Attention all providers: Due to the COVID-19 pandemic, the Alabama Medicaid Agency has suspended all EPSDT and Specialist Referrals at this time. Please view the provider Alert posted on the Alabama Medicaid Agency website: www.Medicaid.Alabama.gov.
My Care Alabama Northwest’s goal is to assist with referrals for Specialist/Consultant services and for Medicaid Recipients to be under the care of a Primary Care Provider (PCP) (Ref: Chapter 40 of Provider Billing Manual). However, My Care Alabama Northwest may provide referrals for Specialist services for Medicaid Recipients who do not have an identified PCP. Referrals are for billing purposes only and are intended to assist Medicaid Recipients and Providers in the interim while Recipients are being linked with PCPs.
For more information on Alabama Coordinated Health Network (ACHN), Primary Care Physician (PCP), and Delivering Healthcare Professional (DHCP) Billing click HERE.
For the Alabama Medicaid Agency’s presentation on the “Role of the Specialist in the ACHN” click HERE
Before submitting a request for a Specialist Referral, please use the following instructions:
- Verify the Recipient’s Medicaid eligibility
- Verify the Recipient’s ACHN assignment
- My Care Alabama Northwest is listed as “ACHNA”
- Verify whether the Recipient has a PCP (this can be done by asking the Recipient or evaluating Medicaid’s eligibility file)
- If a PCP cannot be identified, PLEASE COMPLETE THE ONLINE SPECIALIST REFERRAL FORM 362 BY CLICKING HERE (all efforts to identify the Recipient’s PCP must be expended before completing Form 362)
You must include the following information on the Form 362:
- Recipient’s name, address, telephone, and Parent/Guardian name(s)
- Recipient’s Medicaid number
- Recipient’s date of birth
- Date referral begins (date of covered visit, procedure, etc.)
- Consultant’s name (Provider requesting referral)
- Consultant’s address
- Consultant’s telephone number
- Consultant’s fax number
- Please include justification of need for multiple visits on a separate sheet from the Form 362. For example, multiple physical therapy visits or chemotherapy and/or radiation treatments (limited to 30 days).
- Please email the referral to infoNW@mycarealabama.org.
Please allow 72 hours, not including weekends, to process the referral. If you have any questions regarding the referral, please call 855-500-9470.
Please inform the Recipient of the need to be linked with a PCP for future referrals and that My Care Alabama Northwest can assist with this process.