Specialist Referrals

North Alabama Community Care’s goal is for Primary Care Providers (PCPs) to make referrals for Specialist services and for Medicaid Recipients to be under the care of a PCP (Ref: Chapter 40 of Provider Billing Manual).  However, North Alabama Community Care will provide referrals for Specialist services for Medicaid Recipients who are not yet attributed to a PCP.  Referrals are for billing purposes only and intended to assist Medicaid Recipients and Providers in the interim while Recipients are being linked with PCPs.

For more information on Alabama Coordinated Health Network (ACHN) Primary Care Physician (PCP) and Delivering Healthcare Professional (DHCP) Billing click HERE.

For the Alabama Medicaid Agency's presentation on the "Role of the Specialist in the ACHN" click HERE

When submitting a Specialist Referral, please use the follow instructions:

  • Verify the Recipient’s Medicaid eligibility

  • Verify the Recipient’s ACHN assignment

    • North Alabama Community Care is listed as  “ACHNB”

  • Verify the Primary Care Provider attribution

    • Attributed Primary Care Provider MUST be contacted prior to contacting North Alabama Community Care for a billing referral.  North Alabama Community Care can provide a referral if the PCP refuses to complete a referral.

    • If no PCP is attributed, complete Form 362 located HERE

  • You must include the following information:

    • Recipient's name, address, telephone, and Parent/Guardian name(s)

    • Recipient's Medicaid number

    • Recipient's date of birth

    • Date referral begins (date of covered visit, procedure, etc.)

    • Consultant's name (Provider requesting referral)

    • Consultant's address

    • Consultant's telephone number

    • Consultant's fax number

  • On your cover sheet, please include justification of need for multiple visits.  For example, multiple physical therapy visits or chemo treatments within one week.

  • Please fax the referral to (256) 382-2715

Please allow 72 hours, not including weekends, to process the referral. If you have any questions regarding the referral, please call (256) 382-2590 or toll-free (855) 640-8827.

Please inform the Recipient of the need to be linked with a PCP for future referrals and that North Alabama Community Care will contact them to assist with this process.