Medicaid Alaska
- ► Alaska Medicaid Home Health (HH), UB-04 Hardcopy
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Alaska Home Health is a regular fee-for-service claim.
Adhere to the following specific Alaska Medicaid Home Health (HH), UB-04 Hardcopy rules:
- Complete all required areas of the UB-04 claim form.
- Print legibly using black ink or use a typewriter.
- Use only the original UB-04 claim forms with the red drop-out ink or file electronically.
- When using a printer, make sure the form is lined up correctly to facilitate electronic scanning.
In Administration>Financial>Insurance Codes>General, define the following items:
- Type – K (Medicaid)
- Mode – R (Regular)
- State – AK (Alaska)
- Form – UB-04
- Authorized Signature – This field can be completed because Alaska accepts typed signatures.
- Separate service codes and billing rates are defined for each type of service that can be provided. Refer to the Alaska Medicaid Provider Handbook for the appropriate Revenue Codes and HCPCS Codes to be billed under this program
In Administration>Financial>Insurance Codes>NPI, define the following items:
- In the IDs to include in Paper Claims section, select Legacy IDs and National Provider IDs (NPI).
- In the IDs to include in EMC files section, select National Provider IDs (NPI).
n Administration>Financial>Insurance Codes>Print Variations, define the following items:
- In the Specialized Formats section, make no selection.
- In the Printer section, select the appropriate printer.
The following fields or areas in the application may be required:
- HCPCS Codes - The required HCPCS codes should be defined in Administration>Financial>Billing Rates>Rates.
- Provider ID - The provider ID assigned by the state to the attending physician should be entered in the License Number field in Resource>General>Roles. This ID prints in FL 76 on the claims.
- Group Name - For FL 61, enter the name of the group or plan providing the insurance to the insured in the Coverage Description field in Administration>Financial>Insurance Companies.
The following setup is required for Alaska Medicaid Home Health (HH), UB-04 Hardcopy.
Locator
Locator Name
Setup
FL 4
Type of Bill
To indicate the 4-digit type of bill, enter 0 in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
FL 8a
Patient Name
Select the Print Insurance ID print variation.
FL 12
Admission Date
Select the Print Admit Date from Admissions & Status screen as of the claim from date print variation.
FL 14
Admission Type
Select the Print '3' or '1' Admission Type/Src print variation. Use 1 for an Emergency.
FL 18-28
Condition Codes
If your agency reports condition codes, enter them in Patient>General>Claim Constants.
- ML indicates that the patient is in a nursing home.
- A1 indicates that the claim is EPSDT related.
- A4 indicates family planning.
FL 29
Accident State
If occurrence codes 01-05 are used, enter the two-character accident state in Patient>General>Claim Constants. This field is required for motor vehicle related accidents.
FL 31ab–34ab
Occurrence Codes
If your agency reports occurrence codes, enter them in Patient>General>Claim Constants.
FL 35ab–36ab
Occurrence Span Codes
If your agency reports occurrence span codes, enter them in Patient>General>Claim Constants.
FL 39 -41
Value Codes Amounts
Select the Suppress Printing Value Code '44' print variation.
Enter the code and the total charge amount of the claim for value codes in Patient>General>Claim Constants.Enter the applicable number of covered and non-covered days; for LTC billers, enter the patient liability for the month of service billed.
- A1 – Deductible Payer A (B1, C1, and others)
- A2 – Coinsurance and/or Co-Payment Payer A (B2, C2, and others)
- 66 – Medicaid Spend Down amount
- A7 – Co-Payment Payer A (B1, C1, and others)
- 34 – LTC patient liability amount.
- 80 – Covered Days
- 81 – Non-Covered Days
- 82 – Coinsurance Days
- 83 – Lifetime Reserve Days
FL 42
Revenue Code
Enter the appropriate 4-digit revenue codes for the insurance in the Revenue Code field in Administration>Financial>Billing Rates>Rates. Ensure that 0001 is entered into the Total Revenue section.
FL 43
Revenue Description
Select the Print 'Page 1 of 1' on line 23 of single-page claim print variation.
FL 44
HCPCS / Rate/ HIPPS Code
To report HCPCS codes, enter them in Administration>Financial>Billing Rates>Rates. Also, include any modifiers in positions 6–7, 8–9, and 10–11 of the HCPCS code field.
FL 57
NPI or Provider ID
Select the Print agency's Provider ID without Qualifier print variation.
FL 59
Patient's Relationship to Insured
Select the Print NUBC Relationship Codes effective as of 10/16/03 print variation.
FL 60
Insured's Unique Identification
Select the Only print value for current claim payer line print variation.
FL 64
Document Control Number
Enter the ICN for the replacement claim in Patient>General>Claim Constants.
FL 69
Admit Diagnosis
Select the Print the patient's diagnosis code as of the patient's admission date print variation.
FL 76
Attending Physician's License Number
Enter the two-digit qualifier of 1G for the Attending in Patient>General>Claim Constants.
FL 77
Operating Physician Name and Identifiers
Select the Print secondary physician's information with NPI, Other Phys No and 1D Qualifier print variation.
FL 78
Other Provider Name and Identifiers
Select the Print referring physician's information with NPI print variation.
FL 79
Other Provider Name and Identifiers
Select the Print referring physician's information with NPI print variation.
FL 80
Remarks
To report remarks, enter them in Patient>General>Claim Constants.
