Attention: Nursing Homes, ICF-MR, Hospice, PEC, Swing Bed, DME, and Physician Providers

Attention:  All Medicaid Providers

The Alabama Medicaid Agency’s new medical and quality review services contractor, Qualis Health, will begin reviews of prior authorization (PA) requests, and hospice, nursing home, ICF-MR, PEC and swing bed records on July 1, 2011.  Qualis will NOT review pharmacy, dental or radiology PAs.

Qualis will review PA requests with Julian dates of 6/16/2011 and after.  For inquiries regarding PAs submitted on June 16, 2011 or later, providers may contact Qualis at (888) 213-7576. The fax number is (888) 213-8548.

For Hospice, Nursing Home, ICF-MR, PEC and Swing Bed Records:

Effective July 1, 2011, these records MUST be mailed to HP, the Alabama Medicaid Agency’s fiscal agent, along with a cover sheet, found on the website at: http://medicaid.alabama.gov/CONTENT/5.0_Resources/5.4_Forms_Library/5.4.3_LTC_Forms.aspx.

The HP address is found on each cover sheet.

These records will be scanned into the system by HP so that staff from the Agency and contractor can review them electronically. Please note that the cover sheet MUST be used to ensure that the record is added to the correct site electronically.

ICF-MR providers should use the “LTC records” cover sheet.

For hospice records, continue to include the Form 165A, along with the HP cover sheet.

Hospice recipient status change (Form 165B) and LTC request for action (Form 161B) forms should be faxed to Qualis at (888) 213-8548 effective July 1, 2011.

For Prior Authorizations:

The process for submitting PA requests to HP remains the same. The Agency will review requests received through June 15, 2011.

For inquiries about PAs received into the system through June 15, 2011, please call:

Transportation: Brenda Fincher (334) 242-5455

Eyecare: Kathy Hardwick (334) 353-5017

All other PAs: Dodie Teel (334) 242-5148, Sheila McDaniel (334) 242-2366 or Theresa Carlos (334) 353-3711.

For inquiries about PAs received on or after June 16, 2011, providers should call Qualis at (888) 213-7576.

Effective July 1, 2011, providers may enter the PA number to this webpage to notify Qualis staff when a denied PA is ready for reconsideration. http://www.qualishealth.org/healthcare-professionals/alabama-medicaid/provider-resources.

Please submit the documents for reconsideration, along with the denial letter to HP, before submitting the PA number to Qualis.

The status of PA requests may also be accessed using:

AVRS (1-800-727-7848)

The Provider web portal, using the link

https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/65/Default.aspx

or the HP Provider Assistance Center at (800) 688-7989.

Please use this link for instructions about using the web portal for PAs:

http://medicaid.alabama.gov/documents/6.0_Providers/6.7_Manuals/6.7.1_Provider_Manuals_2011/6.7.1.2_April_2011/6.7.1.2_Webuser.pdf