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Does Alabama Medicaid require prior authorization?
Prior Authorization (approval in advance) is required for many procedures, services or supplies, including transportation. Click here for information on obtaining an Emergency PA for medications.
What does Medicaid not cover in Alabama?
Below is a partial listing of some goods and services that are not covered by Medicaid in Alabama. Medicaid will NOT pay for: Cosmetic surgery or procedures. partials, dentures or bridgework, gold caps or crowns, or periodontal or gum surgery. Hearing services for adults (age 21 and older).
Does Alabama Medicaid require a referral?
As of August 1, 2021, Alabama Medicaid no longer require PCP referrals to specialists. However, some provider offices may require a referral prior to rendering services to Alabama Medicaid recipients. In this case, the referring provider would need to comply with the rendering providers request.
What is the phone number for Medicaid prior authorization in Alabama?
For questions related to prior authorization or overrides, contact Acentra Health at 1-800-748-0130.
Does Medicare require prior authorization?
Generally speaking, if you are covered by Medicare Part A or Part B, you rarely need prior authorization. Many services are already pre-approved.
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How To Get Prior Authorization: Step-by-Step Guide Step 1: Check client eligibility. Step 2: Determine if a code or service requires Prior Authorization. Step 3: Find and complete forms. Step 4: Submit a PA request. Step 5: Check the status of an authorization.
Related links
Prior Authorization - Alabama Medicaid
Prior Authorization. The Prior Authorization Program is designed to ensure that only medically necessary services are provided in a cost-effective manner.
Ala. Admin. Code r. 560-X-16-.28 - Prior Authorization
(1) The use and payment of drug items may be restricted and require prior authorization. The Alabama Medicaid Agency will utilize the Pharmacy and Therapeutics
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