Providers must notify the Alabama Medicaid’s Agency prior to
releasing information (claims, charges and medical records) regarding a
patient’s care. This ensures that Medicaid is informed when the
recipient intends to use the information in order to obtain third party
funds from an insurance company or through a lawsuit that should be paid
to the provider or to Medicaid.
Providers are NOT required to notify Medicaid if records are requested
under the following circumstances:
- Requests from Medicaid or its fiscal agent.
- Requests from federal or other state agencies
- Requests by insurance companies to process an application for
insurance, to pay life insurance benefits, or to pay a loan
- Requests from other providers for medical information needed in the
coordination of a patient's treatment.
- Requests from insurance companies for information pertaining to a
claim filed by the provider in accordance with Medicaid regulations and
for which an assignment of benefits to the provider was furnished to the
insurance company.
For other exceptions, see Chapter 20 of the Administrative Code.
NOTE: Effective January 1, 2010, Health Management Systems (HMS)
is under contract with Alabama Medicaid to process the "Request for Medical
Records" and perform the evaluation and case tracking functions of all
casualty and litigation cases. Medical record request forms are to be faxed
to HMS at 866-274-5974. To contact HMS by phone regarding a medical record
request or for information related to a casualty or litigation case, you may
reach HMS at 877-252-8949.