Effective December 28, 2021, the Alabama Medicaid Agency will replace Claim Adjustment Reason Code (CARC) 45 with a new code to ensure compliance with the Committee on Operating Rules for Information Exchange (CAQH CORE) combinations reported on the X12 835 Electronic Remittance Advice (RA). The new CARC is as follows: 

CARC (96) – (non-covered charge(s)) with an appropriate Recipient Advice Remark Code (RARC) for the situation. 

UPDATE: These changes are currently available in our test environment for Provider and Vendor testing. Testing should be completed by December 24, 2021. The updated reporting will be implemented for claims appearing on the January 7, 2022 check write going forward.  

Also in Alabama, effective December 28, 2021, Alabama Medicaid will implement changes to the 271 Eligibility and Benefit Response transaction to ensure compliance with the Committee on Operating Rules for Information Exchange (CAQH CORE) for “Normalizing” the last name, which means removing all special characters, punctuation, upper case letters, suffixes, and prefixes to increase the chances of a match.  

UPDATE: These changes are currently available in our test environment for Provider and Vendor testing. Testing should be completed by December 24, 2021.  

Providers with questions concerning the upcoming change can submit them via the following email address: interChange_testing@DXC.com. 

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

The Board of Pharmacy has been notified there is another scam whereby an individual is posing as Board staff. The caller identifies herself as “Linda” and claims she is an employee of the Board updating information from a data merge and following up from a letter that had been sent out previously. She first asks for the pharmacy address, the supervising pharmacist and the primary drug wholesaler. She also asks for the account number “for our wholesaler for recall purposes”. There is no one on staff named Linda, so if you receive a call from her, please know this is NOT a legitimate phone call. Please do not entertain this conversation. The Board is not involved with recalls from wholesalers, and any official communication that needs to be sent to you directly will be sent via mail. If you ever have a suspicion whether a phone call, email, fax or other form of communication is legitimate, we welcome you to call our office or send an email to a staff member. You can find our staff directory on our website under “Contact Us”.

Also in Alabama, as a reminder, effective January 1, 2020, all newly registered technicians are required to complete a Board-approved training program within six (6) months of registration. Failure of a technician to complete the required training within the specified time period may result in disciplinary action for the technician, as well as the supervising pharmacist and the permit holder. Any technician required to complete training that has not done so will not be able to renew their technician registration online. Renewal notices have been mailed to all facilities and technicians. Online renewals are now open. Please note that ALBOP will be processing renewals as timely as possible, but to ensure registrations and permits do not lapse, please submit renewals as early as possible.

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

All previously published expiration dates related to the COVID-19 emergency are once again extended by the Alabama Medicaid Agency (Medicaid). The new expiration date is the earlier of November 30, 2021, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT. A listing of previous Provider ALERTs and notices related to the health emergency is available by selecting the Agency’s COVID-19 page.

Also in Alabama, as a reminder, effective January 1, 2020, all newly registered technicians are required to complete a Board approved training program within six (6) months of registration. Failure of a technician to complete the required training within the specified time period may result in disciplinary action for the technician, as well as the supervising pharmacist and the permit holder.  Any technician required to complete training that has not done so will not be able to renew their technician registration online.

Finally in Alabama, renewal notices have been mailed to all facilities and technicians.  Online renewals are now open.  Please note that ALBOP will be processing renewals as timely as possible, but to ensure registrations and permits do not lapse, please submit renewals as early as possible.

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

At the onset of the COVID-19 pandemic, the Alabama Medicaid Agency (Medicaid) temporarily ceased revalidation for providers. Medicaid has now resumed revalidation for providers. Affected providers may contact the Gainwell Provider Enrollment Unit at 1-888-223-3630 and speak to a Provider Enrollment Specialist. To learn more about the revalidation process please visit www.medicaid.alabama.gov, select the ‘Providers’ tab, then click on ‘Provider Enrollment‘ to view details. If a provider does not revalidate their enrollment, it will result in the provider enrollment being closed which can cause patients to not receive medications.

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

Alabama Pharmacy Association has partnered with the Tennessee Pharmacists Research and Education Foundation to offer live OSHA training. If you are a pharmacist providing immunizations or CLIA-waived testing services, or a pharmacy technician or other health care professional assisting with these services, you must have live OSHA training on bloodborne pathogens every year. The Tennessee Pharmacists Research and Education Foundation (TPREF) is offering a webinar that meets all of OSHA’s training requirements, including the live component. This webinar will provide attendees with one (1.0) contact hour of live ACPE Continuing Education. More information and registration can be found here.

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

Effective September 2, 2021, Governor Kay Ivey (R) issued a supplemental state of emergency proclamation for Hurricane Ida evacuees. The proclamation increases the allowable emergency supply of prescription medications that may be refilled from a 72-hour supply to a 30-day supply. Emergency prescription refills may be dispensed only if certain conditions apply. Please read the full proclamation for details. The proclamation is written in such a manner that an emergency rule from the Alabama Board of Pharmacy is not required.

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

The Alabama Medicaid Agency’s (Medicaid) new Medical and Quality Review Services Contractor, Kepro, will begin reviewing prior authorization (PA) requests, hospice, nursing home, ICF-IID, PEC, and swing bed records on October 1, 2021. Kepro will review PA requests with dates of October 1, 2021, and after. Kepro will NOT review pharmacy, dental or radiology PAs. 

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

After further review, the Agency will not resume the EPSDT referral requirement as referenced in the July 27, 2021 Provider ALERT. This allowance will continue through the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.

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

All previously published expiration dates related to the COVID-19 emergency are once again extended by the Alabama Medicaid Agency (Medicaid). The new expiration date is the earlier of September 30, 2021, the conclusion of the COVID-19 national emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT. A listing of previous Provider ALERTs and notices related to the health emergency is available by selecting the Agency’s COVID-19 page in the bottom section:  https://medicaid.alabama.gov/news_detail.aspx?ID=13729.  

Also in Alabama, please find below a link for the ALERT for pharmacy billing of the third C19 vaccine dose in selected immunocompromised patients.  Effective Aug 13, pharmacy providers may submit claims for the third dose in that selected population:  https://medicaid.alabama.gov/alert_detail.aspx?ID=15570 

Finally in Alabama, please note a subsequent ALERT will be disseminated for the third dose for the expanded population as we near the September 20th approval date.  See https://www.cdc.gov/media/releases/2021/s0818-covid-19-booster-shots.html for more information.

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