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PDF Version

TO:   Physicians, FQHCs, RHCs,
Independent Labs, and Hospitals


RE:   Non-Invasive Prenatal Test for Fetal
Aneuploidy (NIPT)



Prior Authorization (PA) Checklist


Effective October 15, 2021,
the Alabama Medicaid Agency added an automated checklist to the Forms menu of
the Alabama Medicaid Interactive Web Portal for all request for NIPT prior
authorizations. This addition is an automation of
the external checklist provided at the onset of coverage for this service.
(This checklist is on Page 3.)


Supporting documentation can be submitted with the prior authorization
form by uploading documents in PDF format or by creating a fax barcode cover
sheet from the Web Portal to accompany documentation that will be submitted at
a later time. NOTE: Submitters will have
30 days from the date of initial PA request submission to submit additional


Accessing the Medicaid Interactive Web Portal

Secure access to the Medicaid Interactive Web Portal is required in
order to access the Medical PA Form. NIPT PA supporting documentation may be
submitted in two different ways:

      Medicaid Interactive Web portal (preferred)

      Fax information using the barcode cover sheet received after submitting
the form in the web portal.


Browser Compatibility

Follow the below instructions to set 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 Settings.

        Click Add.

        Click Close.

        Refresh Browser to apply the 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
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 Documentation

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 PA2 – Medical PA Supporting Documentation form from the drop-down
list. Complete all fields (record ID field will auto populate). Required fields
are indicated with an asterisk (*).

a.  PA Number – A valid PA number must
exist prior to submitting supporting documentation.

PA Type – Select NIPT.

Detail Line Item Number – Select the detailed line
items that corresponds with the documentation being submitted. If this
documentation applies to more than one line item, check all that apply.

4.       Click Browse and select the required records documentation from your
network drive
or PC.

5.       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.

6.       Press Submit.

7.       A message will be generated
at the top of the page that states, “Your form was submitted

A barcode cover sheet will be 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.

9.       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:

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.

4.       DO NOT place anything over the barcode on the cover sheet or alter it in any

5.       DO NOT fax double-sided pages.

6.       DO NOT fax multiple sets of records at the same time; each fax should be sent


NOTE* A fax submission
cannot be processed without the barcode cover sheet.

Providers with questions
concerning the upload supporting documentation should contact one of their
provider representatives. A link to the provider representative’s contact
information may be found at this


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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