To: All Providers
Effective April 1, 2009, Alabama Quality Assurance Foundation (AQAF) will perform medical and quality reviews for the Alabama Medicaid Agency. AQAF will perform prior authorizations for durable medical equipment, private duty nursing and certain medical services; long-term care reviews, including hospice pre-certification and concurrent reviews; and retrospective review of institutional admissions.
• The current contractor (APS Healthcare), will stop accepting PA and other requests on March 27, 2009.
• Documents requiring URGENT attention (NOT ROUTINE) between 03/27/09 and 03/31/09 should be mailed or faxed to the Alabama Medicaid Agency at the following address or number:
LTC Medical & Quality Review Unit
Alabama Medicaid Agency
501 Dexter Avenue, Suite 3014
P.O. Box 5624
Montgomery, Alabama 36103-5624
Fax: (334) 353-4909
Prior Authorization (PA) Requests
• Effective April 1, 2009, AQAF will process all PAs except those related to:
o Dental Services,
o Radiology Services, and
o Augmentative Communication Devices.
• The process for submitting PA requests will remain the same.
o Attachments required as part of the PA review process must be sent to EDS for scanning into the system. This allows the EDS system to link the request by PA number as well as generate a response to the provider.
o Linking hard copy attachments with a PA request submitted electronically will delay the PA process. To expedite the attachment process, submit within 48 hours of the submission of the PA request.
• If you have questions regarding the status of a PA request that is less than 30 days from submission call the Automated Voice Response System (AVRS) Line at (800) 727-7848.
• If you need assistance with a PA that is greater than 30 days from the date of submission, contact the Provider Assistance Center at (800) 688-7989. If you are unable to resolve your problems after contacting the AVRS Line or Provider Assistance Center, you may contact AQAF at 1-205-970-1600, extension 3314.
• Expediting turnaround time for DME Conditional Approvals
o To expedite the turnaround time for converting conditional approvals to an approved status, please fax delivery tickets and invoices to APS Healthcare at (770) 991-5429 by 03/27/09.
o Effective April 1, 2009, please mail or fax to AQAF at the following address:
Alabama Quality Assurance Foundation
Two Perimeter Park South, Suite 200 West
Birmingham, Alabama 35243-2337
Fax: (205) 970-1614
• Chapter 15, Submitting Prior Authorization Requests, in the Provider Electronic Solutions Manual provides additional information regarding the PA process.
Reviews for Institutional, Hospice, Post Extended Care Hospital (PEC), and Swing Bed providers
• Effective April 1, 2009, AQAF will assume responsibility for reviewing applications for admissions for the programs listed below:
o Swing Beds
o Retrospective review process for appropriateness of admissions to Nursing Homes, ICF/MR facilities and IMD facilities
• Faxed attachments will not be accepted by AQAF with the exception of inpatient psychiatric facilities.
• Applications for admission to Hospice, PEC, and Swing bed programs more than 30 pages must be mailed to AQAF to the address above.
• AQAF will request monthly retrospective reviews for Nursing Homes, ICF/MR facilities, and IMD facilities. Medical record documentation, in response to such requests, which contains more than 30 pages, must be mailed to AQAF to the address indicated above.
• Medical record documentation which contains less than 30 pages, Hospice Recipient Status Change Forms (Form 165B) and Long Term Care Request for Action Forms (Form 161A) may be faxed to AQAF at the number below:
Fax: (205) 970-1614
Providers with questions may contact Theresa Carlos,Associate Director of Medicaid’s LTC Medical & Quality Review Unit, at firstname.lastname@example.org or 334-353-3711.