Physician Enhancement Self-Attestation
Per 42 CFR 447.400, beginning January 1, 2013 and continuing through December 31, 2014 Medicaid is required to pay certain physicians up to the current Medicare rate.
In order to qualify for this enhanced rate, physicians must provide attestation that they are Board certified in family medicine, general internal medicine, pediatric medicine or a sub-specialty within one of these specialties.
Or, a provider may qualify for the enhanced payment if 60% or more of all Medicaid services they bill (including Medicaid managed care environments) are for the following codes: 99201 - 99499 and vaccine administration codes 90460, 90461, 90471, 90472, 90473 and 90474.
In the form below, please include the required provider information as well as an attestation under one of the above mentioned criteria.
Please note that certification to either of these criteria is subject to audit.