Each person or entity who is operating or may operate as a ICN Collaborator shall possess a certificate (Certificate to Collaborate) issued by the Alabama Medicaid Agency qualifying such person or entity to collaborate as set forth in Section 22-6-163 of the Alabama Code.
Important Note: Regarding Collaboration: The Agency is not able to provide legal advice regarding the interpretation of Act 2015-322 or any other law. Should you have any questions about the new law you should carefully review the language of the Act with the counsel of your choice.
To Apply for a Certificate to Collaborate
- To apply for a certificate to collaborate as an RCO Collaborator, you must first create a profile in the Agency's online system and then submit your application through the portal.
Click to Apply for a Certificate
To Submit a Periodic Report
Each Collaborator issued a Certificate to Collaborate is required to submit a periodic report to the Alabama Medicaid Agency no later than June 1 and December1 of each year in which the Collaborator holds a Certificate to Collaborate.
Authorized Collaborators will receive an email with instructions and a direct link to log in to the account to complete the report form online. If unable to log in using the link in the email, click on the red button below to go to the log in screen.
If the email of record on the application has changed, or if the contact person of record has changed, it is the responsibility of the certificate holder to update their file in order to receive notifications about reporting. This does not relieve the certificate holder of responsibility for filing the report on a timely basis.
Online Reporting is not yet available - Contact Ginger Wettingfeld at (334) 242-5018 for questions related to ICN Collaborator reporting.
IMPORTANT NOTE: You may only have one submission pending with the Medicaid Agency at any given time. Once a periodic report has been submitted, no other activity (e.g. submission of an amended application) may occur within the account until an action has been taken on the report. Conversely, if you submit an amended application, you will not be able to submit a periodic report until an action has been taken on the application.