s 0 N s COMPANION BILLS: (SB 604) GOVERNOR S ACTION:

More information

MaineCare Value Based Purchasing Initiative

MaineCare Value Based Purchasing Initiative MaineCare Value Based Purchasing Initiative The Accountable Communities Strategy Jim Leonard, Deputy Director, MaineCare Peter Kraut, Acting Accountable Communities Program Manager Why Value-Based Purchasing

More information

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Current Approved State Plan Language

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Current Approved State Plan Language Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Current Approved State Plan Language Limitations on Attachment 3.1-A Page 9 Type of Service Covered for Medi-Cal eligibles under 21 years

More information

NJ FamilyCare D. Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ FamilyCare B NJ FamilyCare C

NJ FamilyCare D. Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ FamilyCare B NJ FamilyCare C Service Medicaid, NJ FamilyCare A and Alternative Benefit Plan (ABP) NJ Division of Developmental Disabilities (DDD) NJ FamilyCare B NJ FamilyCare C NJ FamilyCare D Abortions and related services (covered

More information

Business-Facts: Healthcare NAICS Summary 2015

Business-Facts: Healthcare NAICS Summary 2015 Business-Facts: Healthcare Summary 5 Radius : 9444 WAPLES ST, SAN DIEGO, CA 9-99,. -. Miles, 6 Healthcare and Social Assistance 8,694 59.9 6 Offices of Physicians (except Mental Health Specialists) 56

More information

Taxonomy Code Mapping Professional Providers

Taxonomy Code Mapping Professional Providers Mapping Professional s Adult Care Nurse Adult Psychiatric Mental Health Nursing 363LA2200X 364SP0809X Adult Health Practice Nursing s Clinical Nurse Specialist Adult Psychiatric/Mental Health Allergy and

More information

Taxonomy Code Mapping Professional Providers

Taxonomy Code Mapping Professional Providers Professional s Adult Care Nurse Adult Psychiatric Mental Health Nursing 363LA2200X 364SP0809X Adult Health Nursing s Clinical Nurse Specialist Adult Psychiatric/Mental Health Allergy and Immunology 207K00000X

More information

ALLIED & MISCELLANEOUS PROGRAM

ALLIED & MISCELLANEOUS PROGRAM ALLIED & MISCELLANEOUS PROGRAM PROGRAM HIGHLIGHTS A.M. Best rated A+ or better carrier. Mid-Continent s allied health care program includes individual health care providers and facilities (some exclusions

More information

CYE09 RFP Minimum Network Standards Excel Spreadsheet Instructions

CYE09 RFP Minimum Network Standards Excel Spreadsheet Instructions TABLE of CONTENTS CYE09 RFP Minimum Network Standards Excel Spreadsheet Instructions Definition of Terms... Introduction/Overview... Attachment 1 Provider Types Requiring NPI.... Attachment 2 Service Provider

More information

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland

Maryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid

More information

Benefit Plan Comparison*

Benefit Plan Comparison* Benefit Plan Comparison* Services Category 1: Ambulatory Services Primary Care Provider No Limits No Limits No Limits Physician Office 4 visits per calendar year Certified Registered Nurse Practitioner

More information

Facility Enrollment Required Document Checklist

Facility Enrollment Required Document Checklist Facility Enrollment Required Document Checklist Facility Classification Ambulatory Infusion Center (AIC) Ambulatory Surgical Facility (ASF) End Stage Renal Disease Facility (ESRD) - Accreditation Commission

More information

Medicare Beneficiaries (QMB) Provider Enrollment Application

Medicare Beneficiaries (QMB) Provider Enrollment Application Iowa Department of Human Services Medicare Beneficiaries (QMB) Provider Enrollment Application Please copy and complete one for each individual professional and institutional category that is part of this

More information

Reference Guide for Allowed Services by Provider Types

Reference Guide for Allowed Services by Provider Types Reference Guide for Allowed Services by Provider Types Version 6.0 For use in conjunction with MIHMS Enrollment Guides MIHMS_RG_0004_v6.0_20150312.doc Version History Version Date Author Action/Summary

More information

Section 5: Credentialing

Section 5: Credentialing Section 5: Credentialing PRACTITIONER CREDENTIALING CRITERIA...124 All Practitioners... 124 All Physicians... 125 Other Licensed Practitioners... 127 Unlicensed Practitioners... 127 Non-Credentialed Practitioners...

