Can providers enter claims online as well as continue
to send batched claims?
Claims can be submitted via hardcopy, batch, and internet transmissions using Alaska
Medicaid Health Enterprise. Changes, if any, to the batch claims process are unknown
at this time. The specific details of system design will be identified during the
next year.
All electronic claims from HIPAA covered entities must be in the HIPAA compliant
format. Electronic claims from HIPAA non-covered entities must be in the most recent
National Standard format or in the HIPAA compliant format.
Will Alaska Medicaid Health Enterprise have a web page
to check claims status and eligibility?
Yes.
Will Alaska Medicaid Health Enterprise be updated with
the latest version of CPT codes and ICD-9 codes?
Alaska Medicaid Health Enterprise will include current CPT and ICD-9 codes; however,
not all codes are reimbursable under Alaska Medical Assistance rules.
Can claims be corrected online?
Providers and other authorized users can adjust and void previously processed claims
and see the on-line claim adjudication results immediately via Alaska Medicaid Health
Enterprise. For instance, when the submitted adjustment’s adjudication status is
to-be-paid, Alaska Medicaid Health Enterprise displays the anticipated reimbursement
amount to the user immediately. If the adjustment is in a to-be-denied or suspended
status, the provider sees the reasons that prevented the adjustment from reaching
a to-be-paid status. Based upon that feedback, the provider can immediately perform
the necessary corrections on-line in order to resubmit the adjustment. Timely filing
rules apply for all claims, including adjustments.
Will the history of a claim be available?
Alaska Medicaid Health Enterprise will allow a provider to view their payment history
and associated Remittance Advice (RA) documentation. The RA will provide the adjustment/void
information. The web pages mimic a 276/277 claim status inquiry that can be used
by the provider to view individual claim information.
Will it be possible to see the line items of a claim?
Yes, each line item is displayed as submitted.
Can questions regarding claims or other processing
issues be submitted online instead of calling Provider Inquiry at the fiscal agent?
Yes, providers will be able to submit written inquiries "Contact Us" feature through
Alaska Medicaid Health Enterprise.
Will the system handle a claim if a patient stays 20
days, but the provider is only billing for 10 days?
The project is currently in the Design Phase. During this time detailed specifications
for the new MMIS are determined and documented.
Will it be possible for a provider to query based on
provider type, provider name, or other fields to see what claims are outstanding?
Yes, providers can perform claim status inquiries by provider id to determine which
claims are paid, denied or suspended.
How often will RAs be produced?
Alaska Medicaid Health Enterprise will continue to run one weekly payment cycle.
The RAs will be produced weekly immediately following the weekly payment cycle.
Following the weekly payment cycle, providers may view their RAs online.
