HIPAA Frequently Asked Questions (FAQs)
Click on a topic in the following menu. It will expand and show you a list of sub-topics. Then click on the sub-topic that most closely relates to your question. A series of frequently asked questions (FAQs) will display. When you click on a FAQ, the answer displays.
I already have a submitter/trading partner ID and password. Do I need a new ID and password to submit electronic claims in 5010 formats?
No, you do not need a new submitter/trading partner ID and password. You can continue to use the ID and password assigned to you. If you have problems with your password or ID, please contact the HIPAA Support Team for assistance.
Do I have to complete a new Billing Agent Information Submission Agreement (BASA)?
Unless you start submitting transactions not already specified in your existing Billing Agent Information Submission Agreement (BASA), you do not have to complete a new agreement. The terms of the BASA are not affected by 5010 standards.
Do I have to complete a new Provider Information Submission Agreement (PISA)?
Unless you change your agreement with your authorized billing agent, you do not have to complete a new Provider Information Submission Agreement (PISA). The terms of the PISA are not affected by 5010 standards.
Do I have to complete any type of re-enrollment?
No, you do not have to complete any type of re-enrollment to be compliant with 5010 transaction standards. However, every submitter must complete certification testing before they are authorized to submit electronic claims in 5010 formats.
How do I change my taxonomy code in my enrollment record?
You can change the taxonomy code on your enrollment record by submitting a Change of Information form. On this form, you must indicate the end-date of the old taxonomy code and the start-date of the new taxonomy code, the affected NPI, and its effective dates. Any changes to the NPI and taxonomy selections on your provider enrollment record must also be reflected on the claims you submit. If the NPI and taxonomy on the provider enrollment record do not match the NPI and taxonomy on your claim, the claim will deny.
You can download the Change of Information form here. Providers can also locate this form at medicaidalaska.com/providers/forms.shtml under the Providers/Forms tab. Once we receive this form, we will send it to the State for approval.
After your form receives approval, we will update your file. If you have multiple Medicaid IDs with the same NPI, you need to list all of your Medicaid IDs so that they can be coordinated with the new taxonomy code. If you do not list all of your Medicaid IDs, then changing the taxonomy code may result in associating only one NPI with that taxonomy code. As a result, it is likely many electronic claims will pend.
Do I have to be certified to submit electronic claims in 5010 formats?
Yes, you must be certified to submit electronic claims in 5010 formats to Alaska Medical Assistance. To be certified, you must complete certification testing by successfully submitting two test files. Each file must have 20 - 50 claim or eligibility transactions for each transaction code that you want to submit electronically.
How do I know if I am certified to submit electronic claims in 5010 formats?
If you are certified to submit electronic claims in 5010 formats, you received or will receive confirmation about your certification from the 5010 testing team.
If you have not successfully completed certification testing, the testing team will work closely with you until you successfully submit two test files. After submitting two successful test files, the testing team will certify you to submit electronic claims in 5010 formats.
I am not certified, and I cannot submit electronic claims in 5010 formats. What do I do?
You must contact the HIPAA Support Team to request permission to complete certification testing for 5010 formats. They will provide you with additional information about certification testing.
I use Payerpath to submit claims. Do I need to be certified?
No, you do not need to be certified. Payerpath has performed all the required testing and is certified to submit your claims in 5010 formats.
Technical Report Type 3 (TR3)
What is a TR3?
A TR3 is a document that provides thorough information about the HIPAA-mandated 5010 standards. They are developed and approved by the ASC X12 committee which is part of the American National Standards Institute, or ANSI.
TR3s give you technical details on how to complete and read an electronic transaction. Each format has its own TR3.
Can you send me the TR3 for a particular transaction?
No, we cannot send you TR3s. These reports must be purchased from Washington Publishing Company. You can purchase them at store.x12.org/store/.
See also 5010 Implementation, Resources.
Is there any training available on 5010 standards?
Yes, Alaska Medical Assistance provided online, live-training sessions on 5010 standards. We have published those trainings at medicaidalaska.com/hipaa_news.shtml#training. You can download the trainings and review them at your convenience.
See also 5010 Implementation, Resources.
How do I contact the Fiscal Agent?