More information

Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado

Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado Mental Health and Substance Abuse Services in Medicaid and SCHIP in Colorado As of July 2003, 377,123 people were covered under Colorado s Medicaid and SCHIP programs. There were 330,499 enrolled in the

More information

Provider Enrollment Instructions

Provider Enrollment Instructions Nevada Medicaid and Nevada Check Up Provider Enrollment Instructions Welcome! Thank you for your interest in the Nevada Medicaid and Nevada Check Up program (hereafter referred to as Nevada Medicaid ).

More information

Benefit Plan Comparison*

Benefit Plan Comparison* Benefit Plan Comparison* Services Category 1: Ambulatory Services Primary Care Provider Physician Office Certified Registered Nurse Practitioner Federally Qualified Health Center/Rural Health Clinic except

More information

Covered Service Description

Covered Service Description Advanced registered nurse practitioner (ARNP) Ambulatory surgical center (ASC) These are given by an ARNP who s licensed to practice in the State of Florida The ARNP and a doctor must make decisions about

More information

TN No: 09-024 Supersedes Approval Date:01-27-10 Effective Date: 10/01/09 TN No: 08-011

TN No: 09-024 Supersedes Approval Date:01-27-10 Effective Date: 10/01/09 TN No: 08-011 Page 15a.2 (iii) Community Support - (adults) (CS) North Carolina is revising the State Plan to facilitate phase out of the Community Support - Adults service, which will end effective July 1, 2010. Beginning

More information

Covered services for NHP MassHealth members

Covered services for NHP MassHealth members Covered services for NHP MassHealth members Neighborhood Health Plan Covered Services for MassHealth Standard & CommonHealth, Family Assistance, and CarePlus Issued and Effective May 1, 2014 nhp.org/member

More information

HEALTH CARE DELIVERY ORGANIZATION/ANCILLARY/LONG TERM CARE PROVIDER APPLICATION

HEALTH CARE DELIVERY ORGANIZATION/ANCILLARY/LONG TERM CARE PROVIDER APPLICATION HEALTH CARE DELIVERY ORGANIZATION/ANCILLARY/LONG TERM CARE PROVIDER APPLICATION Enclosures Please submit all applicable documents from the list below with your completed and signed application. Failure

More information

and Substance Abuse Services Amended Date: August 1, 2013 Table of Contents

and Substance Abuse Services Amended Date: August 1, 2013 Table of Contents Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligible Beneficiaries... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 2 2.2 Special

More information

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012

Maryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012 Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 15, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint

More information

NEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-M 1301 MEDICAL ASSISTANCE SERVICES PROVIDED BY EDUCATION AGENCIES

NEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-M 1301 MEDICAL ASSISTANCE SERVICES PROVIDED BY EDUCATION AGENCIES CHAPTER He-M 1300 SPECIALIZED SERVICES PART He-M 1301 MEDICAL ASSISTANCE SERVICES PROVIDED BY EDUCATION AGENCIES Statutory Authority: RSA 186-C:27; I-II He-M 1301.01 Purpose. The purpose of these rules

More information

Place of Service Codes for Professional Claims Database (updated November 1, 2012)

Place of Service Codes for Professional Claims Database (updated November 1, 2012) Codes for Professional Claims Database (updated November 1, 2012) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity where

More information

Division of Behavioral Health. Requirements for Program Staff

Division of Behavioral Health. Requirements for Program Staff Division of Behavioral Health Requirements for Program Staff Integrated BH Regulations Training 1 Program Staff Program Staff are professionals who render behavioral health services directly to a recipient.

More information

Place of Service Codes for Professional Claims Database (updated November 1, 2012)

Place of Service Codes for Professional Claims Database (updated November 1, 2012) Place of Codes for Professional Claims Database (updated November 1, 2012) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity

More information

Fidelis Care NY State of Health: The Official Health Plan Marketplace Standard Products

Fidelis Care NY State of Health: The Official Health Plan Marketplace Standard Products PRODUCT INFORMATION Fidelis Care NY State of Health: The Official Health Plan Marketplace Standard Products NY State of Health: The Official Health Plan Marketplace (the Marketplace) is an online insurance

More information

Place of Service Codes for Professional Claims Database (updated August 6, 2015)

Place of Service Codes for Professional Claims Database (updated August 6, 2015) Place of Codes for Professional Claims Database (updated August 6, 2015) Listed below are place of service codes and descriptions. These codes should be used on professional claims to specify the entity

