Health Insurance Portability and Accountability Act (HIPAA) sets national standards for electronic health care transactions and for national identifiers for providers, health plans, and employers. The Department of Health and Human Services (HHS) oversees and enforces these standards. In Alaska, the Department of Health and Social Services (DHSS) implements them through the Alaska Medical Assistance Program.
These standards have specific HIPAA requirements, and compliance with HIPAA affects all providers, billing services, and clearinghouses that submit or receive transactions electronically with the Alaska Medical Assistance Program. For more information about the history of HIPAA and about complying with HIPAA, click here.
The Alaska Medical Assistance Program HIPAA webpages provide information to any entity that submits or receives transactions electronically with the Alaska Medical Assistance Program.
HIPAA News and Updates
The 5010 transaction standard introduces several improvements to the 4010 transaction standard, including:
- Requirements for business information related to transactions, such as:
- Provider name
- 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.
Payerpath accommodates the 5010 transaction standard. A quick reference identifies the major changes and lists new codes that you must use. In addition to summarizing general changes, this handy guide:
- 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.
The pharmacy standard for electronic transmissions comes from the National Council for Prescription Drug Programs (NCPDP) D.0. As a result, the standard is known as D.0.
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.
You may have questions about what HIPAA is, if it affects you, or how you become compliant. This section gives you the information you need to know to successfully submit or receive transactions electronically with the Alaska Medical Assistance Program.
To learn more about HIPAA, click on the questions below:
What is the Health Insurance Portability and Accountability Act (HIPAA)?
The Health Insurance Portability and Accountability Act (HIPAA) is a law enacted in 1996 that protects health insurance coverage and medical records for workers and their families. It applies to all insurance carriers, such as state Medicaid programs, including the Alaska Medical Assistance Program. A substantial portion of this law addresses "Administrative Simplification," which includes:
- EDI Transactions and Code Sets: Standardizing data content and format for electronic transactions
- Privacy: Protecting the privacy of confidential personal health care information
- Security: Securing physical access to records
- Identifiers: Developing identifiers for providers, employers, and health plans
To get additional information from CMS about HIPAA, click here and open the Toolkit section.
How are providers, clearinghouses, and billing services impacted by HIPAA?
HIPAA impacts providers, clearinghouses, and billing services in several ways. The value of complying with HIPAA greatly overshadows any challenges faced in implementing its requirements.
HIPAA standardizes the electronic transactions and claim forms required for a given type of service. For example, if you are billing for professional services, you use the 837P professional claim transaction electronic form or the CMS-1500 paper form.
HIPAA also requires that all providers, clearinghouses, and billing services meet minimum privacy requirements for protected health information (PHI). However, states and federal laws may expand on these minimum requirements. As a result, some states have stricter privacy requirements than the minimum defined by HIPAA. In these cases, states, providers, and insurance carriers may be required to meet additional, stricter privacy requirements.
There are many other aspects of HIPAA that impact one or more of the following groups: providers, clearinghouses, billing services, and insurance carriers. For example, if you are a provider of health care related services, HIPAA requires that you have a National Provider Identifier (NPI). An NPI is a unique number assigned to one provider that identifies that provider when communicating with or billing any insurance carrier.
For more information, please refer to the Toolkit. The Toolkit has more details about the components of Administrative Simplification.
The Alaska Medical Assistance Program requires providers, billing services, and clearinghouses to sign submission agreements.
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).
|Billing Agent Information Submission Agreement (BASA)||07/26/2007||Billing Agent Information Submission Agreement (BASA) Instructions||08/19/2009||Electronic Remittance (835) Authorization Form||02/03/2012||Provider Information Submission Agreement (PISA)||08/19/2009||Provider Information Submission Agreement (PISA) Instructions||08/19/2009|
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.
All trading partners must test each type of electronic transaction they plan to submit to the Alaska Medical Assistance Program (e.g., 837P, 837I, and 837D Health Care Claims).
Testing helps to ensure compliance with HIPAA requirements for both in-coming and out-going transactions in the data interchange.
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.
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.
Companion Guides supplement the Technical Reports Type 3 (TR3s). They provide information on specific code handling and situation handling that you must follow when submitting claims electronically for processing by the Alaska Medical Assistance Program.
Current Versions of Companion Guides
Click on the title of the Companion Guide to download the current version.
|Alaska 5010 Legacy 270-271 Companion Guide v2.03||03/28/2013||Alaska 5010 Legacy 835 Companion Guide v2.02||03/28/2013||Alaska 5010 Legacy 837P Companion Guide v2.03||02/14/2013||Alaska 5010 Legacy 837I Companion Guide v2.03||02/14/2013||Alaska 5010 Legacy 837D Companion Guide v2.03||02/14/2013|
Several 5010 courses were developed to help you and your office staff bill for services provided to Medicaid, Denali KidCare, and CAMA recipients. These courses were originally presented by webinar and are now available to print.
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.
Other helpful HIPAA documents are available. These documents can be easily printed and kept as references and guides for you and your office as you bill Alaska Medicaid.
|MMIS HIPAA Edit Crosswalk to CARCs and RARCs||03/18/2013||HIPAA 5010 Training Decision Flowchart||11/09/2011||Diagnosis Codes 5010 Quick Reference||01/12/2012||Payerpath Covered & Non-Covered Days Reference||02/07/2012||Tips for Payerpath 5010 Quick Reference||01/10/2012||Alaska Medicaid D.0 Payer Specification||04/04/2012||New Billing Provider Address Requirements for HIPAA 5010 Transactions||04/04/2012|
The 5010 transaction standard requires diagnosis codes and pointers on all professional (837P), institutional (837I), and transportation (837P atypical) claims.
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:
|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.
Frequently Asked Questions
Frequently Asked Questions (FAQs) about 5010 are compiled and organized. You can easily skim this document and find answers related to specific topics. Click here to go to the FAQs.
You may want to learn more about HIPAA. The information below connects you with sources that provide background, definitions, and other relevant information about HIPAA.
Review the list below and click on the corresponding link.
What is HIPAA?
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.
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.
For a glossary of HIPAA-related terms and abbreviations, refer to HIPAA Glossary.
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.
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
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.
Did you know that you can receive automatic notifications from the Alaska Medicaid HIPAA tab by subscribing to an RSS (Really Simple Syndication) feed? Our RSS feed gives you a quick and easy way to stay informed.
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.
Popular RSS feed readers include:
- Amphetadesk (Windows, Linux, Mac)
- FeedReader (Windows)
- NewsGator (Windows - integrates with Outlook)
Web-based RSS feed readers include:
Click on the RSS feed icon above to get started.
If you have additional questions on HIPAA-related topics, please contact the HIPAA Support Team at 907.644.6800, or 800.770.5650 (toll-free in Alaska).
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
This page, and all associated materials, was developed as an aid for Alaska Division of Health Care Services providers to understand the federal obligations imposed by the Health Insurance Portability and Accountability Act (HIPAA) and are for informational use only. Neither Xerox State Healthcare, LLC nor the State of Alaska can provide any legal advice or statement of law regarding providers' obligations under federal law. Xerox State Healthcare, LLC and the State of Alaska cannot warranty any information contained herein. As with any matter of law, independent legal counsel should be consulted regarding compliance with HIPAA.