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)
https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/66/Default.aspx
• 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 - http://www.primopdf.com/
• Solid PDF Creator - http://www.freepdfcreator.org/
• PDF24 - http://pdf24-pdf-creator.en.softonic.com/
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: https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/66/Default.aspx
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.
NOTE:
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.