Note: Alaska Medicaid uses this field to report overflow field for additional codes that do not fit into other fields.
- ► Alaska Medicaid Home Health (HH), 837I 4010A1 Electronic
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The following fields in the application are required for Alaska Medicaid Home Health (HH), 837I 4010A1 Electronic.
- ► Alaska Medicaid Home Health (HH), 837I 5010A2 Electronic
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For Alaska Medicaid Home Health (HH), 837I 5010A2 Electronic, define the following items:
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In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14–15 to ensure the ANSI 5010 Billing Template compliance.
Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
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Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA.
The following fields in the application are required for Alaska Medicaid Home Health (HH), 837I 5010A2 Electronic.
- ► Alaska Medicaid Hospice (HO), UB-04 Hardcopy
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Alaska Medicaid Hospice is a benefit claim. Adhere to the following specific Alaska Medicaid Hospice (HO), UB-04 Hardcopy rules:
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Use only original UB-04 claim forms with the red drop-out ink or file electronically.
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When using a printer, make sure the form is lined up correctly to facilitate electronic scanning.
In Administration>Financial>Insurance Codes>General, define the following items:
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Authorized Signature – This field can be completed because Alaska accepts typed signatures.
In Administration>Financial>Insurance Codes>NPI, define the following items:
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In the IDs to include in Paper Claims section, select the Legacy IDs and National Provider IDs (NPI) check box.
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In the IDs to include in EMC files section, select the National Provider IDs (NPI) check box.
In Administration>Financial>Insurance Codes>Per Diem, define the following items:
In Administration>Financial>Insurance Codes>Print Variations, define the following items:
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The following fields or areas in the application may be required.
In Administration>Financial>Insurance Codes>Print Variations, define the following items for Alaska Medicaid Hospice (HO), UB-04 Hardcopy.
- ► Alaska Medicaid Personal Care Agency, 837P 4010A1 Electronic
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The following fields in the application are required for Alaska Medicaid Personal Care Agency, 837P 4010A1 Electronic.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
For FL 50, enter payer ID codes as required by Alaska Medicaid in Administration>Financial>Insurance Codes>Carrier Codes.
Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes and/or Administration>Financial>Insurance Company.
The Medicare assignment code is currently set to A (Assigned) by default. If any other code is selected in the Medicare Assign field in Patient>General>Payers>Pay Source>HIPAA, the value of C (Not Assigned) will print to the claim file.
If the Rel Infor (Release of Information) field is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500, Block 12/13 on file).
This field is located in Patient>General>Payers>Pay Source>HIPAA.
In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem.
Enter AKMEDICAID FHSC into the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
For the patient's referral source (defined in the Referral field in Patient>General>Admissions & Status), enter either the federal tax ID or Social Security Number in Resource>General>Roles according to the HIPAA requirements.
Enter the submitter ID assigned by Alaska Medicaid in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
Certain Alaska Medicaid claims require supporting documentation that must be faxed to Alaska Medicaid as an "attachment" to the claim. Electronic claims require the provider generated attachment number to be included in the file; therefore, you must generate a unique attachment control number, place it on the fax and in Claims>Process>Annotate Claims in Allscripts Homecare.
To enter the attachment control number in Allscripts Homecare, perform the following actions:
1. Go to Claims>Process>Annotate Claims.
2. In the Select Billing Cycle window, select the appropriate open billing cycle.
4. Highlight the appropriate claim to annotate.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
In Administration>Financial>Insurance Codes>Print Variations, select the following print variations.
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All other locators are standard.
- ► Alaska Medicaid Personal Care Agency, 837P 5010A1 Electronic
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The following fields in the application are required for Alaska Medicaid Personal Care Agency, 837P 5010A1 Electronic.
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable.
Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes and/or Administration>Financial>Insurance Company.
The Medicare assignment code is currently set to A (Assigned) by default. If any other code is selected in the Medicare Assign field in Patient>General>Payers>Pay Source>HIPAA, the value of C (Not Assigned) will print to the claim file.
If the Rel Infor (Release of Information) field is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500, Block 12/13 on file).
This field is located in Patient>General>Payers>Pay Source>HIPAA.
Enter 100000 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC.
Enter 77200 in the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC.
Enter AK MEDICAID in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC.
For the patient's referral source (defined in the Referral field in Patient>General>Admissions & Status), enter either the federal tax ID or Social Security Number in Resource>General>Roles according to the HIPAA requirements.
Enter the submitter ID assigned by Alaska Medicaid in the Submitter ID field in Administration>Financial>Insurance Codes>EMC.
Certain Alaska Medicaid claims require supporting documentation that must be faxed to Alaska Medicaid as an "attachment" to the claim. Electronic claims require the provider generated attachment number to be included in the file; therefore, you must generate a unique attachment control number, place it on the fax and in Claims>Process>Annotate Claims in Allscripts Homecare.
To enter the attachment control number in Allscripts Homecare:
1. Go to Claims>Process>Annotate Claims.
2. In the Select Billing Cycle window, select the appropriate open billing cycle.
4. Select the appropriate claim to annotate.
5. In the PWK Segment section, in the Attachment Number field, enter the unique ID number to identify the attachment.
For the document type, define OZ – Support Data for Claim and set FX – By Fax as the transmission method.
Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent.
In Administration>Financial>Insurance Codes>Print Variations, select the following print variations.
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All other locators are standard.