Non-Invasive Prenatal Test for Fetal Aneuploidy (NIPT)

PDF Version

Automated Prior Authorization (PA) Checklist

Effective October 15, 2021, the Alabama Medicaid Agency added an automated checklist to the Forms menu of the Alabama Medicaid Interactive Web Portal for all request for NIPT prior authorizations. This addition is an automation of the external checklist provided at the onset of coverage for this service. (This checklist is on Page 3.)

Supporting documentation can be submitted with the prior authorization form by uploading documents in PDF format or by creating a fax barcode cover sheet from the Web Portal to accompany documentation that will be submitted at a later time. NOTE: Submitters will have 30 days from the date of initial PA request submission to submit additional documentation.

Accessing the Medicaid Interactive Web Portal

Secure access to the Medicaid Interactive Web Portal is required in order to access the Medical PA Form. NIPT PA supporting documentation may be submitted in two different ways:

• Fax information using the barcode cover sheet received after submitting the form in the web portal.

Browser Compatibility

Follow the below instructions to set browser compatibility settings:

• Navigate to the Medicaid Interactive Web Portal using the URL provided above.

• Select Tools from upper right-hand corner of browser. The feature is displayed as a wheel.

• Choose Compatibility View Settings.

• Click Add.

• Click Close.

• Refresh Browser to apply the setting.

Documents must be in a Portable Document Format (PDF)

Documents must be in a PDF for upload through the Web Portal. If you do not currently have the ability to create PDF versions of supporting documentation, you may perform an internet search and find free downloadable utilities that can be installed to create a PDF. For your convenience, Gainwell is including a list of three PDF creation utilities that can be installed to create PDF documents at no charge:

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