Frequently Asked Questions

Will Alaska Medicaid Health Enterprise have real-time Medicaid eligibility information?

The Request For Proposal (RFP) requires “A daily transaction update interface with the State’s eligibility information system (EIS) to obtain all necessary data for the Alaska MMIS recipient database.” The MMIS system eligibility information is limited to the data contained within the State’s EIS.

What options will be available to verify recipient eligibility in the new system?

Providers will be able to verify recipient eligibility in the following ways:

• Online eligibility inquiry and response through Alaska Medicaid Health Enterprise
• Submission of batch inquiry in a 270/271 format through the web portal
• Health Care Eligibility Benefit Inquiry and Response (270/271) through a clearing house or other trading partner/biller to ACS
• Automated Voice Response System (AVRS) for eligibility verification
• Customer Call Center i.e. Provider Inquiry
• Use the “Contact Us” feature which allows an authenticated provider to submit a written request via the web portal

Can recipient eligibility verification be done via a batch file?

A batch file of eligibility verification requests may be sent via the mail, via electronic file transfer, or via Alaska Medicaid Health Enterprise. Alaska Medicaid Health Enterprise allows an authenticated provider to upload a batch file of eligibility verification requests to the MMIS via a drop down menu choice. The MMIS will then return the file of responses to the provider’s mailbox located on the web portal.

Will there be a way to send a file with information on multiple recipients and do bulk eligibility verification of recipients?

Any Medicaid approved entity that has signed a Trading Partner Agreement with the State of Alaska may submit a batch file of eligibility verification requests via the X12 270 format. There may be multiple requests on the file for multiple different members, as well as multiple verification requests for the same member. The State will return a response file of X12 271 transactions via the MMIS that contains the requested eligibility verification information. For each eligible response, the 271 will contain a Confirmation Number that will be used when the claim is submitted to ensure that the claim passes the eligibility related adjudication edits.

Will the EIS system change with the new MMIS?

The EIS system is a separate system maintained by the Division of Public Assistance (DPA). The new MMIS will not replace the EIS system; however, the new MMIS will continue to receive recipient eligibility data from EIS.

Will the recipient eligibility process be streamlined?

The recipient application process for Medicaid is administered by the Division of Public Assistance. The recipient eligibility application process will not be changed by the implementation of the new MMIS. The new MMIS will be receiving recipient eligibility data more frequently. The new MMIS Request for Proposal (RFP) requires “A daily transaction update interface with the State’s eligibility information system (EIS) to obtain all necessary data for the Alaska MMIS recipient database.”

Will providers be able to enroll recipients?

The recipient application process for Medicaid will continue to be administered by the Division of Public Assistance. The recipient eligibility application process will not be changed by the implementation of Alaska Medicaid Health Enterprise.