Effective October 1, 2020, the Alabama Medicaid Agency will cover
the following NIPT testing procedure codes with prior authorization:
- 81420 – Fetal chromosomal aneuploidy (e.g., trisomy 21, monosomy X) genomic
sequence analysis panel, circulating cell-free fetal DNA in maternal
blood, must include analysis of chromosomes 13, 18, and 21
- 81507 – Fetal aneuploidy (trisomy 21,18, and 13) DNA sequence analysis of
selected regions using maternal plasma, algorithm reported as a risk score
for each trisomy
Medicaid may cover these tests for women with singleton gestations
considered at increased risk for fetal aneuploidy in whom cell free fetal DNA
may be used as a primary screening option.
The recipient must meet at
least one of the criteria listed below:
·
Maternal age 35 years or older at delivery; OR
·
Fetal ultrasonographic findings indicating an increased risk of
aneuploidy; OR
·
History of a prior pregnancy with a trisomy; OR
·
Parental balanced Robertsonian translocation with increased risk of
fetal trisomy 13 or trisomy 21; OR
·
Positive test result for aneuploidy, including first trimester, sequential,
or integrated screen, or a quadruple screen.
Providers may begin using the Medical PA Form for all requests for NIPT
prior authorizations via the Forms menu of the Alabama Medicaid Interactive Web
Portal. Supporting documentation should be submitted with the prior
authorization form by uploading documents in PDF format or creating a fax
barcode cover sheet from the Web Portal.
Additional prior authorization
supporting documentation must include the following:
- Evidence
that pretest counseling included patient education inclusive of the
following:
Cell-free DNA testing is the most
sensitive and specific screening test for the common fetal
aneuploidies (Trisomy 13, 18, and 21). Cell-free DNA testing is not equivalent
to diagnostic testing (Chorionic Villus sampling or Amniocentesis).
- A family history to determine if the patient should be offered
other forms of screening or prenatal diagnosis for familial genetic
disease.
Note *Cell free fetal DNA testing is not covered for low-risk women or
women with multiple gestations at this time.
Accessing the Medicaid Interactive
Web Portal
Secure access to the Medicaid Interactive Web Portal is required in
order to access the Medical PA Form. NIPT 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,
or
•
Fax information using the barcode cover sheet received after submitting
the form in the web portal.
Browser Compatibility
Follow the below instructions to set 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 the 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:
- Log on to Medical
Interactive Web portal: https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/66/Default.aspx.
- Select Trade Files/Forms.
- Select PA2 – Medical PA Supporting Documentation form from
the drop-down list. Complete all fields (record ID field will auto
populate). Required fields are indicated with an asterisk (*).
- PA Number - A valid PA number
must exist prior to submitting supporting documentation.
- PA Type – Select NIPT.
- Detail Line Item
Number
- Select the detailed line items that corresponds with the documentation
being submitted. If this documentation applies to more than one line
item, check all that apply.
- Click Browse and select
the required records documentation from your network drive or PC.
- 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.
- Press Submit.
- A message will be generated at the top of the page that states,
“Your form was submitted successfully."
- 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.
- Select the Print Friendly
View button to print the barcode cover sheet.
Steps to Fax Documentation
Information can also be faxed in for review. Providers should follow the
instructions below to fax documentation:
- Follow steps 1-10 documented above.
- Include the barcode cover sheet as page one of the fax transmission
for the corresponding prior authorization number.
- 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.
- DO NOT place anything over
the barcode on the cover sheet 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.
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.