Effective October 1, 2020, the Alabama Medicaid Agency will cover the following NIPT testing procedure codes with prior authorization:

• 81420 – Fetal chromosomal aneuploidy (e.g., trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21
• 81507 – Fetal aneuploidy (trisomy 21,18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy 

Medicaid may cover these tests for women with singleton gestations considered at increased risk for fetal aneuploidy in whom cell free fetal DNA may be used as a primary screening option.

The recipient must meet at least one of the criteria listed below: 

·         Maternal age 35 years or older at delivery; OR

·         Fetal ultrasonographic findings indicating an increased risk of aneuploidy; OR

·         History of a prior pregnancy with a trisomy; OR

·         Parental balanced Robertsonian translocation with increased risk of fetal trisomy 13 or trisomy 21; OR

·         Positive test result for aneuploidy, including first trimester, sequential, or integrated screen, or a quadruple screen.

Providers may begin using the Medical PA Form for all requests for NIPT prior authorizations via the Forms menu of the Alabama Medicaid Interactive Web Portal. Supporting documentation should be submitted with the prior authorization form by uploading documents in PDF format or creating a fax barcode cover sheet from the Web Portal.

Additional prior authorization supporting documentation must include the following:

• Evidence that pretest counseling included patient education inclusive of the following:

Cell-free DNA testing is the most sensitive and specific screening test for the common fetal aneuploidies (Trisomy 13, 18, and 21). Cell-free DNA testing is not equivalent to diagnostic testing (Chorionic Villus sampling or Amniocentesis).

• A family history to determine if the patient should be offered other forms of screening or prenatal diagnosis for familial genetic disease. 

Note *Cell free fetal DNA testing is not covered for low-risk women or women with multiple gestations at this time.

Accessing the Medicaid Interactive Web Portal

Secure access to the Medicaid Interactive Web Portal is required in order to access the Medical PA Form. NIPT PA supporting documentation may be submitted in two different ways:

•         Medicaid Interactive Web portal (preferred)

https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/66/Default.aspx, or

•         Fax information using the barcode cover sheet received after submitting the form in the web portal.

Browser Compatibility

Follow the below instructions to set browser compatibility settings:

•         Navigate to the Medicaid Interactive Web Portal using the URL provided above.

•         Select Tools from upper right-hand corner of browser. The feature is displayed as a wheel.

•         Choose Compatibility View Settings.

•         Click Add.

•         Click Close.

•         Refresh Browser to apply the setting.

Documents must be in a Portable Document Format (PDF)

Documents must be in a PDF for upload through the Web Portal. If you do not currently have the ability to create PDF versions of supporting documentation, you may perform an internet search and find free downloadable utilities that can be installed to create a PDF. For your convenience, HPE is including a list of three PDF creation utilities that can be installed to create PDF documents at no charge:

•         PrimoPDF - http://www.primopdf.com/

•         Solid PDF Creator - http://www.freepdfcreator.org/

•         PDF24 - http://pdf24-pdf-creator.en.softonic.com/

Steps to Upload Documentation

Once a PDF utility has been successfully downloaded and the PDF document created, providers should follow these steps to upload documentation for review:

1. Log on to Medical Interactive Web portal: https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/66/Default.aspx.
2. Select Trade Files/Forms.
3. Select PA2 – Medical PA Supporting Documentation form from the drop-down list. Complete all fields (record ID field will auto populate). Required fields are indicated with an asterisk (*).
1. PA Number - A valid PA number must exist prior to submitting supporting documentation.
2. PA Type – Select NIPT.
3. Detail Line Item Number - Select the detailed line items that corresponds with the documentation being submitted. If this documentation applies to more than one line item, check all that apply.
4. Click Browse and select the required records documentation from your network drive or PC.
5. Review all the values entered for completion and accuracy as no further updates will be allowed once the Submit button is pressed. Note: If any error messages are presented, resolution of the identified errors is required to complete submission.
6. Press Submit.

7. A message will be generated at the top of the page that states, “Your form was submitted successfully."
8. A barcode cover sheet is generated and will be displayed. It is imperative that you save a copy of this cover sheet should you be requested to submit additional documentation for this packet.
9. Select the Print Friendly View button to print the barcode cover sheet.

 Steps to Fax Documentation

Information can also be faxed in for review. Providers should follow the instructions below to fax documentation:

1. Follow steps 1-10 documented above.
2. Include the barcode cover sheet as page one of the fax transmission for the corresponding prior authorization number.
3. Fax the required documentation with the barcode cover sheet on top to (334) 215-7416.

Important: Barcode cover sheets are unique to each prior authorization number. DO NOT use it for another prior authorization number.

4. DO NOT place anything over the barcode on the cover sheet or alter it in any manner.
5. DO NOT fax double-sided pages.
6. DO NOT fax multiple sets of records at the same time; each fax should be sent separately.

NOTE* A fax submission cannot be processed without the barcode cover sheet.

Providers with questions concerning the upload supporting documentation should contact one of their provider representatives. A link to the provider representative’s contact information may be found at this link.