MedicaidAdministrativeHigh impact
Removal of Medicare and TPL Exemption
Alabama Medicaid·AL · Optometry·Provider Notice
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Effective October 1, 2026, Alabama Medicaid is removing the exemption that allowed optometrists and opticians to file claims directly with Medicaid. Providers must now file with the beneficiary's primary insurance (including Medicare) before submitting claims to Medicaid. This represents a shift to mandatory primary-secondary claim filing sequencing.
Action Required
By September 30, 2026: Billing team must update billing system configuration to enforce mandatory primary insurance claim filing before Medicaid submission for all optometry and optician claims. Update claim scrubbing rules to identify Medicare and other primary coverage and route claims accordingly. Modify encounter templates and billing worksheets to require documentation of primary insurance verification. Train all billing staff and providers on the new sequencing requirement. Implement validation rules to prevent direct Medicaid filing when primary insurance is identified. Contact Gainwell Technologies Provider Assistance Center at 1-800-688-7989 with implementation questions. Failure to comply will result in Medicaid claim denials and potential audit findings. Reference Alabama Medicaid Provider Billing Manual, Chapter 5 for detailed filing instructions.