Alabama Medicaid Policy Changes & Prior Auth Updates

We track 10 documented policy changes from Alabama Medicaid across AL. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Alabama Medicaid notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Alabama Medicaid updates automatically.

High impact
Applied Behavioral Analysis Therapy Diagnostic Requirements
Alabama Medicaid·Effective Jul 1, 2026
Effective July 1, 2026, Alabama Medicaid requires pediatricians to obtain a special ABA Specialty 175 designation before they can make autism diagnoses for ABA therapy referrals. Without this specialty designation, all ABA therapy referrals from pediatricians will be denied, and nurse practitioners can no longer diagnose autism for ABA referrals.
Medium impact
Provider Secure Web Portal Outage – Scheduled Maintenance
Alabama Medicaid·Effective Jun 23, 2026
The Provider Secure Web Portal operated by Gainwell will be unavailable from Tuesday, June 23, 2026 at 11:59 PM CT through Wednesday, June 24, 2026 at 5:00 AM CT for scheduled maintenance. During this 5-hour outage, providers will not be able to submit claims, process transactions, or verify eligibility through the web portal.
Medium impact
Prior Authorization Requirements for 2026 Radiology CPT Codes
Alabama Medicaid·Effective Jul 1, 2026
Alabama Medicaid will require prior authorization for two specific CT scan procedures (head/neck blood vessels and brain blood flow with contrast) starting July 1, 2026. Claims submitted without approved prior authorization will be denied.
Medium impact
Reminder of Patient-Centered Medical Home (PCMH) Recognition Attestation Deadline
Alabama Medicaid·Effective Oct 1, 2026
Alabama Medicaid is reminding Primary Care Physician groups participating in the Alabama Coordinated Health Network (ACHN) that Patient-Centered Medical Home (PCMH) recognition attestations for Fiscal Year 2027 must be submitted by October 1, 2026. All PCP groups must attest regardless of which certifying entity provided their PCMH recognition.
High impact
Alabama Medicaid 2026 Off-Cycle Revalidation
Alabama Medicaid·Effective Jun 5, 2026
Alabama Medicaid is conducting mandatory off-cycle revalidation for all providers in 2026, with high-risk providers (DME, Home Health, Hospice, Nursing Facilities, ABA Therapy, Behavioral Health) requiring swift revalidation and all other provider types requiring 24-month revalidation. Providers will receive phased revalidation notices and must complete required forms through the Medicaid Secure Web Portal.
Medium impact
Provider Secure Web Portal Outage – Scheduled Maintenance
Alabama Medicaid·Effective May 21, 2026
The Provider Secure Web Portal operated by Gainwell will be unavailable for scheduled maintenance from Thursday May 21, 2026 at 11:59 PM through Friday May 22, 2026 at 5:00 AM Central Time. During this outage, providers cannot access the portal for claims submission, processing, eligibility verification, or related transactions.
Medium impact
Applied Behavior Analysis Providers
Alabama Medicaid·Effective May 18, 2026
Alabama Medicaid now requires that beneficiaries must be evaluated and diagnosed with an ABA-eligible diagnosis by qualified practitioners (licensed psychologists, psychiatrists, or pediatricians) before receiving Applied Behavior Analysis services. A program update meeting is scheduled for June 15, 2026.
Medium impact
Follow-Up to June 15, 2026 ALERT - Applied Behavioral Analysis Therapy Diagnostic Requirements
Alabama Medicaid·Identified Jun 21, 2026
Alabama Medicaid has paused the implementation of new Applied Behavioral Analysis (ABA) therapy diagnostic requirements that were set to take effect July 1, 2026. The agency will provide additional guidance and clarity on these requirements at a later date.
Low impact
Provider Secure Web Portal Outage – Scheduled Maintenance Cancelled
Alabama Medicaid·Effective May 21, 2026
The previously scheduled maintenance for the Provider Secure Web Portal on May 21-22, 2026 has been cancelled. The portal will remain fully operational during the originally scheduled timeframe with no outage occurring.
Low impact
Elimination of the Out of State Hospital Update Form
Alabama Medicaid·Effective May 1, 2026
Alabama Medicaid is eliminating the Out-of-State Hospital Update Form effective May 1, 2026. All hospital providers will now receive 5-year enrollment periods but will be purged if they don't have paid claims within 24 months. Currently active out-of-state hospitals must complete revalidation by the end of their current 6-month extension.

Related

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