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Provider Enrollment

How do I enroll as a new provider or trading partner?

Can I start an application to enroll in Alaska Medicaid, save, and come back to it later?

Can I check my provider or trading partner application status?

 

Member Eligibility

How do I check member eligibility?

 

Claim Submission

How do I determine whether a member has any third-party resources?

How do I submit a claim in Health Enterprise?

How do I send a claim attachment?

How do I determine whether my claim was received by Health Enterprise?

Can I check claim status?

How long do I have to file a claim?

Is the history of a claim available to view in Health Enterprise?

 

Claim Payment

How do I check to see what claims have paid?

 

Remittance Advice, Adjustments, and Voids

Are remittance advices (RAs) available online?

How often are remittance advices (RAs) published?

Are electronic remittance advices (RAs) available in advance of when checks are submitted?

How do I review RA messages in Enterprise?

Can I correct and resubmit a claim that was previously denied?

 

Other

How do I log in to my Health Enterprise account?

What provider training is available and how do I register?

Where do I find Provider Billing Manuals?

My account is locked and I can't access Health Enterprise, how do I reset my password?

What is Automated Voice Response (AVR)?

 

 

Provider Enrollment

 

 

 

How do I enroll as a provider or trading partner?

 

 

From the Provider drop down menu, select Enrollment, then in the Become a Provider or Become a Trading Partner section, select Group Provider Enrollment, Individual Provider Enrollment, or Trading Partner Enrollment. Enrollment instructions are available on the Learning Management System at

 

https://manuals.medicaidalaska.com/docs/akmedicaidtraining.htm.

 

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Can I start an application to enroll in Alaska Medicaid, save, and come back to it later?

 

 

Yes, when you start an application you will receive an application tracking number (#) which will allow you to bring up your in-process application. You will also need the corresponding social security number (SSN) or your federal employer identification number (FEIN) to access your application.

 

 

To recall your application:

 

  1. Select Provider > Enrollment from the main menu bar.
  2. Locate the Recall Provider Application box on the right hand side.
  3. Fill out the required fields noted by an asterisk (*).

 

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Can I check my provider or trading partner application status?

 

 

If your application has been submitted through Health Enterprise, you can check the status anytime.

 

 

To check the status:

 

  1. Go to the Provider tab on the main menu bar and select Enrollment.
  2. Locate the Application Status box on the right hand side.
  3. Enter the Application Tracking Number indicated by an asterisk (*) and click Submit.

 

Statuses include:

 

  • Approved
  • Application Complete
  • Application Cancelled
  • Denied
  • Application is In Process
  • Application is Pending
  • Application not Complete

 

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Member Eligibility

 

 

 

How do I check member eligibility?

 

 

To check eligibility online, log in to Health Enterprise and from the main menu select Member > Check Eligibility. From there, you can check the eligibility for up to 10 members at a time using any combination of the following fields:

 

  • Member ID (any other fields are then optional and will be used to verify that the system finds the correct number)
  • SSN, First Name, and Last Name (any other fields are then optional and will be used to verify that the system finds the correct number)
  • Health Insurance Claim (HIC) Number, First Name, and Last Name (any other fields are then optional and will be used to verify that the system finds the correct number)
  • First Name, Last Name, and Date of Birth (any other fields are then optional and will be used to verify that the system finds the correct number)

 

To check member eligibility using Automated Voice Response (AVR):

 

  1. Log in to the AVR.
  2. Choose option 1 from the main menu for Member Eligibility.
  3. Enter search criteria when prompted. The system allows you to search member eligibility in two different ways:
    • Select 1 to search by Member ID.
    • Select 2 to search by Social Security Number (SSN) and Date of Birth (DOB).
  4. The AVR will return any results that match the search criteria.

 

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Claim Submission

 

 

How do I determine whether a member has any third-party resources?

 

 

Providers who bill Alaska Medicaid are required to bill all third party resources (except the Indian Health Service) prior to billing Alaska Medicaid.

 

 

To check for any third-party liability (TPL):

 

  1. Log in to Health Enterprise.
  2. Go to the Member tab and select Check Eligibility from the dropdown menu.
  3. Complete the request by entering the search criteria.
    • To inquire about a specific member's eligibility, enter any of the following combination of fields:
      • Member ID. If the member ID is entered, other fields are optional
      • SSN, First Name, and Last Name. Any of the other fields are optional
      • First Name, and Last Name. Any of the other fields are optional.
  4. Click Search. The system will display all members that match. An error message will display for any member that is not found.
  5. Click on the appropriate Member ID within the Search Results; TPL span information will display.

