TO: All Providers
Effective December 7, 2016,
providers will be able to upload or fax Enrollment supporting
documentation via the “Forms” menu of the Alabama Medicaid Interactive
Web Portal. A new form will allow providers the ability to upload
Enrollment supporting documents in PDF format or create a fax barcode
cover sheet from the Web Portal. The following will be supported under
the Enrollment Supporting Documentation process:
• Electronic Funds Transfer (EFT) Supporting Documentation
• Enrollment Update Supporting Documentation
• Ordering, Prescribing, and Referring (OPR) Supporting Documentation
• Re-Enrollment Update Application Supporting Documentation
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.
Enrollment supporting documentation will continue to be accepted in paper format until January 7, 2017.
After that date, supporting documents received on paper will be
returned to the provider: Refer to Chapter 2 (Becoming a Medicaid
Provider) of the Alabama Medicaid Provider Manual for further details.
Accessing the Medicaid Interactive Web Portal
secure logon to the Medicaid Interactive Web Portal is required to
access the new attachment option. For new providers, Medicaid will send
a letter containing a personal identification number (PIN) and other
information on how providers can access the Portal. Upon logging into
the Medicaid Interactive Web Portal, providers should follow the
instructions on the site to set up their account.
If you have a
Provider Administrator account and would like your ‘Clerk’ accounts to
have access to the “Forms” menu; navigate to the ‘Clerk Maintenance’
panel, select desired clerk, add the ‘Forms’ role from the ‘Available
Roles’ list and select ‘Save’. Once saved, the clerk(s) will have access
to the Forms menu.
Enrollment supporting documentation may be submitted in two different ways:
• Medicaid Interactive Web portal (preferred)
• Fax information using barcode cover sheet
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 setting.
Please Note – Internet Explorer is the only supported browser for the Provider Web Portal.
Documents must be in a Portable Document Format (PDF)
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
a PDF utility has been successfully downloaded and the PDF document
created, providers should follow these steps to upload documentation for
1. Log on to Medicaid 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 Enrollment Supporting Documentation choices are noted in bold.
• CS1 – Consent Form
• EFT – EFT Supporting Documentation
• ERU – Enrollment Updates
• LTC – Hospice Records
• LTC – LTC Records
• LTC – PEC Swing Bed Records
• LTC – Psychiatric/Retrospective Review Records
• OPR – OPR Application Supporting Documentation
• PA1– Dental PA Supporting Documentation
• PA2 – Medical PA Supporting Documentation
• REA – Re-Enrollment Application Supporting Documentation
4. Complete all fields (record ID field will auto populate). Required fields are indicated with an asterisk (*).
a. Provider ID (NPI)
– A valid NPI must exist prior to submitting supporting documentation.
This applies to EFT, OPR, Re-Enrollment and Enrollment Update forms.
b. MCD (Medicaid ID)
– A valid MCD must exist prior to submitting supporting documentation.
This applies to EFT, Re-Enrollment and Enrollment Update forms.
5. Click Browse and select the required medical 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.
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: Record IDs are unique to each
transmission for a provider. For an update submitted under Record ID,
all supporting articles associated with the update should be transmitted
to HPE using the corresponding Record ID barcode coversheet.
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.
A fax submission cannot be processed without the barcode cover sheet.
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 the following link: http://medicaid.alabama.gov/content/10.0_Contact/10.3_Provider_Contacts/10.3.5_Provider_Reps.aspx
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.