More information

SUMMARY OF BADGERCARE PLUS BENEFITS

SUMMARY OF BADGERCARE PLUS BENEFITS SUMMARY OF BADGERCARE PLUS BENEFITS Medical, mental health and substance abuse services Dental emergency NOT Pharmacy, chiropractic and dental services NOT 13 Ambulatory surgery centers Coverage of certain

More information

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES Version 2015-1 Page 1 of 11 Table of Contents SECTION I REQUIREMENTS FOR PARTICIPATION IN MEDICAID 3 QUALIFIED PRACTITIONERS. 3

More information

Licensed Counselors (LPCC)

Licensed Counselors (LPCC) CREDENTIALING Molina Healthcare of Ohio s credentialing process is designed to meet the standards of the National Committee for Quality Assurance (NCQA). In accordance with those standards, Molina Healthcare

More information

REFERENCE ACTION ANALYST STAFF DIRECTOR or BUDGET/POLICY CHIEF. 2) Health & Human Services Committee 14 Y, 0 N Holt Calamas

REFERENCE ACTION ANALYST STAFF DIRECTOR or BUDGET/POLICY CHIEF. 2) Health & Human Services Committee 14 Y, 0 N Holt Calamas HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: CS/HB 349 Treatment Programs for Impaired Professionals SPONSOR(S): Health Quality Subcommittee; Renuart TIED BILLS: IDEN./SIM. BILLS: REFERENCE ACTION ANALYST

More information

LCTS Public Health Activity Code Reference Guide

LCTS Public Health Activity Code Reference Guide LCTS Public Health Activity Code Reference Guide Section 4-80 LOCAL COLLABORATIVE TIME STUDY LCTS Federal Code Titles I. Health/Medical Related G. MA Eligibility Determination Assistance H. Health/Medical

More information

CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK. This table reflects Medicare Specialty Codes as of April 1, 2003.

CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK. This table reflects Medicare Specialty Codes as of April 1, 2003. CMS SPECIALTY CODE CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK This table reflects Medicare Specialty Codes as of April 1, 2003. This table reflects Healthcare Provider Taxonomy Codes (HPTC)

More information

CHAPTER 700 SCHOOL-BASED CLAIMING PROGRAM/DIRECT SERVICE CLAIMING 700 CHAPTER OVERVIEW... 700-1 710 MEDICAL AND FINANCIAL RECORDS...

CHAPTER 700 SCHOOL-BASED CLAIMING PROGRAM/DIRECT SERVICE CLAIMING 700 CHAPTER OVERVIEW... 700-1 710 MEDICAL AND FINANCIAL RECORDS... 700 CHAPTER OVERVIEW... 700-1 GENERAL REQUIREMENTS 700-1 REFERENCES. 700-3 710... 710-1 720 COVERED SERVICES... 720-1 A. AUDIOLOGY... 720-1 B. BEHAVIORAL HEALTH SERVICES... 720-2 BEHAVIORAL HEALTH PROVIDERS...

More information

Circular (15 /2014) Registration Department in Qatar Council for Healthcare Practitioners presents to you its compliments

Circular (15 /2014) Registration Department in Qatar Council for Healthcare Practitioners presents to you its compliments From Circular (15 /2014) Dr.Jamal Rashid Al-Khanji A/ Chief Executive Officer (CEO), Qatar Council for Healthcare Practitioners (QCHP) To All Healthcare Practitioners in the State of Qatar All Healthcare

More information

Florida Medicaid and Implementation of SB 2654

Florida Medicaid and Implementation of SB 2654 Florida Medicaid and Implementation of SB 2654 Shachi Mankodi Counsel to the Chief of Staff Florida Agency for Health Care Administration Autism Compact Presentation September 18, 2008 Overview What is

More information

Preauthorization Requirements * (as of January 1, 2016)

Preauthorization Requirements * (as of January 1, 2016) OFFICE VISITS Primary Care Office Visits Primary Care Home Visits Specialist Office Visits No Specialist Home Visits PREVENTIVE CARE Well Child Visits and Immunizations Adult Annual Physical Examinations

More information

Benefit Plan Comparison* Services Category 1: Ambulatory Services Primary Care Provider Physician Office Certified Registered Nurse Practitioner Federally Qualified Health Center/Rural Health Clinic except

