State · AL
Medical billing services in Alabama
Short answer
Medical billing services in Alabama send almost every Medicaid claim to one payer: the state has no full-benefit Medicaid managed care plans, so claims go electronically to the Alabama Medicaid Agency's fiscal agent, and only a clean claim received within one year of the date of service is paid.
Care coordination runs through the Alabama Coordinated Health Network, a primary care case management entity with seven regions and about 811,000 members in 2024, and non-emergency transportation is a reimbursement program the Agency runs itself. Commercial insurers pay health claims under Section 27-1-17. A Remitwright dedicated biller works those rules, serving Alabama practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Alabama: what's different
The rules below change how a claim is filed and paid in Alabama. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Alabama | Source |
|---|---|---|
| Medicaid program | Alabama MedicaidAlabama Medicaid Agency | 12 |
| Fee-for-service portal | Alabama Medicaid Agency website and fiscal agent web portal | 12 |
| How Medicaid is delivered | Alabama has no full-benefit Medicaid managed care plans | 4 |
| Managed care plans | 3 plansAlabama Coordinated Health Network, Alabama Select Network, Mercy Life of Alabama | 5 |
| Medicaid timely filing (fee-for-service) | One year from the date of service | 1 |
Alabama Medicaid
Alabama Medicaid is run by the Alabama Medicaid Agency. Fee-for-service claims and provider enrollment go through the Alabama Medicaid Agency website and fiscal agent web portal12, at www.medicaid.alabama.gov. Alabama has no full-benefit Medicaid managed care plans: 193 of 1,098,614 enrollees were in a capitated plan in 2024, a PACE program, while 76 percent were in a primary care case management entity, almost all of them the Alabama Coordinated Health Network4. CMS managed care enrollment data for 2024; the entities below come from the same CMS report. The Agency contracts with a fiscal agent to process and pay all claims submitted by providers under the state plan, so an ACHN member's claim is a fee-for-service claim.
Fee-for-service filing limit: One year from the date of service for a clean claim to be received by the Agency's fiscal agent, unless a different limit is set elsewhere in the Medicaid administrative code1. Rule 560-X-1-.17: providers must submit claims electronically, a clean claim is one that can be paid or denied without more information from the provider, and a claim returned to the provider for missing information is not counted as a timely clean claim.
Managed care plans5
- Alabama Coordinated Health NetworkPrimary care case management entity, 811,224 members in 2024, one network in each of seven regions
- Alabama Select NetworkIntegrated Care Network, a statewide primary care case management entity since October 1, 2018, with 26,388 members in 2024
- Mercy Life of AlabamaPACE program in Mobile and Baldwin counties, 193 members in 2024
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Alabama Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Alabama11: Blue Cross and Blue Shield of Alabama, UnitedHealthcare, Ambetter of Alabama, Oscar Insurance Company. No two of them share a provider manual: filing windows, corrected-claim processes and appeal levels are set payer by payer, and the timely filing limits table lists verified deadlines, each with its source.
Prompt pay in Alabama is governed by Code of Alabama Section 27-1-17 (reimbursement of health claims), as applied by Alabama Department of Insurance Chapter 482-1-1248. The Department of Insurance claims standards say reimbursement of health claims is handled as Section 27-1-17 requires, and that an insurer must send claim forms or assistance within 15 days of notice of a claim, begin processing within 15 days of receiving proof of loss, reply to other written claim correspondence within 20 days, send written notice of a denial with its reasons within 15 days of deciding to deny, and issue an explanation of benefits with each health claim payment. Days are calendar days. In A/R follow-up, a clean claim that sits unpaid is escalated with the statute cited.
NEMT and home care in Alabama
Non-emergency medical transportation. Alabama's Non-Emergency Transportation (NET) program is operated by Agency staff as an administrative service: reimbursement goes through an Electronic Benefit Transfer process that the recipient uses to buy the ride, on a tiered fee that weighs mileage, the recipient's physical or medical condition, regional rates and the level of transport required, with public transportation used whenever it can meet the need; non-emergency ambulance is paid fee-for-service3. Rules 560-X-18-.18 and 560-X-18-.19, revised July 15, 2022. The Agency can redirect a reimbursement on the recipient's behalf to a more appropriate address, keeps a list of certified and licensed transporters, and reviews the reimbursements it issues retrospectively. The NEMT billing in Alabama page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. CMS found Alabama compliant with the Cures Act EVV requirement for personal care services under its 1915(c) waivers and 1915(j) self-directed personal attendant care on January 7, 2021, and lists the state as compliant for home health care services as of January 1, 20249. The compliance letter covers the authorities, not the system: which EVV system a provider uses and how visits reach the Agency come from the Agency's EVV guidance for each program. CMS asked Alabama to update its survey once personal care moved to the state plan benefit under EPSDT. See home care billing in Alabama for waiver programs, EVV exceptions and authorizations.
