March 2, 2017

State of Alabama
Press Release: Medicaid

Medical and Dental Prior Authorization (PA) Supporting Documentation Changes

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







  • For more information, visit http://medicaid.alabama.gov
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