More information

Benefit. Benefits Covered by UnitedHealthcare Community Plan

Benefit. Benefits Covered by UnitedHealthcare Community Plan Benefits Covered by UnitedHealthcare Community Plan As member of UnitedHealthcare Community Plan, you are covered for the following services. (Remember to always show your current member ID card when getting

More information

The emergency amendment of 8 AAC (m) is made permanent to read:

The emergency amendment of 8 AAC (m) is made permanent to read: The emergency repeal of 8 AAC 45.082(l)(2) is made permanent: (2) repealed 12/1/2015; The emergency amendment of 8 AAC 45.082(m) is made permanent to read: (m) A fee or other charge for medical treatment

More information

Ryan White Program Services Definitions

Ryan White Program Services Definitions Ryan White Program Services Definitions CORE SERVICES Service categories: a. Outpatient/Ambulatory medical care (health services) is the provision of professional diagnostic and therapeutic services rendered

More information

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center SECTION 5 HOSPITAL SERVICES Table of Contents 1 GENERAL POLICY... 2 1-1 Clients Enrolled in a Managed Care Plan... 3 1-2 Clients NOT Enrolled in a Managed Care Plan (Fee-for-Service Clients)..................

More information

BadgerCare Plus and Wisconsin Medicaid Covered Services Comparison Chart

BadgerCare Plus and Wisconsin Medicaid Covered Services Comparison Chart and Wisconsin Covered Services Comparison Chart The covered services information in the following chart is provided as general information. Providers should refer to their service-specific publications

More information

DC Health Professional Licensing Fees

DC Health Professional Licensing Fees Profession Description of Service Fees Acupuncturist Application Fee (original, temporary, or reinstatement) 85 Acupuncturist License Fee 145 Acupuncturist Re-Examination 119 Acupuncturist Paid Inactive

More information

Facility Classification

Facility Classification Facility Classification Facility Enrollment Required Document Checklist To avoid processing delays gather these items before you get started. If applying to network, complete the application signature

More information

West Virginia Children s Health Insurance Program

West Virginia Children s Health Insurance Program West Virginia Children s Health Insurance Program Billing Instruction Manual for Federally Qualified Health Centers (FQHC s) and Rural Health Centers (RHC s) Under a Prospective Payment System December

More information

Access to Health Care Nevada Medicaid

Access to Health Care Nevada Medicaid Brian Sandoval Governor Richard Whitley Interim Director Laurie Squartsoff Administrator Division of Health Care Financing and Policy Access to Health Care Nevada Medicaid Assembly Health and Human Services

More information

None. services will be provided through the Department s BHSA, Magellan. Magellan care managers are all licensed mental health professionals.

None. services will be provided through the Department s BHSA, Magellan. Magellan care managers are all licensed mental health professionals. Serious Mental Illness (SMI) Eligibility Screenings SMI Eligibility Screenings (short and long) will be performed as part of the GAP eligibility process, and can be performed by Community Services Boards,

More information

02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION. Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING

02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION. Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING 02- DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 380 BOARD OF NURSING Chapter 8 REGULATIONS RELATING TO ADVANCED PRACTICE REGISTERED NURSING SUMMARY: This chapter identifies the role of a registered

More information

THE ASSISTANT SECRETARY OF DEFENSE

THE ASSISTANT SECRETARY OF DEFENSE THE ASSISTANT SECRETARY OF DEFENSE 1200 DEFENSE PENTAGON WASHINGTON, DC 20301-1200 HEALTH AFFAIRS 13 Feb 12 MEMORANDUM FOR ASSISTANT SECRETARY OF THE ARMY (MANPOWER AND RESERVE AFFAIRS) ASSISTANT SECRETARY

More information

Division of Public Health

Division of Public Health Division of Public Health FY 2013 July 1, 2012 June 30, 2013 Department of Health and Human Services Division of Public Health Licensure Unit Nebraska State Office Building 301 Centennial Mall South Third

More information

CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK

CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK CMS SPECIALTY CODES/HEALTHCARE PROVIDER TAXONOMY CROSSWALK This document walks the CMS Medicare specialty codes to the taxonomy codes currently maintained by the Washington Publishing Company as mandated

More information

Public Act No. 15-226

Public Act No. 15-226 Public Act No. 15-226 AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR MENTAL OR NERVOUS CONDITIONS. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Section

More information

Provider Qualifications

Provider Qualifications Provider Qualifications The following establishes general qualifications for providers by type of service. Additional qualifications may need to be met depending on the program and related funding source

