November 17, 2020

State of Alabama
Press Release: Medicaid

Implementation of the PA Reconsideration Supporting Documentation Process

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


RE: Implementation of the PA Reconsideration Supporting Documentation


A new Prior Authorization (PA) Reconsideration Form was released on July 7, 2020 for providers to request reconsideration of rejected PAs. The new form can be accessed via the Forms menu of the Alabama Medicaid Interactive Web Portal.


The PA Reconsideration Form allows providers to submit reconsiderations for any dental, ABA, rehabilitation, and medical PA requests. Supporting documentation will be submitted with the PA form by uploading documents in PDF format or creating a fax barcode cover sheet from the web portal. Providers should take this action in place of checking the reconsideration box on the PA form.


Accessing the Medicaid Interactive Web Portal

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

         Medicaid Interactive Web Portal (Required), or

   Fax additional documentation using barcode cover sheet received after submitting the form in the web portal.


Browser Compatibility – IE11

Follow the instructions below to set the 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, Gainwell Technologies 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 PA Reconsideration choice is highlighted in red.)

         CS1 – Consent Form

         DIG – Digital Upload

         ERU – Enrollment Updates

         LTC – Hospice Records

         LTC – LTC Records

         LTC – PEC Swing Bed Records

         LTC – Psychiatric/Retrospective Review Records

         PA1 – Dental PA Supporting Documentation

         PA2 – Medical PA Supporting Documentation

         PA3 – Rehab PA Supporting Documentation

         PA4 – ABA Therapy PA Supporting Documentation

         PAR – PA Reconsideration

         REA – Re-Enrollment Application Supporting Documentation

  1. Complete all fields (Record ID field will auto populate). Required fields are indicated with an asterisk (*).
    1. PA Number - A valid PA number must exist prior to submitting supporting documentation.
    2. Detail Line Item Number - Select the detailed line items that correspond with the documentation being submitted. If this documentation applies to more than one line item, check all that apply.
  2. Click Browse and select the required records documentation from your network drive or PC.
  3. 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.
  4. Press Submit.
  5. A message will be generated at the top of the page that states, “Your form was submitted successfully."
  6. 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.
  7. 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:

  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.

  1. DO NOT place anything over the barcode on the cover sheet or alter it in any manner.
  2. DO NOT fax double-sided pages.
  3. 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 their Provider Representative. Contact information may be found at the following link:


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