Alaska Medicaid HIPAA EDI Requirements And Transactions Guidelines
Alaska Medicaid HIPAA EDI Companion Guide is authored by the health plan. The purpose of a companion guide is to supplement the Technical Reports Type 3 (TR3s) which are also known as the HIPAA EDI Implementation Guides. These TR3s can be purchased at the X12 Store. Companion guides are available for download from the health plan’s website.
To learn more about HIPAA EDI, TR3s and become a certified EDI professional please visit our course schedule page.
Like most states, the state of Alaska has a Medicaid program. According to Medicaid.gov, Alaska has over 215,000 members in Medicaid and CHIP programs.
Most states use a private health plan to administer insurance. These are known as MCO (Managed-Care-Organizations). For example, United Healthcare is one of the MCOs for states such as Arizona and Maryland. CareSource is the MCO for the state of Ohio and Georgia. There are hundreds of such health plans serving 48 states.
Alaska and Wyoming are an exception. They do not use an MCO.
Medicaid Agencies use Electronic Data Interchange (EDI) technology for these transactions. Alaska is one of the Medicaid agencies using EDI. Alaska has contracted with Conduent EDI Solutions, Inc. to process EDI Transactions.
Alaska uses standard HIPAA EDI Transactions which are listed below.
- The Medicaid Payer ID ‘77200’ is used in the following data elements: GS03 group receiver ID; NM109 of the claim receiver loop NM1*41 1000B; NM109 of the NM1*P4 payer loop 2010BB
- 270 Eligibility Request / 271 Eligibility Response 005010X279A1
- 276 Claim Status Request / 277 Claim Status Response 005010X212
- Alaska has not implemented the 278 Prior Authorization Request / 278 Prior Authorization Response 005010X217 Perhaps they will implement it in the future.
- 837D Dental Claim 005010X224A2
- 837P Professional (HCFA) Claim 005010X222A1
- 837I Institutional (UB) Claim 005010X223A2
- 835 Electronic Remittance Advice 005010X221A1
- Alaska uses Conduent EDI Solutions, Inc as an EDI Gateway / clearinghouse
Alaska Medicaid does a good job explaining the EDI Acknowledgement process. The below flow charts show the EDI Editing and Validation Flow Diagram.
The validation and acknowledgement processing diagram below shows the inbound processing workflow for the inbound 837 professional claim. We strongly encourage you view the Alaska Medicaid Companion guides which contain links in the paragraph above.