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  • Al Form 471 2011

Get Al Form 471 2011

On for Change Please use this section to denote what field(s) on the PA request require a change. Complete all applicable fields below. Examples: Add/Change Modifier: Add RR to E1088 Correct Date(s) of Service: Change requested effective date from 08/01/2010 to 10/01/2010 Add/Change Modifier Correct Number of Service(s) Correct Place of Service Correct Diagnosis Code(s) Correct Date(s) of Service Correct NPI Other (Please Explain) Comments NOTE: The Alabama Medicaid Agency cannot r.

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Contact support

For numbers not listed here, call Medicaid's main switchboard at (334) 242-5000 for assistance. Monday-Friday, 8:00 a.m. - 4:30 p.m.

You must request the appeal by noon of the day prior to termination of services (this can be done by phone or in writing). You may contact California's Quality Improvement Organization, HSAG at 1-800-841-1602, or 1-800-881-5980 (TDD for the hearing impaired).

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

FCC Form 486 (Receipt of Service Confirmation and Children's Internet Protection Act Certification Form) notifies USAC that the billed entity and/or the eligible entities that it represents is receiving, or has received, service in the relevant funding year from the named service provider(s).

Generally, Medicaid requires all claims to be filed within one year of the date of service; however, some programs have different claims filing time limit limitations. Refer to your particular provider type program chapter for clarification.

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.

The posting of an applicant's FCC Form 470 (Description of Services Requested and Certification Form) opens the required competitive bidding process.

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.

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.

Income & Asset Limits for Eligibility 2024 Alabama Medicaid Long-Term Care Eligibility for Seniors Type of MedicaidSingle Institutional / Nursing Home Medicaid $2,829 / month* $2,000 Medicaid Waivers / Home and Community Based Services $2,829 / month† $2,000 Regular Medicaid / Medicaid for Elderly and Disabled $963 / month $2,0001 more row • May 29, 2024

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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
DMCA 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
AL Form 471
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