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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?

Pharmacy FAQs
Drug Look-Up