If you are in or near Anchorage, you should contact the Fiscal Agent, Xerox State Healthcare, LLC, on the regular line at 907-644-6800.
If you are outside of Anchorage, you should contact the Fiscal Agent, Xerox State Healthcare, LLC, toll-free at 1-800-770-5650.
What is the HIPAA Support Team email address?
The HIPAA Support Team email address is AKHIPAASupport@xerox.com.
Where do I download trainings?
You can download trainings at medicaidalaska.com/hipaa_news.shtml#training.
Where do I download Companion Guides?
You can download Companion Guides at medicaidalaska.com/hipaa_news.shtml#companion_guides.
Where do I purchase Technical Report Type 3 (TR3)?
You can purchase them at store.x12.org/store/.
Where do I download forms?
You can download forms at medicaidalaska.com/providers/forms.shtml.
Where do I get information about 5010 certification testing?
You can get information about certification testing on medicaidalaska.com/hipaa_news.shtml#testing.
Eligibility Benefit Inquiry and Response (270/271)
Eligibility Verification System (EVS)
Did EVS change because of 5010 standards?
No, EVS did not change because of 5010 standards. It only impacts electronic claims.
Can I still use EVS to obtain eligibility information on recipients?
Yes, you can still use EVS to obtain eligibility information on recipients.
What is the maximum number of inquiries that I can request on a 270 Eligibility Benefit Inquiry?
The maximum number of inquiries you can request on a 270 Eligibility Benefit Inquiry is 99. If your inquiry exceeds 99 request, it will reject immediately. A 271 Eligibility Benefit Response will not be returned.
I do not have the recipient’s Alaska Medicaid ID, but I do have their name and other information. Can I still submit a 270 Eligibility Benefit Inquiry without a recipient’s Alaska Medicaid ID?
No, you cannot submit a request if you do not have the recipient’s Alaska Medicaid ID. You must enter the Recipient Medicaid ID in the appropriate field. You must also submit the following:
- Date of Birth
- Last Name
- First Name
What Medicare information does the 271 Eligibility Benefit Response return?
According to 5010 standards, a 271 Eligibility Benefit Response can only return Medicare coverage information – the Medicare type code (A, B, or D) and associated dates. HIC#s are no longer included in the 271 Eligibility Benefit Response.
See also 5010 Implementation, Resources.
Third Party Liability Information
Is Third Party Liability (TPL) information returned on the 271 Eligibility Benefit Response?
According to 5010 standards, a 271 Eligibility Benefit Response can only return limited Third Party Liability (TPL) information -- the name and associated dates. TPL policy coverage, identification numbers, and group numbers will no longer be included in the 271 Eligibility Benefit Response.
See also 5010 Implementation, Resources.
Why don’t I receive the 271 Eligibility Benefit Response immediately after I submit the 270 Eligibility Benefit Inquiry?
Because the 270 Eligibility Benefit Inquiry is not a real-time transaction, it cannot be processed and returned immediately. All 270 Eligibility Benefit Inquiries are gathered and processed at the same time during the nightly batch. You can only obtain immediate information if you use EVS.
When can I expect to receive a 271 Eligibility Benefit Response?
After the 270 Eligibility Benefit Inquiry is submitted, the turnaround time for a 271 Eligibility Benefit Response is one day, which means the 271 Eligibility Benefit Response will be available on the next day. For example, it does not matter if you submit the 270 Eligibility Benefit Inquiry on Monday at 11:59 p.m., the 271 Eligibility Benefit Response will be sent on Tuesday.
Claim Transaction (837P Professional, 837I Institutional, 837D Dental)
Is the transmission process for 5010 the same as 4010?
No, the transmission process has changed. You must use the instructions provided to you when you were notified about your certification to submit electronic claims in 5010 formats.
If you have problems with the transmission process, please contact the HIPAA Support Team for assistance.
Are paper claims impacted by 5010 standards?
No, paper claims are not impacted by 5010 standards. Only electronic claims are impacted.
Why do I have to submit a 9-digit zip code?
According to 5010 standards, you must enter a 9-digit zip code (zip +4) in the zip code fields for the claim to process. If you enter a 5-digit zip code, your claim will be rejected.
Where can I find the 9-digit zip code for an address?
