TO:   Targeted Case Management (TCM) Agencies


RE:   Transferring a TCM Prior Authorization via a Digital



Effective July 13,
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


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:,

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

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

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 –

Solid PDF Creator –

PDF24 –


   Steps to Submit the TCM PA
Transfer Forms

  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.

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

  1. 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.
  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
  6. 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.
  7. 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.


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:

The Current Procedural Terminology (CPT) and Current Dental Terminology
(CDT) codes descriptors, and other data are copyright © 20
American Medical Association and © 20
21 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.

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