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
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.
instructions below to set the browser compatibility settings (only if using
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
Refresh browser to apply setting.
Documents must be in a Portable Document Format
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 – http://www.primopdf.com/
Solid PDF Creator – http://www.freepdfcreator.org/
Steps to Submit the TCM PA
- 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.
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
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
- Complete all fields.
Required fields are indicated with an asterisk (*).
- PA Number – A valid PA number must exist prior
to submitting supporting documentation.
- Medicaid Number – Indicate the
recipient Medicaid ID number.
- Current Provider Name – The name of the
- Current Provider NPI – The NPI of the
- Receiving Provider Name – The name of the
provider receiving the recipient.
- Receiving Provider NPI – The NPI of the
provider receiving the recipient.
- Receiving Case Manager Name – The name of the
receiving case manager.
- 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
- 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.
- Select the Print Friendly View button to
print the barcoded cover sheet.
Steps to Fax Documentation
also be faxed in for review. Providers should follow the instructions below to
- Follow steps 1-10
- Include the barcoded
cover sheet as page one of the fax transmission for the
corresponding prior authorization number.
- 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.
- DO NOT place anything over the barcode on the cover
sheet or alter it in any manner.
- DO NOT fax double sided pages.
- 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 © 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.