You can find them at https://tools.usps.com/go/ZipLookupAction!input.action. When you enter an address, you will get the 9-digit zip code for that address.
If the +4 is not available for that location, you must enter four zeroes after the zip code.
How do I enter 9-digit zip codes in 5010 format?
You must enter a 9-digit zip code without dashes or spaces. You must not leave the zip code field blank or the claim will reject.
Do recipient addresses require a 9-digit zip code?
No, recipient addresses do not require a 9-digit zip code. Only the billing and rendering provider addresses must have a 9-digit zip code.
Why do I have to submit a physical address as my billing or servicing address?
According to 5010 standards, you must enter a physical address for the billing or servicing address. If you enter a P.O. Box, your claim will be rejected. Usually, your physical address is your street address.
Rejections occur if you enter any of the variations for a post office box:
- P. O. Box
- PO Box
- P O Box
- Post Office Box
Is a physical address the same as a street address?
Yes, a physical address is the same as a street address.
What if I do not have a street address?
If you do not have a street address, you may enter the local description, such as “the third building to the left of the big rock” or “the building on the north end of the lake next to the dock.”
How do I make sure RAs come to our P.O. Box and not our physical address?
The address where you receive your physical mail will not change unless you submit a Change of Information form. Completing this form allows you to update your mailing address in the Alaska Medical Assistance master file. The addresses you enter on claims do not affect where we send physical mail.
Once we receive this form, we will send it to the State for approval.
If I provided a service in a recipient’s home, what address do I submit in the service address field?
You must enter the place of business address, not the recipient’s home address.
Do recipient addresses require a physical address?
No, recipient addresses do not require a physical address. Only the billing and rendering provider addresses must have a physical address.
See also 5010 Implementation, Resources.
I have more than one NPI. How do I know which NPI to use?
According to 5010 standards, you must be consistent in your use of NPIs. The NPI you use may be either an organizational NPI or a subpart NPI. An organizational NPI identifies the business entity. A subpart NPI defines a specific line of business for the entity or a department within the organizational entity.
If you use a subpart NPI in billing, you must use it consistently for claims for the same services. When billing for the same service, you cannot use the organizational NPI for a claim one time and then use the subpart NPI another time.
I bill Medicaid with a different NPI than I do other carriers. Can I continue that?
No, you cannot bill Medicaid with a different NPI than you use for other carriers. 5010 standards require providers to use the same NPI for all payers.
For all HIPAA-covered entities, you must submit the NPI for the billing provider identifier along with the identification code qualifier XX.
I am a Sole Proprietor. What NPI do I use on electronic claims?
If you are a Sole Proprietor, you must use your individual NPI.
I am a Personal Care Provider, and I do not have an NPI. What do I do?
If you submit electronic claims using the 837P Professional Claim Transaction format, you must submit your Medicaid Provider Number (PCG####) with the qualifier G2 in the REF transaction segment. That qualifier tells the system that you are an atypical provider who does not need an NPI. For more information, you should refer to the Alaska 5010 Legacy 837P Companion Guide.
How do I change the NPI that is on my enrollment record?
You can change the NPI on your enrollment record by submitting a Change of Medicaid Provider Information form. Completing this form allows you to indicate the end-date of the old NPI and the start-date of the new NPI, its taxonomy, and its effective dates. Any changes to the NPI and taxonomy selections on your provider enrollment record must also be reflected on the claims you submit. If the NPI and taxonomy on the provider enrollment record do not match the NPI and taxonomy on your claim, the claim will deny. You can download the Medicaid Provider Change of Information form here. Providers can locate this form at medicaidalaska.com/providers/forms.shtml under the Providers/Forms tab.
Once we receive this form, we will send it to the State for approval. After your form receives approval, we will update your file.
See also 5010 Implementation, Resources.
Do I have to submit a taxonomy codes on electronic claims in 5010 format?
Yes, if you have a NPI you must submit a billing provider taxonomy code on your electronic claim. This code must be entered into the Billing Provider Specialty Information segment. The NPI and taxonomy entered on your electronic claim must match the NPI and taxonomy on your provider enrollment record or the claim will deny.
What identification qualifier for taxonomy codes do I enter?
You must also enter the new taxonomy qualifier PXC.
