Frequently Asked Questions

To tell if a procedure is covered by Alabama Medicaid review the appropriate fee schedule. Fee schedules are available on the Agency website under Providers > Fee Schedules.

Recipients may not be billed for claims rejected due to provider-correctable errors or failure to submit claims in a timely manner. The recipient may be billed for services that are non-covered and for which Medicaid will not make any payment. Services that exceed the set limitation (for example, physician visits, hospital visits, or eyeglasses limit) are considered non-covered services. Reference: Provider Manual Chapter 7.

Generally, Medicaid requires all claims to be filed within one year of the date of service; however, some programs have different claims filing time limit limitations. Refer to your particular provider type program chapter for clarification. Reference: Provider Manual Chapter 5.

If the claim was never filed within the one year filing limit (measured from the date of service) there is nothing that can be done. The provider has to meet the requirements putting forth a good faith effort and one of the criteria is filing within one year. Some claims can be processed after one year under two main scenarios. Reference: Provider Manual Chapter 5.

Claims for services rendered to a recipient during a retroactive eligibility period may be processed if received by the fiscal agent within one year from the date of the retroactive award. Providers must submit these claims electronically. Reference: Provider Manual Chapter 5.

In the case of a retroactive request (retroactive eligibility) the recipient must have been eligible on the date of service requested. The provider must submit the PA request within 90 calendar days of the retroactive eligibility award (issue) date. If a retroactive PA request is submitted and does not reference retroactive eligibility the request will be denied. Reference: Provider Manual Chapter 4.

Once a Prior Authorization is submitted to Medicaid it can take up to 30 business days to process. At the end of this time period the provider will be notified of the decision made. Any requests for reconsideration of a denied request may be sent with additional information that justifies the need for requested service(s). Once the resubmitted information is received it can take up to 30 business days to process. Reference Provider Manual Chapter 4.

Medicaid does not have a process to expedite a PA. The same process is followed for all PAs. If a medical emergency is referenced, the provider must submit the PA request within 30 days of the date of service. Supporting documentation must provide evidence that the service was not scheduled and that delays greater than 72 hours would have resulted in serious injury or harm. Prior authorizations must be received by the fiscal agent within 30 days of dispensing equipment, providing vision services, or for laboratory procedures within 30 days of the date of service. Reference: Provider Manual Chapter 4.