August 30, 2021
TO: Nursing Homes, ICF-IID-, Hospice, PEC, Swing Bed, DME, Physicians and Medicaid Providers
RE: Medical and Quality Review Services Contractor
The Alabama Medicaid Agency’s (Medicaid) new Medical and Quality Review Services Contractor, Kepro, will begin reviewing prior authorization (PA) requests, hospice, nursing home, ICF-IID, PEC, and swing bed records on October 1, 2021. Kepro will review PA requests with dates of October 1, 2021, and after. Kepro will NOT review pharmacy, dental or radiology PAs. For inquiries regarding PAs submitted on October 1, 2021, or later, providers may contact Kepro at (800) 426-7259 or (800) 472-2902.
For Hospice, Nursing Home, ICF-IID, PEC and Swing Bed Records:
Hospice, Nursing Home, ICF-IID, PEC and Swing Bed records should continue to be submitted via the electronic upload process as per the instructions in the Provider Billing Manual on the Agency’s website (Refer to Chapter 18 for the hospice records and Chapter 26 for the nursing facility records). The process for electronically uploading records is the same for the ICF/IID, PEC, and Swing Bed records.
Effective October 1, 2021, Hospice Recipient Status Change (Form 165B) and LTC Requests for Action (Form 161B) should be faxed to Kepro at (833) 536-2134 or (833) 536-2136.
For questions related to the Long-Term Care reviews on or after October 1, 2021, providers should contact Kepro at (800) 426-7259 or (800) 472-2902.
For Prior Authorizations (NOT pharmacy, dental or radiology PAs):
The process for submitting PA requests to Gainwell Technologies remains the same. Comagine will review requests received through September 30, 2021.
For inquiries about PAs received into the system through September 30, 2021, please call:
• Transportation: Brandon Williams firstname.lastname@example.org
• Eyecare: David Poole email@example.com
• All other PAs: Dodie Teel (334) 242-5149, Sheila McDaniel (256) 890-3159 or Tommy Stedham (334) 353-3711
• For inquiries about PAs submitted on or after October 1, 2021, providers should call Kepro at (800) 426-7259 or (800) 472-2902
The status of PA requests may also be accessed using:
• AVRS (1-800-727-7848)
• The Provider web portal, using the link:
https://www.medicaid.alabamaservices.org/alportal/Account/SecureSite/tabid/56/Default.aspx or the Gainwell Provider Assistance Center at (800) 688-7989
Please use this link for instructions about using the web portal for PAs: https://medicaid.alabama.gov/documents/7.0_Providers/7.6_Manuals/7.6_AMMIS_Interactive_Services_Website_User_Manual_6-29-21.pdf.