Why do I have to submit a diagnosis code?
According to 5010 standards, every professional or institutional claim you submit to Alaska Medical Assistance must contain at least one valid ICD-9 diagnosis code. If you do not submit a valid diagnosis code, your claim will reject.
I do not have access to a recipient’s medical records. What diagnosis code do I submit?
If you do not have access to a recipient’s medical records, you must submit either:
- The specific diagnosis code that accurately reflects the recipient’s medical condition
- A default diagnosis code from the table below
I am a provider type that does not have access to a recipient’s medical records, but I already submit a diagnosis code. Should I use one of the new default diagnosis codes or the diagnosis code I already submit?
If you know the recipient’s diagnosis and have a valid diagnosis code that is more accurate for the services you provide, continue to use that diagnosis code. The default codes are for providers who do not have access to a recipient’s specific diagnosis codes.
What are the default diagnosis codes?
The suggested default diagnosis codes are listed below. If you must submit a default diagnosis code, you must pick the ICD-9 code that matches the type of provider you are:
|Provider Type||Provider Description||ICD-9 Code*||ICD-9 Description|
|HC####||Home and Community Based Agency (HCB)||780.99||Other general symptoms||RL####||Residential Supported Living Arrangements||V60.6||Person living in residential institution||EM####||Environmental Modifications||V60.1||Inadequate housing||CMG####||Care Coordination||780.99||Other general symptoms||AC#### HM#### HO####||Pre-Maternal Home||V22.2||Pregnancy state, incidental||PCG####||Personal Care Agency||799.9||Other unknown and unspecified cause||SB####||School Based Services||780.99||Other general symptoms||TR#### TX#### AC#### HM#### HO####||Taxi Services and Hotel/Motel||V63.0||Residence remote from hospital or other health care facility||BR####||Behavioral Rehabilitation||V60.6||Person living in residential institution||MS####||Lifeline Waiver||780.99||Other general symptoms|
*Note: The ICD-9 diagnosis codes are entered without the decimal in Payerpath.
You can download a quick reference for diagnosis codes by clicking here.
I submit electronic claims using Payerpath. Where do I enter the diagnosis code?
If you submit electronic claims using Payerpath, you must enter the diagnosis code without the decimal point in the Diagnosis Code Segment (field 21).
Are there any changes to how I submit the CCAN number?
No, you bill the CCAN number as you did under 4010 standards. Current billing and business rules will continue to apply to 5010 standards as they did to 4010 standards.
I heard that 5010 standards accept a new value code of ME (milligrams) when billing for drugs administered in a physician’s office. Does Alaska Medical Assistance accept this new code?
No, Alaska Medical Assistance will not accept the code of ME for claims processing.
On claims submitted for drugs administered in a physician’s office, Alaska Medical Assistance accepts the following four codes:
- F2 = International Unit
- GR = Gram
- ML = Milliliter
- UN = Unit
Can I submit electronic claims with the new ICD-10 codes?
No, you cannot submit electronic claims with the new ICD-10 codes. Claims submitted with ICD-10 codes will reject until they go into effect, which is expected in October 2014. You should continue using the ICD-9 codes until further notice.
I am a transportation provider. What Place of Service (POS) codes do I submit?
According to 5010 standards, transportation providers must enter POS codes. The POS code you use depends on specific conditions.
Review the chart below to determine what POS code to submit based on the transportation you provide:
|Transportation Type||Transportation Description||POS Code|
|Ambulance||Air or Water||42|
|Other||Other Place of Service||99|
I heard that the 837I Institutional Claim Transaction requires a Present on Admission (POA) indicator. What is a POA indicator and what are the valid values?
A Present on Admission (POA) indicator communicates to the payer whether the associated diagnosis code was present when the patient was admitted to the facility. The POA is required on hospital admission for principal and other diagnosis codes.
There are four valid POA values for inpatient claims. They are:
|POA Value||POA Description|
|Y||Diagnosis present at time of inpatient admission|
|N||Diagnosis not present at time of inpatient admission|
|U||Documentation insufficient to determine if condition was present at the time of inpatient admission|
|W||Affirms that the hospital has determined that, based on data and clinical judgment, it is not possible to document when the onset of the condition occurred|
How do I report anesthesia minutes?
