• Requirements for business information related to transactions, such as:
• Provider name
• Address
• Requirements for business needs, such as:
• Present on admission conditions for institutional (837I) claims
• Introduction of future clinical data reporting standards for:
• International Classification of Diseases, Tenth Revision – Clinical Modification (ICD-10-CM) diagnosis codes
• International Classification of Diseases, Tenth Revision – Procedure Classification System (ICD-10-PCS) procedure codes
• Improved data for principal diagnosis, including:
• Admitting diagnosis
• External cause of injury
• Patient reason for visit codes
• Collection of statistical data, such as:
• Illness mortality rates
• Clinical reasons for care
• Length of hospital stays

Transaction format specifications are in the Technical Reports Type 3, also known as TR3s. Each transaction type has its own TR3. The TR3 guidelines are available from Washington Publishing Company.

• Provides information about diagnosis reporting requirements and how to use diagnosis pointers
• Addresses changes to the re-bill functionality
• Includes new requirements and codes for institutional, professional and transportation claims

Click here to download a quick reference.

For information about entering covered and non-covered days in Payerpath, click here.

If you would like more detailed information, you can find it in the Payerpath training module.

It includes improvements that focus on Medicare, but it also affects Medicaid. The implementation of D.0, provides better ways to identify patient responsibility, stages of benefits, and gaps in coverage on secondary claims. The D.0 transaction standard also helps facilitate claims that involve compounded drugs.

To download a document with information about D.0, click here.

To learn more about HIPAA, click on the questions below:

A submission agreement is an authorization to submit clinical and financial information directly to the State (i.e., the Alaska Medical Assistance Program) either electronically by you or through a billing service on your behalf.

If you are a provider who plans on submitting electronic information whether directly, indirectly, or through an outside resource (i.e. billing service, third-party biller, or clearinghouse), you must sign and submit the Provider Information Submission Agreement (PISA).

If you are a billing service, third-party biller, or clearinghouse that plans on submitting information in any form on behalf of a provider, you must sign and submit the Billing Agent Information Submission Agreement (BASA).

After you sign the submission agreement, send it to:

Xerox State Healthcare, LLC
HIPAA Support Team
P.O. Box 240808
Anchorage, Alaska 99524-0808

* Original signatures are required. Facsimile transmissions are not acceptable.

Once the BASA is submitted, you are assigned a submitter identification number, but that number is only given to your designated submitter. The designated submitter is a person, company, or organization that you authorize to bill the Alaska Medical Assistance Program on your behalf. For instance, if a provider is using a billing service, only the billing service receives the submitter identification number.

The submission agreements and the Companion Guides outline the requirements for testing and submitting electronic information to the Alaska Medical Assistance Program, including electronic HIPAA-compliant information. You should review the Companion Guides that are relevant to you. To see a list of Companion Guides and download them, click here and open the Companion Guides section.

Testing helps to ensure compliance with HIPAA requirements for both in-coming and out-going transactions in the data interchange.

Trading Partners

Trading partners include providers, billing services, clearinghouses, and third-party billers. If you are a trading partner that is new to submitting claims to the Alaska Medical Assistance Program, you must complete the following forms before you begin testing:

• The Provider Information Submission Agreement (PISA)
• The Billing Agent Information Submission Agreement (BASA)

For more information about submission agreements, click here.

Instructions

The Alaska Medicaid Program supports provider testing of 5010 X12 transactions through the use a free testing website sponsored by Edifecs, Inc. Edifecs validates Alaska Trading Partners’ syntactical compliance for 5010. By using the Edifecs 5010 transaction testing website, you can be certain that your 5010 transactions comply with the minimum X12 standards for 5010 transaction data format.

Trading partners may request a User ID and Password to access the Edifecs testing website by emailing AKHIPAASupport@acs-inc.com or by calling the toll-free number 855-226-9391.

