Alabama Pre-Certification Required

• Category: Alabama Workers Compensation - Official
• State: Alabama
• Control #: AL-032-WC
• Format: PDF

Description

Pre-Certification Required Alabama Recertification Required is a process by which medical providers in the state of Alabama must acquire certification from the Alabama Medicaid Agency in order to receive reimbursement for services provided to Medicaid recipients. Recertification is required for inpatient hospitalizations, outpatient hospitalizations, skilled nursing facility stays, and some high-cost medical procedures. There are three types of recertification required in Alabama: Prior Authorization, Concurrent Review, and Retrospective Review. Prior Authorization is a pre-certification process that requires medical providers to obtain approval from the Alabama Medicaid Agency before providing a service. Concurrent Review is a process where the Alabama Medicaid Agency reviews a service provided to a Medicaid recipient to determine if it was medically necessary and if it was billed correctly. Retrospective Review is a process where the Alabama Medicaid Agency reviews services provided to a Medicaid recipient after the service has been provided to ensure it was medically necessary and billed correctly.

Alabama Recertification Required is a process by which medical providers in the state of Alabama must acquire certification from the Alabama Medicaid Agency in order to receive reimbursement for services provided to Medicaid recipients. Recertification is required for inpatient hospitalizations, outpatient hospitalizations, skilled nursing facility stays, and some high-cost medical procedures. There are three types of recertification required in Alabama: Prior Authorization, Concurrent Review, and Retrospective Review. Prior Authorization is a pre-certification process that requires medical providers to obtain approval from the Alabama Medicaid Agency before providing a service. Concurrent Review is a process where the Alabama Medicaid Agency reviews a service provided to a Medicaid recipient to determine if it was medically necessary and if it was billed correctly. Retrospective Review is a process where the Alabama Medicaid Agency reviews services provided to a Medicaid recipient after the service has been provided to ensure it was medically necessary and billed correctly.