Mandatory provisions of the Affordable Care Act require the Medicaid Agency (Medicaid) to select and provide oversight for a Medicaid Recovery Audit Contractor (RAC) to perform provider audits. Alivia Analytics, LLC (Alivia) was selected to be Medicaid’s RAC effective October 1, 2024. The RAC program is designed to improve payment accuracy by identifying under and overpayments in Medicaid. The Medicaid RAC program is separate from the Medicare RAC overseen by the Centers for Medicare and Medicaid Services.

Reviews will be conducted by Alivia staff to include a medical director, certified professional coders and experienced clinicians. Audits will be conducted by Alivia using a “top down” approach where data analysis, through data mining, is applied against the universe of paid claims to identify patterns of utilization or billing which look atypical based on Medicaid and/or national standards. Following the high-level claims analysis, Alivia may expand its review by requesting clinical records and/or other documents in accordance with state and federal regulations.

Alivia has been informed of the critical role that all providers play in a successful Medicaid program and requires that auditors be professional, objective and consistent in performing all required audits/reviews.

Providers are reminded that the Alabama Administrative Code, the Provider Manual and their Provider Agreements require compliance with requests for medical records for Medicaid program audits.

Questions regarding the audits should be directed to Jamie Cousins, RAC Program Manager, at (334) 353-8025 or Yulonda Carter, Recipient Review Associate Director, at (334) 242-5161.

Also in Alabama, the State Board of Pharmacy will transition to a new database in October of this year. The new system and the renewal process will look different. The changes will ultimately be positive but require you to create a new account to renew licenses, permits and registrations.

Finally in Alabama, as a reminder, 2024 is a year for pharmacist license renewals and pharmacy permit renewals.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Medicaid will begin to migrate the remaining recipients from the Alabama Medicaid Agency Eligibility System (AMAES) to the newer Centralized Alabama Recipient Eligibility System (CARES) in June 2024. Medicaid anticipates the process will be completed by July 1, 2024.  

Medicaid recipients with a Medicaid ID number starting with 500 will get a new Medicaid ID number that starts with 530 (unless they already have a 530 Medicaid number). New Medicaid cards will be sent to recipients who do not already have a Medicaid card with the new 530 number.  

Recipients in nursing facilities may receive a new Medicaid number but not a card. Medicaid is “linking” the old Medicaid ID number to the new Medicaid ID number. Recipients may continue to use the old Medicaid ID number during June 2024. Once numbers are linked, either number will work. Providers who need assistance may call the Medicaid Provider Assistance Center at 1-800-688-7989. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The 2024 Legislative Session has adjourned. A Legislative Study Group is being developed over the summer to address the PBM issues in Alabama. 

Also in Alabama, as a reminder, federal regulations require states to conduct a fingerprint-based criminal background check on providers or any person with five percent or more direct or indirect ownership interest in the provider who meets any of the criteria listed in the ALERT pursuant to 42 C.F.R. § 455.450. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Board of Medical Examiners (BME) has certified rules for collaborative practice. A meeting between the Board of Pharmacy and the BME will be scheduled to work out the logistics for protocols on approval of agreements.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

HB 238 (The FAIR Meds Act) was introduced in the House this week. The goal of this legislation is fairness and access. Please register with the VoterVoice Action Center to join the effort and keep up with the latest calls to action. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Medicaid Agency created a new form titled “Notification of Request for Medical Records from Provider.” This form should be used by all Medicaid providers to notify Medicaid that recipients have requested copies of their medical records. For more information, click here.  

Also in Alabama, the Alabama Pharmacy Association is excited to announce the introduction of its podcast, “Off Script” hosted by Dr. Garrett Aikens. Through “Off Script”, they hope to provide important and timely updates about the ever-changing world of pharmacy. Go follow us on Spotify then listen to the intro and expect the first episode later this week as Louise and Danielle recap this week’s Board of Pharmacy meeting. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Members should make plans to attend this workgroup meeting either in person at the Board of Pharmacy office or virtually. The meeting will delve into Alabama Administrative Code 680-X-2-.14, which defines the roles and duties of pharmacy technicians within the healthcare system. Plan to participate in the discussion and share ideas, as this will have big implications for the profession in the state. 

February 19, 2024, 6:30 pm
Alabama Board of Pharmacy
111 Village Street
Hoover, AL 35242 

or virtually: https://albop.com/board-meetings/ 

Also in Alabama, the Alabama Pharmacy Association is currently accepting nominations for the chain designated seat on the Board of Pharmacy. Please submit nominations to Louise Jones by email at LJones@aparx.org or by fax to 334-271-5423. All nominations must include the name, place of employment and contact information for both the nominee and nominator. All nominations must be received no later than March 31. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Alabama Pharmacy Association is currently accepting nominations for the chain designated seat on the Board of Pharmacy. Please submit nominations to Louise Jones by email at LJones@aparx.org or by fax to 334-271-5423. All nominations must include the name, place of employment, and contact information for both the nominee and nominator. All nominations must be received no later than March 31.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

To streamline the provider enrollment process, Alabama Medicaid provider enrollment applicants should gather all needed materials before applying. READ MORE for some of the most common reasons why applications are denied. If you have any questions regarding your application, please contact Provider Enrollment at (888) 223-3630.  

Also in Alabama, on January 17, at 2:00 pm CST, the Board of Pharmacy will hold a Practice of Pharmacy Workgroup Meeting, where they will delve into Alabama Administrative Code 680-X-2-.14. This code defines the pivotal roles and duties of pharmacy technicians within the healthcare system. For those who wish to attend in person, the meeting will be held at 111 Village Street, Birmingham, AL 35242. Virtual attendance is available here. Do not miss this chance to be a part of the conversation that shapes the future of pharmacy in Alabama.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.