This testing opportunity does NOT:

• Require new enrollment forms for current trading partners.
• Pertain to Pharmacy Providers. Pharmacy providers receive separate instructions regarding D.0 transaction testing.

For questions about transaction testing, please contact us using the email address or toll-free telephone number listed above.

Be sure to share this communication with your software vendors and clearinghouses and watch for future updates on this initiative in the Xerox Alaska Medicaid newsletters and on the Alaska Medical Assistance, Xerox State Healthcare website at http://medicaidalaska.com.

Click on the title of the Companion Guide to download the current version.

When you print the trainings, you will notice text below each slide which explains the information you see on the slide. This design makes these presentations handy reference guides for you.

Not Sure if You Need HIPAA Training?

Alaska Medicaid Provider Training has a flowchart to help you decide if and what classes you and your practice should take. Open the HIPAA 5010 Training Decision Flowchart to find the 5010 classes that are best for you.

Current Versions of Trainings

Click on the title of the training presentation to download the current version.

Diagnosis codes and pointers can be put on dental (ADA) claims, and sometimes they are required on dental (ADA) claims. Failure to include a diagnosis code causes your claim to reject.

The table below lists the suggested default diagnosis codes for providers who may not have access to information about a recipient’s medical condition. If you know the recipient’s diagnosis and have a valid diagnosis code that is more accurate for the services you are providing, continue to use that code. Otherwise, you may use one of the following:

*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.

Review the list below and click on the corresponding link.

For a basic overview of HIPAA (especially administrative simplification) including information on who is impacted by HIPAA and the reasoning behind HIPAA, refer to HIPAA 101 for Health Care Providers’ Offices.

HIPAA Agreements

For information regarding HIPAA agreements, including guidelines for determining trading partners and business associates, regulatory information, and a sample business associate contract, refer to HIPAA Agreements: Overview, Guidelines, and Samples.

HIPAA Terms

For a glossary of HIPAA-related terms and abbreviations, refer to HIPAA Glossary.

Privacy Resources

For information about the HIPAA privacy requirements, refer to HIPAA Privacy.

For a basic checklist to help you become compliant with the HIPAA Privacy Rule, refer to HIPAA Checklist: Activities to Making Health Information More Secure.

For a list of practical tips for keeping protected health information (PHI) private, refer to HIPAA Tips: Steps to Making Health Information More Secure.

For information about HIPAA privacy and security rules, refer to Security and Privacy Workgroup: Introduction.

Electronic Transactions

For information related to electronic transactions, refer to Transaction Workgroup White Papers.

For an overview of electronic transactions and code sets, refer to HIPAA 101 for Health Care Providers’ Offices.

For an explanation of covered entities and electronic transactions, refer to Are you a Covered Entity?

For current information on electronic billing and EDI transactions, refer to Electronic Billing and EDI Transactions

Additional Resources

For answers to frequently asked HIPAA questions, links to other HIPAA sites, and information on the law, regulations, and enforcement, refer to CMS HIPAA.

For notices on HIPAA, new tools, educational material, and related information, refer to the outreach listserve of the U.S. Department of Health and Human Services.

For the website of the federal agency overseeing HIPAA privacy requirements, refer to the Office for Civil Rights.

Once you subscribe, you are notified about HIPAA-related updates and information. Subscribing to the RSS feed makes keeping up with HIPAA-related information easier, but you may still want to return occasionally to the website and inspect it for new content. A variety of RSS Readers.

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Click on the RSS feed icon above to get started.

If you have additional questions on how HIPAA-related topics, please contact the HIPAA Support Team. You can call them at 907.644.6800, or 800.770.5650 (toll-free in Alaska). You can also email them at AKHIPAASupport@xerox.com.

The mailing address for HIPAA-related materials, forms, agreements, etc. is:

Xerox State Healthcare, LLC
HIPAA Support Team
P.O. Box 240808
Anchorage, Alaska 99524-0808