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  • Al Form 471 2024

Get Al Form 471 2024-2025

Alabama Medicaid Agency Prior Authorization (PA) Change Request Supplier Information Contact Name: NPI: Phone Number:Recipient Information Recipient Name: Medicaid ID:Prior Authorization Number Reason.

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Purpose of FCC Form 471 Applicants file an FCC Form 471 (Description of Services Ordered and Certification Form) to request discounts on eligible services and equipment for the upcoming funding year.

Agency name: Alabama Medicaid Agency – Medicaid Appeals You have 60 days from the date of your Eligibility Determination Notice to file for a fair hearing. Hotline for assistance (toll free number): 1-800-362-1504, TTY: 1-800-253-0799 Hours of operation: Monday – Friday, 8:00 a.m. – 4:00 p.m.

The patient or their representative can contact their insurance company and provide the relevant information to start the Prior Authorization process. It's best to confirm with the healthcare provider if they have the information and are willing to submit the request.

For questions related to prior authorization or overrides, contact Acentra Health at 1-800-748-0130.

Alabama Medicaid On this site you will find all of the forms needed to request a Prior Authorization. Please download the proper form, and fill it out COMPLETELY. You can fax the completed form to 1-800-748-0116, or e-mail it to al_pa@acentra.com. If you need further assistance, please contact us at 1-800-748-0130.

Does Medicaid pay for diabetic testing supplies? Alabama Medicaid will reimburse covered diabetic supplies for Medicaid recipients.

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.

Under prior authorization, the provider or supplier submits the prior authorization request and receives the decision before services are rendered.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232