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471 form for alabama medicaid 2025

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The document is a Prior Authorization Change Request form for the Alabama Medicaid Agency, used by suppliers to request changes to existing prior authorizations. It includes sections for supplier and recipient information, details on the changes needed, and instructions for submission. The form cannot be used for claims that have already been paid or for reconsiderations of denied prior authorizations.

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What is the claim form for Medicaid in Alabama?

Alabama recognizes two standard claim forms (UB-04 and CMS-1500) and three Medicaid non-standard claim forms (Pharmacy, Dental, and one Medicare/Medicaid-related claim form). The providers provider type determines which claim type to bill, as illustrated in the table below.

Does Alabama Medicaid accept paper claims?

Claims Submission Methods In some cases, a provider may have to file a claim on paper, for example, an administrative review or a commercial insurance denies a claim. Claims filed on paper must be submitted on a CMS-1500 claim form.

What documentation is required for Medicaid in Alabama?

To qualify for Medicaid, applicants must meet income, age or other requirements; provide proof of income and other information, fill out forms correctly and turn in a completed application to the correct office or worker. For more help, applicants should contact 1-800-362-1504.

What is the income limit to qualify for Medicaid in Alabama?

Medicaid is a costly program, and federal law requires every state to have whats called a Medicaid Estate Recovery Program. So, if you receive Medicaid benefits in Alabama, your family might need to repay the state after your death for certain services Medicaid paid for during your lifetime.

What is the claim form for Medicaid health insurance?

The CMS-1500 form is the official standard Medicare and Medicaid health insurance claim form required by the Centers for Medicare Medicaid Services (CMS) of the U.S. Department of Health Human Services.

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What paperwork do you need for Medicaid?

Proof of date of birth (e.g., birth certificate) Proof U.S. citizenship or lawful residence (e.g., passport, drivers license, birth certificate, green card, employment authorization card) Proof of all types of income, earned and unearned (e.g., paycheck stubs, retirement benefits, Supplemental Security Income)

471 form for alabama medicaid 2025

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What is the claim form for Medicaid in Alabama?

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