Frequently Asked Questions

Provider Billing

Below are some questions providers often ask about billing.  Click on the questions to see the answers:

To tell if a procedure is covered by Alabama Medicai, review the appropriate Fee Schedule. Fee schedules are available on the website, under the Provider tab, then under the Fee Schedule tab.
The only circumstance in which a provider can bill a recipient for services is if the recipient is notified prior to services being rendered. The recipient must also sign a waiver stating that they will be responsible for any services not covered by Alabama Medicaid.
Providers have one year from the date of service to file a claim and get the claim paid. Reference: Provider Manual Chapter 5, page 5.
If the claim was never filed within the one year filing limit(measured from the date of service), there is nothing one can do. 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. Please see the Provider Manual section Chapter 5, Section 1, subsection 1.
The provider must refile the claim within 120 days of the date that eligibility was awarded. This requires the provider to monitor the status of the patient’s eligibility. It also requires the provider to ask the right questions of a patient that has applied or reapplied for Medicaid coverage.
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, Page 5.
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.
Medicaid does not have a process to expedite a PA. The same process is followed for all PAs.