TO:   Targeted Case Management (TCM) Agencies

RE:   Transferring a TCM Prior Authorization via a Digital Process

Effective July 13, 2021, providers will begin using the new “TCM PA Transfer” forms in the Provider Web Portal to transfer a TCM PA. This digital process will replace the current Form 385 to expedite the transfer of a TCM PA for a recipient from one agency to another.

Accessing the Medicaid Interactive Web Portal

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

•       Medicaid Interactive Web Portal – Available via the Alabama Medicaid website by selecting the “Learn More” button for Providers & Billing and then selecting the link for the Secure Portal Login under the “More” section. The Web Portal can also be accessed directly using the following URL:

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

•       Fax additional documentation using the barcoded 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/

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 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

•       PA   – TCM Receiving Recipient Form

•       PA   – TCM Sending Recipient Form

•       PAR – PA Reconsideration Supporting Doco

•       REA – Revalidation Application Supporting Doco

•       TPL – TPL Claims Attachment Supporting Doco

4. Complete all fields. Required fields are indicated with an asterisk (*).
1. PA Number - A valid PA number must exist prior to submitting supporting documentation.
2. Medicaid Number – Indicate the recipient Medicaid ID number.
3. Current Provider Name – The name of the sending provider.
4. Current Provider NPI – The NPI of the sending provider.
5. Receiving Provider Name – The name of the provider receiving the recipient.
6. Receiving Provider NPI – The NPI of the provider receiving the recipient.
7. Receiving Case Manager Name – The name of the receiving case manager.
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 barcoded cover sheet is generated and will be displayed only for the PA - TCM Receiving Recipient Form. 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 barcoded 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 barcoded cover sheet as page one of the fax transmission for the corresponding prior authorization number.
3. Fax the required documentation with the barcoded cover sheet on top to (334) 215-7416.
   Important: Barcoded 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.

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