Rules that change how Alabama claims are billed
A claim returned to the provider is not a timely claim1
Rule 560-X-1-.17 says Medicaid pays only clean claims submitted on time to its fiscal agent, and a timely claim is a clean claim the fiscal agent receives within one year of the date of service. A claim without enough information to enter the automated claims system is returned to the provider and does not count as a clean claim submitted timely, so a claim bounced in month eleven has to be corrected and received again inside the year. Claims must be submitted electronically, and the completion instructions live in the provider manuals on the Agency website.
ACHN runs in seven regions, each with one coordination network2
Rule 560-X-37-.07 consolidated the Maternity Care, Health Homes and part of the Family Planning case management programs into seven primary care coordination management entities, effective October 1, 2019: Central (Montgomery, Elmore, Autauga and eight more counties), East (Calhoun, Etowah, Talladega and others), Jefferson and Shelby, Northeast (Madison, Morgan, Limestone, Marshall, Jackson and Cullman), Northwest (Tuscaloosa, Lauderdale, Walker and others), Southeast (Lee, Houston, Russell and others) and Southwest (Mobile, Baldwin and six more). The member's county decides the network, and chapter 560-X-37 also sets attribution and the payments to primary care physicians who participate.
NET is a reimbursement benefit, not a broker program3
Chapter 560-X-18 keeps non-emergency transportation inside the Agency: staff operate the NET program as an administrative service, reimbursement reaches the recipient through an Electronic Benefit Transfer process, and a tiered fee reflects mileage, the recipient's condition, prevailing regional rates, available transportation resources and whether a family member, commercial carrier or ambulance transporter drives. Public transportation comes first, and the Agency may issue EBT fare reimbursement for recipients who can use it. Non-emergency ambulance is the exception, paid fee-for-service with prior authorization rules of its own.
Insurers must start processing in 15 days and explain a denial in 15 days8
Alabama Department of Insurance Chapter 482-1-124 sets minimum claim handling standards for life, accident and health claims, and rule 482-1-124-.04 gives health claims these marks: claim forms or assistance within 15 days of notice of a claim, processing begun within 15 days of proof of loss, a reply within 20 days to other written claim correspondence, written notice of a denial with the reasons within 15 days of the decision to deny, and an explanation of benefits naming the provider, services and dates with each health claim payment. Reimbursement itself is handled as Section 27-1-17 requires, and an insurer may not withhold part of a health benefit to offset an overpayment on a prior claim unless it holds clear documented evidence of the overpayment, the claimant's written authorization and proof that the error was clearly erroneous, was not a mistake of law and was reported to the claimant within six months of the error.
ACHN's federal authority is a 1915(b) waiver effective January 1, 20226
Medicaid.gov lists the Alabama Coordinated Health Network (AL-09) under 1915(b)(1), (b)(3) and (b)(4) authority, approved June 14, 2019 and effective January 1, 2022, with the Agency operating the waiver directly. CMS's 2020 program features table records ACHN as a statewide primary care case management entity that started October 1, 2019, alongside the Integrated Care Network, a statewide PCCM entity since October 1, 2018, and PACE in Mobile and Baldwin counties. None of the three is a capitated health plan, which is why claims keep flowing to the fiscal agent.
Services for Alabama practices
Remitwright serves Alabama practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Alabama practices
What is the Alabama Medicaid timely filing limit?
Does Alabama have Medicaid managed care plans we need to contract with?
How fast must an Alabama insurer pay a clean claim?
Does Alabama Medicaid require EVV for home care visits?
Who arranges Medicaid transportation in Alabama?
Which commercial payers did you list for Alabama, and why those?
Where do Alabama Medicaid claims go, and who answers claim questions?
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