To: All Dental Providers
To ensure the safety of Alabama Medicaid recipients, state dental providers using IV sedation must submit documentation of their certification to the Agency prior to August 1, 2010.
On August 1, 2010, Alabama Medicaid will deny procedure codes D9241 and D9220, if the provider does not submit their IV sedation certification to Medicaid.
To ensure that Medicaid enrollment files are updated prior to the August 1, 2010 start date, providers are asked to complete the form below and return it with a copy of your IV sedation certification by June 21, 2010 to:
Provider Enrollment
HP Enterprise Services
301 Technacenter Dr
Montgomery, AL 36117
Please complete the following:
Provider’s Name ___________________________________________________
Provider’s NPI ________________________________________
Medicaid Numbers (please include Medicaid assigned numbers for all clinics the provider is enrolled to provide services)
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ATTACH a copy of Certificate