Alabama Application Service Provider Agreement

State:
Multi-State
Control #:
US-CP1027-AM
Format:
Word; 
Rich Text
Instant download

Description

This sample form, a detailed Application Service Provider Agreement document, is for use in the computer, internet and/or software industries. Adapt to fit your circumstances. Available in Word format.
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FAQ

For help enrolling as a Medicaid provider, contact 1(888) 223-3630 or (334) 215-0111.

Who is eligible for Alabama Medicaid? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows

Medicaid patients get medical care from a variety of sources. Covered medical services include dental, eye and hearing care, lab and x-ray services as well as renal dialysis and transplant coverage.

For help enrolling as a Medicaid provider, contact 1(888) 223-3630 or (334) 215-0111.

How is Alabama Medicaid funded? Medicaid is funded jointly by the state and federal government. Medicaid's matching rate is approximately 70 percent federal, 30 percent state.

Prior authorization and other forms are available below. For questions related to prior authorization or overrides, contact KEPRO at 1-800-748-0130.

Contact Provider Enrollment at 1-888-223-3630 or visit the Provider Enrollment page of the Medicaid website, .medicaid.alabama.gov, under the Providers tab for instructions and forms to enroll.

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Alabama Application Service Provider Agreement