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Provider FAQ
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? 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.
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:
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:
Statuses include:
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:
To check member eligibility using Automated Voice Response (AVR):
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):
To check for any third-party liability using the Automated Voice Response (AVR):
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:
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.
How do I send a claim attachment?
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.
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:
To check claim status using the Automated Voice Response (AVR):
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.
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.
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:
To check for paid claims using the Automated Voice Response (AVR):
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:
To check the most recent RA issued using Automated Voice Response (AVR):
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.
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.
How do I review RA messages in Enterprise?
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:
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.
Other
How do I log in to my Health Enterprise account?
For Providers who have enrolled in Medicaid:
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:
Where do I find Provider Billing Manuals?
Provider manuals are available from the Alaska Medicaid Health Enterprise home page by selecting Provider > Provider Manuals.
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.
What is Automated Voice Response (AVR)?
The AVR replaces the former Eligibility Verification System (EVS). You may use the AVR system to:
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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