 

To check for any third-party liability using the Automated Voice Response (AVR):

 

  1. Log in to the AVR.
  2. Choose option 1 from the main menu for Member Eligibility.
  3. Enter member identification criteria when prompted.
  4. The AVR will ask you to enter the appropriate beginning and end dates of service to determine third-party liability.
    • The AVR only stores service date information for 18 months.
  5. After the AVR successfully determines eligibility, choose option 3 from the Member Eligibility Information Menu to request Medicare and Other Insurance Information. The AVR will return results for all third-party liability on file.

 

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How do I submit a claim in Health Enterprise?

 

 

Claims can be submitted via hardcopy, batch, and internet submission using Alaska Medicaid Health Enterprise. Online claim submission is available 24/7.

 

 

All electronic claims from HIPAA covered entities must be in the HIPAA compliant format. Electronic claims from HIPAA non-covered entities must be in the most recent National Standard format or in the HIPAA complaint format.

 

 

To file a claim online:

 

  1. Log in to Health Enterprise.
  2. Go to the Claims tab and then select Create Claims from the dropdown menu.
  3. Fill out all required information, noted by an asterisk (*).
  4. Save the claim for future submission or Submit the claim.

 

To become certified as a Trading Partner or to report an affiliation with a new Trading Partner, please contact the Alaska Medicaid EDI Helpdesk at 907.644.6800, option 3 or 800.770.5650, option 1, 4.

 

 

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How do I send a claim attachment?

 

 

  1. Log in to Health Enterprise.
  2. Go to the Claims tab and select Create Claims from the dropdown menu.
  3. Select the type of claim you want to submit and enter the required fields for claim submission.
  4. For the question "Does this claim have Attachments?" select yes.
  5. Click Add Attachment and select the appropriate valid value for the Type of Attachment and Attachment Transmission Code fields.
  6. Save the claim for future submission or submit the claim. The system saves the entry and provides an Attachment Control Number, visible under the Attachment Control # field.
  7. Depending on the valid selection for Attachment Transmission Code, mail or fax the attachment to the Fiscal Agent for processing with your claim.

 

 

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How do I determine whether my claim was received by Health Enterprise?

 

 

When a claim is submitted in Health Enterprise, the system immediately validates the data, runs it through all rules and edits, and adjudicates the claim. If you submit your claim online using the Health Enterprise Create Claims feature, you will receive instant confirmation that the claim was received, including indication of the assigned control number for the claim. Any errors are immediately apparent and can be more quickly identified and re-submitted.

 

 

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Can I check claim status?

 

 

To avoid erroneous duplicate billing, providers should keep up-to-date records of all claims by reading their remittance advice and routinely checking on the status of claims.

 

 

To check claim status online:

 

  1. Log in to Health Enterprise.
  2. Go to the Claims tab and then select Claims Status Inquiry from the dropdown menu.
  3. Enter Search criteria and click the Search button. At a minimum, either the Transaction Control Number (TCN) or Claim Service Period Date(s) must be entered.
    • You can enter information in any or all of the fields when performing a claim status inquiry:
      • Entering a TCN will return the exact matching claim.
      • Entering date and/or member information will return a list of claims matching the search criteria.
      • Entering a provider type or provider name will return a list of claims matching that provider.
    • If no claim service period end date is entered, the end date will be either today's date or one year forward from the begin date entered (whichever is less).
  4. A list of claims that match the search criteria will be displayed.
    • A maximum of 100 results will be returned. You can refine your search by entering additional search criteria.
  5. The status of each claim will display.
  6. Clicking on the TCN will display detailed information about the claim.

 

To check claim status using the Automated Voice Response (AVR):

 

  1. Log in to the AVR.
  2. Select 2 from the main menu to select Claim Status Inquiry and Response.
  3. Enter search criteria when prompted. The Claims Inquiry and Response allows you to search for a claim status in two different ways.
    • Select 1 to search by Member ID and Service Dates.
    • Select 2 to search by Transaction Control Number (TCN)
  4. The AVR will return any results that match the search criteria.

 

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How long do I have to file a claim?

 

 

Providers must submit a claim for reimbursement within one year of the date services were rendered.

 

 

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Is the history of a claim available to view in Health Enterprise?

 

 

Alaska Medicaid Health Enterprise allows a provider to view their payment history and associated remittance advice (RA) documentation. The RA provides the adjustment/void information. The web pages mimic a 276/277 claim status inquiry that may be used by the provider to view individual claim information.

 

 

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Claim Payment

 

 

 

How do I check to see what claims have paid?

 

 

If Health Enterprise validates the information on the claim and information successfully passes all edits and audits, Alaska Medical Assistance will pay on the claim and record the payment in the provider's weekly remittance advice (RA). You can also see all paid claims by performing a Payment Inquiry.

 

 

To check paid claims online:

 

  1. Log in to Health Enterprise.
  2. Select Payment Inquiry from the Claims dropdown menu.
  3. Enter Search criteria (begin and end dates) and click Search.
  4. A list of issued payments will display that showing the Date Paid, the Check/EFT number the reimbursement amount, and the RA number.
  5. Clicking on the RA number will display an image of the RA for the associated payment.

