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Alabama MedicaidMedicaid · Administrative · Claims & Billing · AL · Family Medicine, General Practice, Internal MedicineMedium impact

Changes in Billing Procedures for Certified Registered Nurse Practitioners

Act
by Feb 1, 2027
Effective date
Feb 1, 2027
Identified
Nov 6, 2026

Summary

Effective February 1, 2027, Certified Registered Nurse Practitioners (CRNPs) providing Rural Health Clinic services must bill with their individual NPI in the rendering provider ID field (Block 24J) of the CMS-1500 claim form. CRNPs affiliated with rural health clinics must be enrolled with an NPI linked to the clinic under provider type 58 – Rural Health Clinic, and those not yet enrolled with Alabama Medicaid should apply through the Electronic Provider Enrollment Application Portal.

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What to do

by Feb 1, 2027 · 5 steps
01Billing team should confirm every CRNP who renders Rural Health Clinic services has an individual NPI linked to the clinic under provider type 58 – Rural Health Clinic, and apply through the Electronic Provider Enrollment Application Portal for any CRNP not yet enrolled with Alabama Medicaid (questions on enrollment to Provider Enrollment at (888) 223-3630).
02Update charge entry and claim templates so claims for CRNP-rendered Rural Health Clinic services enter the individual CRNP NPI in Block 24J of the CMS-1500 claim form.
03Tell providers and front desk staff that CRNP encounters must be attributed to the individual CRNP.
04Watch for the Chapters 32 and 36 updates to the Provider Billing Manual, scheduled for publication in the April 2027 update, and direct billing questions to Dominique Lassiter at Dominique.Lassiter@medicaid.alabama.gov.
05Claims submitted without the individual CRNP NPI in Block 24J are not described in the source, so confirm with the payer before assuming a specific outcome.

Original notice

Changes in Billing Procedures for Certified Registered Nurse Practitioners
medicaid.alabama.gov · Always check the source before changing claims.
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