TO: All Providers, Alabama Dental Association,
Alabama Hospital Association,  

       Oral Surgeons, and State Agencies


RE: Implementation of the PA Reconsideration
Supporting Documentation



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.

Click Close.

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 –

Solid PDF Creator –

PDF24 –


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


  1. Log on to Medical
    Interactive Web portal:
  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. (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


REA – Re-Enrollment Application Supporting Documentation

  1. 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. 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.

  2. Click Browse and select
    the required records documentation from your network drive or PC.
  3. 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.
  4. Press Submit.
  5. A message will be generated at the top of the page that states,
    “Your form was submitted successfully.”
  6. 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.
  7. Select the Print Friendly
    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.

  1. DO NOT place anything over
    the barcode on the cover sheet or alter it in any manner.
  2. DO NOT fax double-sided
  3. 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:


Source link

Author: Editor
Editor represents multiple online news sites, including STL.News, RSSNews.Press and more. As a media company offering website hosting, design and SEO we create the news sites in part to illustrate our "search engine friendly" web hosting and design services. In addition, we believe that our "direct source news" concept helps provide accurate information to the public without bias.