Notification of Third Party Resource Other Than Recipient’s Own Insurance

TO: All Medicaid Providers

RE: Notification of Third Party Resource Other Than Recipient's Own Insurance

The Alabama Medicaid Agency (Medicaid) created a new form titled "Notification of Third Party Resource other than Recipient's Own Insurance." This form should be used by all Medicaid providers to notify Medicaid that the provider has filed with a third party resource other than the recipient's own insurance for payment (as stated in Medicaid's Administrative Code Rule No. 560-X-20-.02 (3)(d)).

It is the Medicaid provider's responsibility to collect all information needed to complete the form and submit to Medicaid by emailing [email protected] within five days of filing with the third party.

This form is available at https://medicaid.alabama.gov/content/9.0_Resources/9.4_Forms_Library.aspx.

If you have questions regarding this ALERT, please contact Codie Rowland at (334) 242-5248 or email [email protected].

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2025 American Medical Association and © 2026 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.