Effective March 23, 2021, providers will begin using the new “Prior Authorization Supporting Doco” form for all prior authorization (PA) requests via the Forms menu of the Alabama Medicaid Interactive Web Portal.

The consolidated PA form allows providers to submit PA supporting documentation for any Dental, ABA, Rehab, Medical, or NIPT PAs using one form. Supporting documentation will be submitted with the PA form by uploading documents in PDF format or creating a fax barcode coversheet from the web portal.

Accessing the Medicaid Interactive Web Portal

A secure logon to the Medicaid Interactive Web Portal is required to access the new PA Supporting Documentation form. PA supporting documentation may be submitted in two different ways:

• Medicaid Interactive Web Portal – Available at www.medicaid.alabama.gov
• Select Providers tab
• Select Secure Provider Portal from the dropdown menu
• A direct link to the portal is: https://www.medicaid.alabamaservices.org/alportal/Account/Logoff%20Session%20Expire/tabId/54/Default.aspx?sessionExpired=true, or
• Fax additional documentation using barcode cover sheet received after submitting the form in the web portal.

 Browser Compatibility

Follow the instructions below to set the browser compatibility settings (only if using Internet Explorer):

• 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 setting.

Documents must be in a Portable Document Format (PDF)

Documents must be in a PDF format 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, Gainwell Technologies 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 Submit the Prior Authorization Supporting Documentation Form

1. Log on to the Medicaid Interactive Web portal:  https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/66/Default.aspx.
2. Select Trade Files/Forms.
3. Select a form from the drop-down list and click on Search. The following is a list of forms available for selection.

•         CS1 – Consent Form

•         DIG – Digital Upload

•         ERU – Enrollment Updates

•         LTC – Hospice Records

•         LTC – LTC Records

•         LTC – PEC/Swing Bed Records

•         LTC – Psychiatric/Retrospective Review Records

•         PA   – Prior Authorization Supporting Doco

•         PAR – PA Reconsideration Supporting Doco

•         REA – Revalidation Application Supporting Doco

•         TPL  – TPL Claims Attachment Supporting Doco

4. 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 the type of PA being submitted (ABA, Dental, Medical, NIPT, or Rehab).
3. Detail Line Item Number - Select the detailed line items that correspond with the documentation being submitted. If this documentation applies to more than one line item, check all that apply.
5. Click Browse and select the required records documentation from your network drive or PC.
6. 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.
7. Press Submit.
8. A message will be generated at the top of the page that states, “Your form was submitted successfully."
9. 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.
10. 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 numbered 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 of supporting documentation should contact their Provider Representative. Contact information may be found at the following link:  http://medicaid.alabama.gov/content/10.0_Contact/10.3_Provider_Contacts/10.3.5_Provider_Reps.aspx.

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2020 American Medical Association and © 2020 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.