Alabama Medicaid Agency

Alabama Medicaid

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Overview

Our work advances health care and improves health for people in Alabama through our expertise in utilization management and quality review. Our staff is composed of Alabamians who provide services within their own community to support the needs of residents. We are privileged to provide this vital work for the state.

Services we provide for the Alabama Medicaid Agency

Our work includes medical record reviews for the Alabama Medicaid Agency to ensure compliance with state and federal guidelines. This includes the following scope of work:

  • Hospital medical record reviews for adult and pediatric admissions and continued stay reviews
  • Review of each hospital’s medical care evaluation plan that focuses on each recipient’s needs
  • Review provider preventable conditions to identify inappropriate treatment for a medical condition
  • Appeal reviews, including informal reviews and fair hearings