August 17, 2016

State of Alabama
Press Release: Medicaid

Implementation of the Dental PA Supporting Documentation Process

PDF Version

TO:  All Dental Providers, Alabama Dental Association, Alabama Hospital Association, Oral Surgeons, and State Agencies

Effective August 19, 2016, providers will be able to upload or fax Dental Prior Authorization (PA) supporting documentation via the Forms menu of the Alabama Medicaid Interactive Web Portal. 
A new form will allow providers the ability to upload Dental PA supporting documents in PDF format or create a fax barcode cover sheet from the Web Portal. Providers may submit additional documentation via fax at a later time and have that documentation combined with original document through the use of the same barcode cover sheet.

Dental PA supporting documentation will continue to be accepted in paper format until November 15, 2016. After that date, supporting documents received on paper will be returned to the provider with the exception of paper/original Photos, Radiographs, and X-Ray images.  

Accessing the Medicaid Interactive Web Portal

A secure logon to the Medicaid Interactive Web Portal is required to access the new attachment option.  Dental PA supporting documentation may be submitted in two different ways:

•    Medicaid Interactive Web portal (preferred)
•    Fax information using barcode cover sheet 

Browser Compatibility

Follow the below instructions to set their browser compatibility settings:

•    Navigate to the Medicaid Interactive Web Portal using the URL provided above.
•    Select Tools from upper right hand corner of browser. The feature is displayed as a wheel.

•    Choose Compatibility View Settings.
•    Click Add.
•    Click Close.
•    Refresh Browser to apply setting.

Documents must be in a Portable Document Format (PDF)

Documents must be in a PDF for upload through the Web Portal.  If you do not currently have the ability to create PDF versions of supporting documentation, you may perform an internet search and find free downloadable utilities that can be installed to create a PDF.  For your convenience, HPE is including a list of three PDF creation utilities that can be installed to create PDF documents at no charge:

•    PrimoPDF -
•    Solid PDF Creator -
•    PDF24 -

Steps to Upload Documentation

Once a PDF utility has been successfully downloaded and the PDF document created, providers should follow these steps to upload documentation for review:

1.    Log on to Medical Interactive Web portal:

2.    Select Trade Files/Forms.

3.    Select a form from the drop down list and click on Search. The following is a list of forms available for selection. Note: The newly added Dental PA Supporting Documentation choice is noted in red.

•    CS1 – Consent Form – Coming Soon
•    EFT – EFT Supporting Documentation - Coming Soon
•    ERU – Enrollment Updates - Coming Soon
•    LTC – Hospice Records
•    LTC – LTC Records
•    LTC – PEC Swing Bed Records
•    LTC – Psychiatric/Retrospective Review Records
•    OPR – OPR Application Supporting Documentation - Coming Soon
•    PA1–  Dental PA Supporting Documentation
•    PA2 – Medical PA Supporting Documentation
•    REA – Re-Enrollment Application Supporting Documentation - Coming Soon

4.    Complete all fields (record ID field will auto populate). Required fields are indicated with an asterisk (*).
a.    PA Number - A valid PA number must exist prior to submitting supporting documentation.
b.    Detail Line Item Number - Select the detailed line items that corresponds with the documentation being submitted.  If this documentation applies to all line items associated with this PA, please check ALL.

5.    Click Browse and select the required medical records documentation from your network drive or PC.

6.    Review all the values entered for completion and accuracy as no further updates will be allowed once the Submit button is pressed. Note: If any error messages are presented, resolution of the identified errors is required to complete submission.

7.    Press Submit.

8.    A message will be generated at the top of the page that states “Your form was submitted successfully."

9.    A barcode cover sheet is generated and will be displayed. It is imperative that you save a copy of this cover sheet should you be requested to submit additional documentation for this packet.

10.  Select the Print Friendly View button to print the barcode cover sheet. 

Steps to Fax Documentation

If a PDF document cannot be created, information may also be faxed in for review.  A barcode fax cover sheet will be required with each submission. Providers should follow the instructions below to fax documentation:

1.    Follow steps 1-10 documented above.
2.    Include the barcode cover sheet as page one of the fax transmission for the corresponding prior authorization number.
3.    Fax the required documentation with the barcode cover sheet on top to (334) 215-7416.

Important: Barcode cover sheets are unique to each prior authorization number. DO NOT use it for another prior authorization number.

4.    DO NOT place anything over the barcode on the cover sheet or alter it in any manner.
5.    DO NOT fax double sided pages.
6.    DO NOT fax multiple sets of records at the same time, each fax should be sent separately.

A fax submission cannot be processed without the barcode cover sheet.

Providers with questions concerning the upload supporting documentation should contact one of their Provider Representatives.  A link to the Provider Representative’s contact information may be found at this link.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2016 American Medical Association and © 2016 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.

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