Elimination of the Out of State Hospital Update Form

TO: Out of State Hospitals

RE: Elimination of the Out of State Hospital Update Form

Effective May 1, 2026, the Alabama Medicaid Agency (Medicaid) will discontinue use of the Out-of-State ASC and Hospital Update Form for granting an extension of the enrollment dates for out-of-state hospital providers. All hospital providers in-state, out-of-state and bordering will be enrolled actively for a five year enrollment period. If the provider does not have a paid claim within a 24-month period, the provider will be subject to be purged, and a new application will be required to reopen the enrollment file.

Please note, all active out-of-state hospital providers must complete their revalidation by the end of their current six-month extension. All providers who meet the criteria will receive a notification letter at the pay to and mail to addresses on the enrollment file when their revalidation is due. The revalidation facsimile will be available for download via the secure web portal. The instructions are at https://medicaid.alabama.gov/documents/9.0_Resources/9.4_Forms_Library/9.4.16_Provider_Enrollment/9.4.16_PE_Download_Reenrollment_FAX_7-12-12.pdf.

If you have questions, please contact Provider Enrollment at (888) 223-3630 between Monday and Friday from 8:00 a.m. until 4:30 p.m. (Central Standard Time).

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