Referral Information for Providers

A referral form must be submitted for all referrals in order to be processed. 

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• Care Coordination Referral Form (For General and Maternity)​

• Childhood Obesity Referral Form

• Children with Medical Complexities Referral Form

• Family Planning Referral Form

• Gestational Diabetes Referral Form

• Substance Use Disorder Referral Form

• Grievance Form

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Please fax the referral to (256) 382-2715 or email to referrals@northalcc.org.

 

Please note that the email address is for provider use only. Recipients should contact us directly using our Contact Us Form (Click HERE) or by calling (256) 382-2590 to prevent delays.

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Specialist Referrals

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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.

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

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Submitting Specialist Referrals

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

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• 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

• 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 or email to referrals@northalcc.org

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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.

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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.

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