Dental Administrative Review Panel

PDF Version

TO: Dental Providers

RE: Dental Administrative Review Panel

Effective October 24, 2026, dental providers can upload documentation for administrative review via the Web Portal using the Admin Review panel. Detailed instructions for submitting a Dental Administrative Review Form are available at www.Medicaid.Alabama.gov. Select the Programs tab, Dental Program, and look under the title, "Dental Forms."

Note: The Admin Review panel is only accessible for Dental Provider and Dental Clerk Web Portal users.

To Access the Admin Review Panel

1. Log on to the Medicaid Interactive Web Portal

https://www.medicaid.alabamaservices.org/ALPortal/Account/Secure%20Site/tabId/66/Default.aspx

1. Select Providers > Admin Review
2. Enter denied ICN
3. Click Search

Results: The following read-only fields will then populate the data from the ICN entered:

• Denied ICN
• Recipient ID
• Recipient Name
• Billing Provider ID (NPI)
• Provider Name
• DOS

To Upload Documentation:

1. Enter the following Required Fields:
2. 1. Submitter First Name
   2. Submitter Last Name
   3. Submitter Phone
   4. Submitter Email
   5. EOB Date
   6. Reason
3. Click Choose File button
4. Select File to Upload (PDF format only)
5. Click Open
6. If additional files need to be attached, click Add and repeat steps 2-3
7. Click Submit
8. Upon submission, the Record ID and ACN (Attachment Control Number) will be generated, and the barcode cover sheet will be available to print

To Print Barcode Cover Sheet:

1. Click Print
2. Click Print on print preview window