HIPAA 5010 FAQs

This section provides answers to frequently asked questions (FAQs) about 5010. It is organized in broad categories to make it easier to find answers related to specific topics. Click on a heading in the sidebar to go directly to questions and answers on a particular subject.

General Information

Do you have a Companion Guide or are you following ANSI-TR3 guidelines?

Both the TR3 and Alaska Companion Guides contain information required to submit transactions using the 5010 formats. TR3s document the requirements common to all 5010 electronic transactions, regardless of the state or program. The Alaska Companion Guides contain Alaska Medicaid specific requirements and must be used in conjunction with the TR3 guidelines.

Where do I locate the Alaska Medicaid Companion Guides?

New Companion Guides are available on this website by clicking on the 5010 Companion Guides tab.

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Testing

The following FAQs only address syntactical testing issues at this time. Additional FAQs related to certification testing will be forthcoming.

Where is the test system and how do I access it?

The syntactical testing will be processed through our Edifecs testing environment which is located at: https://sites.edifecs.com/?medicaidalaska. However, you must apply for your new submitter ID and password before accessing the site. Request a User ID and Password to access the testing website either by email (AKHIPAASupport@acs-inc.com) or by calling the toll-free number (855) 226-9391 or the local Alaska number at (907) 644-6831.

I submit through a clearinghouse. Will I have to test for 5010?

All clearinghouses are responsible for their own transaction testing. If you process your transactions through a clearinghouse, you will not need to be set up for testing with Alaska Medicaid. Please contact your clearinghouse to ensure that they are taking the appropriate steps to become certified for 5010 transactions.

When can I start testing my 5010 transactions?

Now. You can test your 5010 file layout and syntactical edits at this time. Specific information regarding certification testing will be forthcoming.

Will files be tested on content or only on 5010 format?

The syntactical test will not take into consideration any data content necessary to process/adjudicate, etc. During this initial testing phase you will be testing for 5010 format only.

Data content will be taken into consideration during certification testing.

What transactions are available for testing?

The supported transaction types for Alaska Medical Assistance requiring testing are:

• ASC X12N 005010X222A1 Health Care Claim: Professional (837)
• ASC X12N 005010X223A2 Health Care Claim: Institutional (837)
• ASC X12N 005010X224A2 Health Care Claim: Dental (837)
• ASC X12N 005010X221A1 Health Care Payment and Remittance Advice (835)
• ASC X12N 005010X279A1 Health Care Eligibility Benefit Inquiry and Response (270/271)
• ASC X12N 005010X212 Health Care Claim Status Request and Response (276/277)

Where do I need to send the test?

For Syntactical testing, upon receipt of the email containing your new submitter ID and password, you may log into the testing website, https://sites.edifecs.com/?medicaidalaska and follow the instructions for submitting 5010 test transactions.

Is there a specific file naming convention?

There is no naming convention for syntactical testing.

What type of data is required (real time or test)?

For syntactical testing, you should de-identify all test files. It is recommended that you do not submit Protected Health Information (PHI) for syntactical testing.

Are there testing instructions anywhere for me to download?

The Edifecs testing system will provide step-by-step instructions on how to submit your test file and retrieve your Edifecs error report.

Am I already set up in your system to test?

You are not automatically set up in the test system. You must contact the AK HIPAA Support Team via email (AKHIPAASUPPORT@acs-inc.com) or by calling the toll free number (855) 226-9391 or the local Alaska number at (907) 644-6831 to request a submitter ID and password.

Do I have to schedule the test in advance?

When you have received your new submitter ID and password you can send the tests and pull the results at your convenience.

What is the next step after passing syntactical testing?

When you have passed syntactical testing, you will not need to do any further testing until the AK HIPAA Support team announces certification testing is available. Until that time however, you may want to review the companion guides to prepare for certification testing.

Can I test my 5010 NCPDP/Pharmacy claims now?

D.0 NCPDP/Pharmacy claims testing information will be forthcoming.

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