Getting Started With Arkansas Medicaid HIPAA EDI Transactions

Tens of millions of Americans have Medicaid Insurance. Medicaid is insurance provided by the state. Arkansas is one of the Medicaid agencies using EDI. Arkansas has about 500,000 Medicaid members. According to medicaid.gov the managed care organization (MCO) for Arkansas can be any carrier but the Member Health Plans include:

Arkansas BlueCross BlueShield & Arkansas Total Care (Centene)

Arkansas uses standard HIPAA EDI Transactions which are listed below.

• 270 Eligibility Request / 271 Eligibility Response 005010X279A1
• 276 Claim Status Request / 277 Claim Status Response 005010X212
• 278 Prior Authorization Request / 278 Prior Authorization Response 005010X217
• 834 Benefit Enrollment and Maintenance X00510X220A1
• 820 Payroll Deducted and Other Group Premium Payment for Insurance Products X00510X218
• 837D Dental Claim 005010X224A2
• 837P Professional (HCFA) Claim 005010X222A1
• 837I Institutional (UB) Claim 005010X223A2
• 835 Electronic Remittance Advice 005010X221A

For connectivity Arkansas uses SFTP and SOAP Real-Time Web Services.

Interesting facts about their transactions:

• Batch size: 2,000 claims per ST/SE
• ISA Sender/Receiver Qualifier/ID is 30/716007869 … 30 is a qualifier for a tax ID.
• Like most payer trading partners (health plans) they will us their ISA ID also as their Submitter/Receiver ID in NM109 where qualifier is 46 (ETIN-Electronic Transmitter’s Identification number)

Here are some other blog posts about HIPAA EDI Companion Guides

https://ediacademy.com/blog/category/hipaa-edi-companion-guides/

To learn more about HIPAA EDI, TR3s and become a certified EDI professional please visit our course schedule page.