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Frequently Asked Questions - Providers

Have a provider or billing-related question for us?  Click here to submit your question!

General Billing and Claims

  • How can I tell if a procedure is covered by Alabama Medicaid?
  • If Alabama Medicaid denies a claim, can the provider bill the recipient?
  • What is the time limit for filing a claim to Alabama Medicaid?
  • If a claim has exceeded the one year timely filing limit, what can I do to receive payment?
  • If the recipient has other insurance and the other insurance denies the claim or makes no payment, how do I file the claim?
  • If the recipient receives "retro" eligibility, how do I submit a claim for payment?
  • How do I file a claim that requires an NDC number for an administered drug?
  • How do I file a claim when Third Party Liability (TPL) has recouped a payment?

Prior Authorization

  • What is the general time frame for a Prior Authorization?
  • Is there any way to expedite a Prior Authorization when services are absolutely necessary (i.e a recipient is leaving the hospital and has to have oxygen)?
  • What if the recipient receives "retro" coverage and the procedure required a prior authorization for Medicaid?

Programs

  • EPSDT FAQs
  • What is the difference between Patient 1st and EPSDT ?
  • How many physician office visits are recipients allowed per calendar year?
  • Is there an exception to the office visit limit of 14 office visits per calendar year?
  • If a drug has been administered to an eligible Medicaid recipient and the drug manufacturer does not participate in the Federal Drug Rebate Program (and I cannot receive payment from Medicaid), can I bill the recipient?

Nursing Home FAQ

Pharmacy FAQs
Drug Look-Up