According to 5010 standards, you must report the anesthesia time as the total number of anesthesia minutes in the units field. For Alaska Medical Assistance, the single-line billing format is required.
My anesthesia charges were not paid correctly. Why?
Your anesthesia charges may not be paid correctly if you submit the number of anesthesia base unit values instead of the total number of anesthesia minutes. Alaska Medical Assistance calculates payment for anesthesia using a specific equation. For instance, if you submit 3 units instead of 30 minutes, you will be underpaid.
Remittance Advice (835)
Before 5010 implementation, I submitted my electronic claims without any problems. Now, they reject. Why?
Your electronic claims may reject for the following reasons:
- You may not be submitting electronic claims using 5010 formats.
- You may not have successfully completed certification testing.
- You may not have received notification from Xerox State Healthcare, LLC that you are certified to submit electronic claims.
- You may not have changed the code T (testing) in your header envelope to code P (production). The field where you make this change is ENV ISA15, the Interchange Usage Indicator.
- If you use Payerpath, you may not have updated the fields related to 5010 standards.
You may also want to check the error code in the 999 Acknowledgement. It provides information about why your electronic claim rejected.
I have pending claims that I submitted before January 1, 2012, but they have not processed. Do I need to rebill these claims?
No, you will not need to rebill these claims. The pending claims are already in our claims processing system. They are not affected by 5010 standards, which only apply to electronic claims you submit after December 31, 2011.
Can I receive electronic notification about claim status?
In the near future, you can receive electronic notification about claim status, but now you cannot.
835 Claim Payment Advice
Why do I not get information about pending claims in my 835 Claim Payment Advice?
According to 5010 standards, information about pending claims is no longer reported in 835 Claim Payment Advice. They only provide information on paid or denied claims.
What do the Payment Method codes in the 835 Claim Payment Advice mean?
Here is a list of the Payment Method codes that may appear in BPR01 and the codes’ definitions:
- H = No payment
- If you see an H, you will see NON in BPR04
- NON = Non-payment
- I = Check has been issued
- If you see an I, you will see CHK in BPR04
- CHK = Check
How do I know who is being paid?
The 835 Claim Payment Advice reports who is being paid. To find the payee information, look in field 1000B N1.
Acknowledgement Transaction (999, TA1)
I received a 999 Acknowledgement. What does this mean?
You receive a 999 Acknowledgement if your claim is successfully received. The 999 Acknowledgement gives you details about accepted, accepted with errors, and rejected claims.
What happened to the 997 Acknowledgement?
The 999 Acknowledgement replaced the 997 Acknowledgement.
I would like to get a list of all the new error codes on the 999 Acknowledgement. Where do I find that list?
You can find a list of new error codes on the 999 Acknowledgement by referring to the trainings that are posted at medicaidalaska.com/hipaa_news.shtml#training. Each of the 837 modules includes a slide that lists the error codes.
See also 5010 Implementation, Resources.
TA1 Interchange Acknowledgement
What is a TA1 Interchange Acknowledgement?
A TA1 Interchange Acknowledgement informs you about problems with your submission. A negative TA1 Interchange Acknowledgement means that the claim was received with an error.
Did Payerpath change because of 5010 standards?
Essentially, the answer is, "No." Payerpath still has the same look and feel, and it still allows you to access and navigate the menus just as you did before 5010 implementation. Payerpath did not change the:
- Navigation options
- Run and save edits
I heard there are new codes, qualifiers, and bigger fields in 837P Professional, 837I Institutional, and 837D Dental Claim Transactions because of 5010 standards. Do these changes apply to claims submitted via Payerpath?
Yes, according to 5010 standards, all changes to the 837P Professional, 837I Institutional, and 837D Dental Claim Transactions apply to Payerpath. These changes are necessary because Payerpath must meet HIPAA guidelines.
Where can I find information about changes in Payerpath and the new codes?
You can find a Payerpath training module with information about the new codes at medicaidalaska.com/hipaa_news.shtml#training. You can download and review this training at your convenience. Other trainings are also available.
I am going to enter a claim from scratch. Will it auto-populate 5010 values even if it auto-populated 4010 values before?
