Federal regulations permit the Alabama Medicaid Agency to require prior 2025

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Federal regulations permit the Alabama Medicaid Agency to require prior Preview on Page 1
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The document outlines the process for obtaining prior authorization (PA) within the Alabama Medicaid program, detailing the criteria for services requiring PA, submission methods for requests, and procedures for receiving approval or denial. It emphasizes the importance of verifying recipient eligibility and provides instructions for both electronic and paper submissions. Additionally, it includes information on using the Automated Voice Response System (AVRS) to review approved PAs and guidelines for submitting claims related to prior authorized services.
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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out Section 1: Requesting Provider Information. Enter your name, license number or NPI, and contact details.
  3. Proceed to Section 2: Rendering Provider Information. Provide the necessary details about the provider rendering services, including their NPI and contact information.
  4. In Section 3: Recipient Information, input the recipient's Medicaid number, full name, and address accurately.
  5. Complete Section 4: Other Information by entering required dates and diagnosis codes using the specified format (CCYYMMDD).
  6. Finally, fill out Section 5: Procedure Information with service dates, place of service, procedure code, and clinical statement before signing and dating the form.

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Review your plan documents or call the number on your health plan ID card for more information about the treatments, services, and supplies that require prior authorization under your specific plan.
Prior authorization is a way for insurance companies to review the medical service, procedure, item, or medication requested and make sure that its necessary for your care. Examples of services or procedures for which prior authorization may be needed include: admission to a hospital or skilled nursing facility.
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. Below are the forms used for Prior Authorization. Prior Review and Authorization Request Note: a completed form is required.
Prior authorization (PA) requires prescribers to obtain approval from the state Medicaid agency (or its contractor) before a particular drug can be dispensed. States may require PA for any drug covered by Medicaid but often do so for high-cost specialty drugs or non-preferred drugs.

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Mar 15, 2021 (2) Where prior authorization is required for Medicaid services, a recipients choice among qualified providers shall not be restricted except

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Ala. Admin. Code r. 560-X-36-.04 - Covered Services

(h) Assistive Technology and Durable Medical Equipment requires prior authorization and approval by the Operating Agency. The maximum allowed for this service

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Exemption 5

Threshold Requirement: Inter-Agency or Intra-Agency Memorandums or Letters. Generally. As an initial matter, Exemption 5 only applies to records that are

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