 

To check for paid claims using the Automated Voice Response (AVR):

 

  1. Log in to the AVR.
  2. Select 3 from the main menu to select Remittance Advice Inquiry and Response.
  3. The AVR will return the results for the most recent remittance advice issued, including:
    • The Alaska Medicaid Provider ID
    • The Payment Date
    • The Total Remittance Amount
    • The Total Number of Claims Paid
    • The Total Number of Claims Denied

 

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Remittance Advice, Adjustments, and Voids

 

 

Are remittance advices (RAs) available online?

 

 

Yes, weekly remittance advices (RAs) are accessible in Health Enterprise.

 

 

To view an RA online:

 

  1. Log in to Health Enterprise.
  2. Go to the Claims tab and select Claims Inquiry from the dropdown menu.
  3. Enter Search criteria (begin and end dates) and click Search.
  4. A list of payments that have been issued will display that shows the Date Paid, the Check/EFT number, the reimbursement amount, and the RA number.
  5. Clicking on the RA number will display an image of the RA for associated payment.

 

To check the most recent RA issued using Automated Voice Response (AVR):

 

  1. Log in to the AVR.
  2. Select 3 from the main menu to select Remittance Advice Inquiry and Response.
  3. The AVR will return the results for the most recent remittance advice issued, including:
    • The Payment Date
    • The Total Remittance Amount
    • The Total Number of Claims Paid
    • The Total Number of Claims Denied

 

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How often are remittance advices (RAs) published?

 

 

RAs are produced weekly immediately following the weekly payment cycle. Following the weekly payment cycle, providers may view their RAs online.

 

 

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Are electronic remittance advices (RAs) available in advance of when checks are submitted?

 

 

Yes, Conduent State Healthcare, LLC (Conduent) processes a payment cycle weekly and performs a daily adjudication cycle. After each daily adjudication cycle, providers may view their adjudicated claims online. The RAs are produced weekly immediately following the weekly payment cycle. RAs are also available for viewing online following the weekly payment cycle.

 

 

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How do I review RA messages in Enterprise?

 

 

  1. Log in to Health Enterprise.
  2. The provider inbox appears on the home page.
  3. Click on the RA message file to open it.

 

 

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Can I correct and resubmit a claim that was previously denied?

 

 

Providers and other authorized users can adjust and void previously processed claims and see the on-line claim adjudication results immediately in Health Enterprise. Timely filing rules apply for all claims, including adjustments.

 

 

To submit an adjustment or void:

 

  1. Log in to Health Enterprise.
  2. Go to the Claims tab and then select Create Claims from the dropdown menu.
  3. Select the Create Claim From Processed Claim option.
  4. Enter the corrected claim information, be sure to select Yes for the prompt "Is this a void/replacement of a previously processed claim?"
  5. Correct the claim using the electronic form, and submit or save the claim.

 

Enterprise will process the adjustment/void and display the anticipated outcome. If there is a problem, the system will display a reason code, allow a provider to make necessary corrections, and resubmit the adjustment/void.

 

 

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Other

 

 

How do I log in to my Health Enterprise account?

 

 

For Providers who have enrolled in Medicaid:

 

  1. From the Sign in portlet on the Home page, select Providers.
  2. Enter your User ID and Password in the Login box on the right hand side.
  3. Check the box indicating you have read and agree to the terms of use and Privacy Policy.
  4. Select Login.

 

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What provider training is available and how do I register?

 

 

Online training is available through the Learning Managament System (LMS) at

 

https://manuals.medicaidalaska.com/docs/akmedicaidtraining.htm. The LMS offers:

  • Web-based courses
  • Computer-based training
  • Online tutorials
  • Job aids

 

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Where do I find Provider Billing Manuals?

 

 

Provider manuals are available from the Alaska Medicaid Health Enterprise home page by selecting Provider > Provider Manuals.

 

 

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My account is locked and I can't access Health Enterprise, how do I reset my password?

 

 

If you work in a provider office, contact your Organization Administrator, who can reset or change your password through the administration account.

 

If you are the Organization Administrator and you have been locked out of your account, call the Conduent Provider Inquiry Unit for assistance at 907.644.6800, option 1, or 800.770.5650, option 1, 1.

 

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What is Automated Voice Response (AVR)?

 

 

The AVR replaces the former Eligibility Verification System (EVS). You may use the AVR system to:

 

  • Check member eligibility.
  • Check claim status.
  • Check the most recent remittance advice summary.
  • Check the status of service authorization requests.

 

To access the AVR, call 855.329.8986 and input your Medicaid Provider ID and AVR PIN number. You should receive your AVR PIN number when you complete re-enrollment and may reset the PIN after your initial login.

 

 

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