Yes, it will automatically use valid 5010 values. Payerpath will save these values, and you can use the Rebill Function for future claims.
My claim rejected due to a taxonomy code error. Why?
Your claim may have rejected if you did not enter a taxonomy code. Taxonomy codes are required in 5010 formats.
Your claim may also have rejected if you entered a taxonomy code that does not match what is on your Alaska Medical Assistance enrollment record. You must keep the codes on your claims and enrollment record in sync.
I need to enter new fields on Payerpath. How do I find these fields?
If you need to enter new fields on Payerpath, you must locate the fields at the line levels. To get to the line level fields, you must click the Electronic Fields link and search for the field in the segments.
What fields in Payerpath should I review before submitting a claim?
You should review the list of fields below and confirm that these fields are correct in Payerpath:
- Addresses – Change P.O. Boxes to street addresses or other physical locations
- Zip Codes – Add the +4 to make it a 9-digit zip code
- Diagnosis Code and Pointer – Enter the appropriate diagnosis codes and pointers
- Referring Providers – Enter an individual, not an entity
- Present on Admission Code – Only enter this code on Institutional electronic claims
- Place of Service Code – Only enter this code on Transportation electronic claims
Payerpath will not accept the diagnosis code I entered. Why?
Payerpath does not accept diagnosis codes if they have a decimal point. For it to accept your diagnosis code, you must enter the diagnosis code without the decimal point.
The Rebill Function does not work anymore. Why?
Actually, the Rebill Function does still work. Here’s some information to help you fix the problem:
The Rebill Function in Payerpath uses the last claim submitted for a recipient as the base for the new claim. If the last claim you submitted for the recipient was before January 1, 2012, then you submitted the claim under 4010 standards. If you used the Rebill Function after January 1, 2012 for the same recipient, the claim still follows 4010 standards. As a result, it attempts to process the claim using 4010 standards, not 5010 standards. The difference between the 4010 and 5010 standards causes the processing errors.
To fix your Rebill Function, you must review the specified recipient’s claim and ensure it meets 5010 standards before you submit it under 5010 standards. After you submit the claim successfully, it will match 5010 standards and the 5010 information will be saved on the recipient’s claim. The Rebill Function will work as it has in the past.
I have to re-enter data in Payerpath when I use the Rebill Function. Why?
Because of 5010 standards, you must update some values the first time you use the Rebill Function to submit a claim for a recipient. If you do not update these values, the claim will reject.
Do I always have to update fields to have the new 5010 values if I use the Rebill Function?
No, you do not always have to update fields to have the new 5010 values. You must only make these changes the first time you submit a claim for a recipient using the Rebill Function. Then, the information will be saved according to 5010 standards.
Patient Signature Source Error
Why do I get an error on the Patient Signature Source?
You may get an error on the Patient Signature Source because the value changed due to 5010 standards. Under 4010, the code was B. You enter the new 5010 code P or you leave the field blank. Claims containing the code B and any associated descriptive text in this field will receive an Invalid Code error.
You must correct the value for the claim to be accepted for processing. If you use the Rebill Function, you may need to change this value on the Electronic Fields screen.
I do not get the Patient Signature Source error on all the claims I submit. Why?
If you started new claims from scratch on or after January 1, 2012, Payerpath defaults the field to the correct 5010 code P. However, if you use the Rebill Function on a claim submitted prior to January 1, 2012, you must change this value on the Electronic Fields screen.
See also Payerpath, Rebill Function.
Primary Payer Facility ID Qualifier
Why do I get an error on the Primary Payer Facility ID qualifier?
You may get an error on the Primary Payer Facility ID qualifier because the qualifier has changed.
According to 5010 standards, the qualifier is G2. It is no longer 1D. Claims that have the qualifier 1D will receive an Invalid Code error.
You must change the qualifier from 1D to G2 for claims to process. If you are using the Rebill Function, you must change this value on the Electronic Fields screen.
Why don’t I get the Primary Payer Facility ID qualifier error on all of the claims I submit?
If you started new claims from scratch on or after January 1, 2012, Payerpath defaults the field to the correct 5010 value G2. However, if you use the Rebill Function on a claim submitted prior to January 1, 2012, you must change this value on the Electronic Fields screen.
See also Payerpath, Rebill Function.