Submit Medical Records

Please follow the timelines and procedures outlined in the medical record request received. Providers have 20 business days from the requested date to submit medical records. 

Instructions to submit the medical records are listed within in the Medical Record Request letter. Please include the cover sheet provided with the record request when records are submitted. Providers may also contact the Provider Customer Service team to obtain similar instructions. 

The following is the P.O. Box address to submit the Medical Records requested with the commonly requested documentation that may be pertinent for the review. 

Alivia – Alabama Medicaid RAC
P.O. Box 3301
Troy, MI 48099

Below are examples of medical support documentation a provider should send:   

1. signature logs 
2. consent forms  
3. treatment records 
4. plan of care  
5. orders/results/interpretation 
6. history and physicals 
7. examinations (with documentation of required elements)/progress notes/follow-up care 
8. referral forms, if applicable 
9. delivery logs/tickets (DME) 
10. itemized statements/invoices (DME)  
11. clinical intake  
12. treatment plans/ISP  

Below are examples of administrative support documentation a provider should send:  

1. names of staff providing services along with credentials,  
2. a typed list of each provider’s name followed by a signature of each provider, 
3. dates (date range) for which the provider was employed by the facility and/or provided services,  
4. list the place of employment for each licensed staff providing services at the time when services included in this review were rendered, and 
5. a copy of the current business license.  

Medical Records Extensions

Providers may request an extension due to extenuating circumstances. Please contact Alivia at the following phone number 866-204-0059 or email at [email protected].