Get Al Form 471 2024-2025

The AL Form 471 is a crucial document for requesting changes to prior authorization from the Alabama Medicaid Agency. This guide will walk you through the process of completing this form online, ensuring you provide all necessary information accurately.

Follow the steps to complete the form seamlessly.

1. Press the ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Begin with the supplier information section. Enter the contact name, NPI, and phone number of the supplier. This information identifies the provider making the request.
3. Next, complete the recipient information section by providing the recipient's name and Medicaid ID. This links the request to the appropriate individual.
4. In the prior authorization number field, enter the number associated with the prior authorization you want to change. This is essential for tracking purposes.
5. Utilize the 'Reason for Change' section to specify the field(s) on the prior authorization request that require modification, such as adding or changing modifiers, correcting dates, or adjusting diagnosis codes.
6. Make sure to complete all applicable fields below, for example: Change requested effective date, or Add 'RR' to ‘E1088’. Provide clear explanations for any other changes as necessary.
7. Use the comments section for any additional remarks regarding your request that may not fit within the other fields.
8. After thoroughly reviewing all information for accuracy, save your changes, and proceed to either download, print, or share the form as needed.

Complete your AL Form 471 online today and ensure all necessary changes are submitted correctly.