TO: All Providers, Alabama Dental Association,
Alabama Hospital Association,
Oral Surgeons, and State Agencies
RE: Implementation of the PA Reconsideration
A new Prior Authorization (PA) Reconsideration Form was released on July
7, 2020 for providers to request reconsideration of rejected PAs. The new form
can be accessed via the Forms menu of the Alabama Medicaid Interactive Web
The PA Reconsideration Form allows providers to submit reconsiderations
for any dental, ABA, rehabilitation, and medical PA requests. Supporting
documentation will be submitted with the PA form by uploading documents in PDF
format or creating a fax barcode cover sheet from the web portal. Providers
should take this action in place of checking the reconsideration box on the PA
Accessing the Medicaid
Interactive Web Portal
A secure logon to the Medicaid Interactive Web Portal is required to
access the new PA Reconsideration Form. PA reconsideration supporting
documentation may be submitted in two different ways:
Medicaid Interactive Web Portal (Required)
• 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:
• Navigate to the Medicaid Interactive Web Portal using the URL provided
• Select Tools from upper right-hand
corner of browser. The feature is displayed as a wheel.
Choose Compatibility View
• Click Add.
Refresh browser to apply 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
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/
Steps to Upload
Once a PDF utility has been successfully downloaded and the PDF document
created, providers should follow these steps to upload documentation for
- Log on to Medical
Interactive Web portal: https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/66/Default.aspx.
- Select Trade Files/Forms.
- Select a form from the drop-down list and click on Search. The following is a list of
forms available for selection. (Note: The newly added PA Reconsideration
choice is highlighted in red.)
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
PA1 – Dental PA Supporting Documentation
PA2 – Medical PA Supporting Documentation
PA3 – Rehab PA Supporting Documentation
PA4 – ABA Therapy PA Supporting Documentation
PAR – PA
REA – Re-Enrollment Application Supporting Documentation
- Complete all fields (Record ID field will auto populate). Required fields are
indicated with an asterisk (*).
- PA Number – A valid PA number must exist prior to submitting
- 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.
- Click Browse and select
the required records documentation from your network drive or PC.
- 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.
- Press Submit.
- A message will be generated at the top of the page that states,
“Your form was submitted successfully.”
- 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.
- 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:
- Follow steps 1-10 documented above.
- Include the barcode cover sheet as page one of the fax transmission
for the corresponding prior authorization number.
- 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.
- DO NOT place anything over
the barcode on the cover sheet or alter it in any manner.
- DO NOT fax double-sided
- DO NOT fax multiple sets of
records at the same time. Each fax should be sent separately.
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.