Non-Invasive Prenatal Test for Fetal Aneuploidy (NIPT)


PDF Version

TO:   Physicians, FQHCs, RHCs, Independent Labs, and Hospitals


RE:   Non-Invasive Prenatal Test for Fetal Aneuploidy (NIPT)



Automated Prior Authorization (PA) Checklist


Effective October 15, 2021, the Alabama Medicaid Agency added an automated checklist to the Forms menu of the Alabama Medicaid Interactive Web Portal for all request for NIPT prior authorizations. This addition is an automation of the external checklist provided at the onset of coverage for this service. (This checklist is on Page 3.)


Supporting documentation can be submitted with the prior authorization form by uploading documents in PDF format or by creating a fax barcode cover sheet from the Web Portal to accompany documentation that will be submitted at a later time. NOTE: Submitters will have 30 days from the date of initial PA request submission to submit additional documentation.


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) px, 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, Gainwell is including a list of three PDF creation utilities that can be installed to create PDF documents at no charge:

         PrimoPDF -

         Solid PDF Creator -

         PDF24 -

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: px.

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 (*).

a.  PA Number - A valid PA number must exist prior to submitting supporting documentation.

b.     PA Type – Select NIPT.

c.      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 will be 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.


The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2021 American Medical Association and © 2021 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.