PDF Version
TO: All Providers
RE: Medical and Dental Prior Authorization (PA)
Supporting
Documentation Changes
Beginning April 1, 2017, providers will be required to submit Medical and Dental
PA (including Hospital Dental PA) Reconsideration documentation via the Forms
menu of the Alabama Medicaid Interactive Web Portal. A ‘Reconsideration’ checkbox was added to both
Medical and Dental PA Supporting Documentation forms that can be selected when
submitting additional information for reconsideration of a denied request.
Please
note: The submission process for paper/original Photos, Radiographs, and X-Ray
images will remain as it occurs today.
Look for additional
information in the upcoming April 2017 edition of the Alabama Medicaid Provider
Manual. (Chapter
4: Obtaining Prior Authorization and Chapter 13: Dentist)
Effective May 1, 2017, Alabama Medicaid will only allow the electronic
upload and submission of Medical and Dental PA (including Hospital Dental PA) supporting
documentation (including Reconsideration) via the web portal. Medical and Dental
PA supporting documentation (including Reconsideration) received on paper after
that date will be returned to the provider with the exception of paper/original
Photos, Radiographs, and X-Ray images.
Steps to Upload Medical and
Dental PA Supporting Documentation (including Reconsideration)
Providers
should follow these steps to upload Medical and Dental PA Supporting
documentation (including Reconsideration) for review:
1. Log on to Medicaid Interactive Web portal:
https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure Site/tabId/66/Default.aspx
2. Select Trade Files/Forms.
3. Select a form from the drop down list and click on Search.
• PA1– Dental PA Supporting Documentation
• PA2 – Medical PA Supporting Documentation
4. Check the box titled ‘Reconsideration’ if the documentation being submitted
relates to a request for reconsideration of a denied request. A copy of the PA
denial letter must be included along with the additional documentation for
reconsideration.
Note: Only check this box if the documentation being submitted is associated with a request for reconsideration of a denied Medical or Dental PA request.
5. 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.
Note: If the documentation being submitted is associated with a request for
reconsideration of a denied Medical or Dental PA request, please enter the
PA number associated with the denial.
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.
6. Click Browse and select the required medical records documentation from your
network drive or PC.
7. 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.
8. Press Submit.
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.
Note: Providers must retain a copy of the barcode coversheet of the ORIGINAL
Medical or Dental PA supporting documentation should they need to submit
additional documentation.
10. Select the Print Friendly View button to print the barcode cover sheet.
11. Send the Medical PA number associated with the reconsideration in an
email to this address: alrecon@qualishealth.org. Do not send any PHI in the
email.
Note: This step is only required when submitting additional information for
reconsideration of a denied Medical PA request.
Steps to Fax Medical or Dental PA Supporting Documentation (including Reconsideration)
If a PDF document cannot be created, information may also be faxed in for review. A barcode fax cover sheet is 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 (PA supporting documentation or reconsideration
supporting documentation) with the appropriate barcode cover sheet on top to
(334) 215-7416.
4. Send the Medical PA number associated with the reconsideration in an email to
this address: alrecon@qualishealth.org. Do not send any PHI in the email.
Note: This step is only required when submitting additional information for
reconsideration of a denied Medical PA request.
Important: Barcode cover sheets are unique to each prior authorization number. DO NOT use a cover sheet that was created for another prior authorization number.
NOTE
NOTE:
DO NOT place anything over the barcode
on the coversheet or alter it in any manner.
DO NOT fax double sided pages.
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 of supporting documentation should contact one of their Provider Representatives. A link to the Provider Representative’s contact information may be found at the following link:
http://medicaid.alabama.gov/content/10.0_Contact/10.3_Provider_Contacts/10.3.5_Provider_Reps.aspx