More information

Place of Service Codes

Place of Service Codes Place of Service Codes Code(s) Place of Service Name Place of Service Description 01 Pharmacy** A facility or location where drugs and other medically related items and services are sold, dispensed, or

More information

Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents

Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Professional Treatment Services in Facility-Based Crisis Program Children and Adolescents Medicaid and North Carolina Health Choice (NCHC) Billable Service WORKING DRAFT Revision Date: September 11, 2014

More information

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida

Florida Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida Mental Health and Substance Abuse Services in Medicaid and SCHIP in Florida As of July 2003 2,441,266 people were covered under Florida's Medicaid and SCHIP programs. There were 2,113,820 enrolled in the

More information

Table of Contents. 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1

Table of Contents. 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 2 2.2 Special

More information

APPLICATION TO PARTICIPATE IN THE FAMILY PACT (FAMILY PLANNING, ACCESS, CARE AND TREATMENT) PROGRAM (Section 24005, Welfare and Institutions Code)

APPLICATION TO PARTICIPATE IN THE FAMILY PACT (FAMILY PLANNING, ACCESS, CARE AND TREATMENT) PROGRAM (Section 24005, Welfare and Institutions Code) State of California Health and Human Services Agency Department of Health Care Services IMPORTANT: APPLICATION TO PARTICIPATE IN THE FAMILY PACT (FAMILY PLANNING, ACCESS, CARE AND TREATMENT) PROGRAM (Section

More information

CHAPTER 30. MEDICAL PROVIDERS-FEE FOR SERVICE SUBCHAPTER 5. INDIVIDUAL PROVIDERS AND SPECIALTIES PART 103

CHAPTER 30. MEDICAL PROVIDERS-FEE FOR SERVICE SUBCHAPTER 5. INDIVIDUAL PROVIDERS AND SPECIALTIES PART 103 CHAPTER 30. MEDICAL PROVIDERS-FEE FOR SERVICE SUBCHAPTER 5. INDIVIDUAL PROVIDERS AND SPECIALTIES PART 103. QUALIFIED SCHOOLS AS PROVIDERS OF HEALTH RELATED SERVICES 317:30-5-1023. Coverage by category

More information

Understanding Managed Long- Term Care

Understanding Managed Long- Term Care Understanding Managed Long- Term Care Managed Long-Term Care (MLTC) plans are insurance plans that are paid a monthly premium ("capitation") by the New York Medicaid program to approve and provide Medicaid

More information

Infant & Toddler Connections of Virginia DRAFT Provider Qualifications 1 Table

Infant & Toddler Connections of Virginia DRAFT Provider Qualifications 1 Table Infant & Toddler Connections of Virginia DRAFT Provider Qualifications 1 Table Audiologist Master s degree plus state licensure Specialist Associate Assistant Screening Audiology, Certified Therapeutic

More information

Glossary of Health Coverage and Medical Terms

Glossary of Health Coverage and Medical Terms Glossary of Health Coverage and Medical Terms This glossary defines many commonly used terms, but isn t a full list. These glossary terms and definitions are intended to be educational and may be different

More information

NEW MEXICO FINANCIAL INCENTIVES FOR HEALTH PROFESSIONALS

NEW MEXICO FINANCIAL INCENTIVES FOR HEALTH PROFESSIONALS NEW MEXICO FINANCIAL INCENTIVES FOR HEALTH PROFESSIONALS ALL S NOTED BELOW ARE COMPETITIVE WITH NO AWARD GUARANTEE ALLIED HEALTH STUDENT LOAN FOR SERVICE who are accepted by or enrolled at an accredited

More information

Arkansas Medicaid Health Care Providers - Occupational, Physical, Speech Therapy Services

Arkansas Medicaid Health Care Providers - Occupational, Physical, Speech Therapy Services Arkansas Department of Human Services Division of Medical Services Donaghey Plaza South P.O. Box 1437 Little Rock, Arkansas 72203-1437 Internet Website: www.medicaid.state.ar.us Telephone (501) 682-8292

More information

Appeal A request that your health insurer or plan review a decision that denies a benefit or payment (either in whole or in part).

Appeal A request that your health insurer or plan review a decision that denies a benefit or payment (either in whole or in part). Glossary of Health Coverage and Medical Terms This glossary defines many commonly used terms, but isn t a full list. These glossary terms and definitions are intended to be educational and may be different

More information