The Alaska Medical Assistance Program has implemented new information submission agreements.

Providers, billing agents, clearing houses, and other entities will be required to sign new agreements as outlined below. The new agreements replace the Electronic Media Agreements.

Specifically, Alaska Medical Assistance requires:

• the Provider Information Submission Agreement be completed by any provider that plans on submitting either electronic information, including claims, directly or any information, including claims, through an outside resource (i.e. billing service, third party biller, or clearinghouse).
• the Billing Agent Information Submission Agreement be completed by any billing service, third party biller, or clearinghouse that plans on submitting information in any form on behalf of a provider.

After the agreement(s) have been completed each provider/billing agent will receive a new submitter identification number. This number will only be given to the designated submitter (i.e. if a provider is using a billing service only the billing service will receive the new submitter ID number).

The agreements and the Trading Partner Companion Guide outline the requirements for testing and submitting electronic information to Alaska Medical Assistance including electronic HIPAA-compliant information. If you plan to submit HIPAA-compliant electronic information to Alaska Medical Assistance, you should review the Trading Partner Companion Guide. This guide provides transaction-specific requirements, as well as information on how to submit electronic information to the Medicaid Management Information System (MMIS), the claims processing system for Alaska Medical Assistance.

Completed agreements should be returned to the following:

Affiliated Computer Services, Inc.
HIPAA Provider Support Team
P.O. Box 240808
Anchorage, Alaska 99524-0808

Please note that original signatures are required. Facsimile transmissions are not acceptable. If you have additional questions on how to properly complete an agreement, please contact the HIPAA Provider Support Team at (907) 644-6800, Option 3, or (800) 770-5650 (toll-free in Alaska), Option 1, 4.

Title	Last Modified
Billing Agent Information Submission Agreement	07/26/2007
Billing Agent Information Submission Agreement Instructions	08/19/2009
Electronic Remittance (835) Authorization Form	11/03/2008
Provider Information Submission Agreement	08/19/2009
Provider Information Submission Agreement Instructions	08/19/2009