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TO:  All Providers

Alabama Medicaid providers must begin to submit certification and support documentation for hysterectomies and abortions with a fillable form starting July 1, 2016.  Handwritten forms will no longer be accepted beginning on July 1, 2016.    

Where can a provider go to access the Hysterectomy (PHY 81243) or Abortion (PHY-96-2) Consent Form?

The fillable consent forms will be available on the website at www.medicaid.alabama.gov.

Where can a provider fax the electronic fillable consent forms?

A fax cover sheet along with the fillable form must be sent to the attention of HPE, Medical Policy Unit/Consent Forms. The fax number is (334) 215-4275.  

Note* The Alabama Medicaid Agency will no longer accept handwritten consent forms by fax.  Provider distribution of hard copy consent forms will be restricted to emergency situations.  If an emergency situation should arise, please contact Beverly Churchwell at Beverly.churchwell@medicaid.alabama.gov. 

Where can a provider go to view additional information about hysterectomies or abortions?

A provider can visit the Alabama Medicaid Agency, Provider Manual, Chapter 28, Physicians at www.medicaid.alabama.gov for further information about hysterectomies or abortions.

For questions regarding certification and support documentation for hysterectomies or abortions, please contact Beverly Churchwell at beverly.churchwell@medicaid.alabama.gov.