All trading partners must test each type of electronic transaction they plan to submit to Alaska Medical Assistance (e.g., 837 Health Care Claim). Testing will help ensure compliance with HIPAA requirements for both incoming and outgoing transactions in the data interchange.

All trading partners new to submitting claims to Alaska Medical Assistance must complete the following forms prior to testing:

• Provider Information Submission Agreement Form – Any provider that plans to submit HIPAA-compliant transactions directly to the Alaska Medical Assistance program will be required to complete this form prior to transaction testing.
• Billing Agent Information Submission Agreement Form – Any third party submitter (clearinghouse, billing service, etc.) that plans to submit HIPAA-compliant transactions to the Alaska Medical Assistance program will be required to complete this form prior to transaction testing.

For more information regarding submission agreements and/or testing procedures, please contact the HIPAA Provider Support Team at (907) 644-6800, Option 3, or (800) 770-5650 (toll-free in Alaska), Option 1, 4.

HIPAA 5010 Testing Begins for Alaska Medicaid Electronic Transactions

The Centers for Medicare and Medicaid Services (CMS) has adopted a new standard for the exchange of electronic health care transactions between trading partners. The current HIPAA 4010A1 electronic transaction standard is being replaced by a new standard, 5010.

Effective January 1, 2012, all HIPAA-covered entities, such as health plans, clearinghouses, and providers are required to conform to HIPAA 5010 standards, as set forth in the Health Insurance Portability and Accountability Act (HIPAA). The HIPAA X12N version 5010 and NCPDP version D.0 are defined by new sets of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims, and remittances. All providers who submit electronic transactions must comply with this new set of standards in order to facilitate proper reimbursement.

The date for implementation/compliance for the 5010 X12N transactions is January 1, 2012. Current information on 5010 can be obtained from the following CMS location: https://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp

The Alaska Medicaid Program is supporting early provider testing of 5010 X12 transactions through the use a free testing website sponsored by Edifecs, Inc. Edifecs has been set up for Alaska Trading Partner testing to validate syntactical compliance for 5010. Utilization of the Edifecs 5010 transaction testing website will enable providers to validate that their 5010 transactions comply with the minimum X12 standards for 5010 transaction data format.

This early testing opportunity will NOT validate Alaska-specific X12 data content requirements. Testing for end-to-end compliance with specific State data requirements will occur later and will be communicated to providers at the appropriate time. HIPAA 5010 does not require new enrollment forms for current trading partners.

Providers may request a User ID and Password to access the testing website, either by email at AKHIPAASupport@acs-inc.com, or by calling the toll free number (855) 226-9391. Once an ID and Password have been assigned, providers may log into the testing website, https://sites.edifecs.com/?medicaidalaska, and follow the instructions for submitting 5010 test transactions. Immediate feedback will be received regarding any format errors that are detected. The transactions can then be corrected and retested until they are error free.

For questions about early 5010 transaction testing on the Edifecs test site, please contact us using the email address or toll free telephone number listed above.

Please share this communication with your software vendors and clearinghouses. Watch for future updates on this initiative in the ACS Alaska Medicaid newsletter and on the ACS website at http://medicaidalaska.com.