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Dear Alaska Medicaid Behavioral Health Provider:
November 1st is tomorrow (can you believe it?) and we are excited to become fully integrated with the Medicaid Management Information System (MMIS). This has been a long road for all of us to get to this point and we appreciate your patience and collaboration throughout the process.
As we transition to the new Medicaid Management Information System (MMIS), the Division of Behavioral Health (DBH) wants to share details regarding key changes in processes that may differ from your current practices. DBH, Health Care Services (HCS), and our new fiscal agent, HMS/Gainwell, have been working diligently to understand these differences and their potential impacts on providers.
Below, we outline some specific changes related to claims adjustment requests for claims previously processed by Optum. We anticipate four potential categories for claim adjustment requests. Please note that this list is not exhaustive, and processes may evolve over time.
Claim Adjustment Request Categories
The claim to be adjusted was a…
Category 1 – Claim processed by Optum is in PAID status with DOS less than 1 year ago
- Provider must complete the AK05 Adjust/Void Request Form identifying the Optum claim to be voided. Instructions on how to complete this form are further down in this notice.
- The record of the Optum claim will be voided by HMS/Gainwell staff.
- Provider submits a new day claim into MMIS.
Category 2 – Claim processed by Optum is in DENIED status, and within timely filing
- Provider submits a new claim to MMIS.
Category 3 - Claim processed by Optum is in ANY status with DOS more than 1 year ago
- Due to timely filing rules, provider will need to work with DBH for claims review and reprocessing on a project-by-project basis. Contact DBH at mpassunit@alaska.gov using the subject line “BH MCD Claims Transition 2024 – Adjustment Request”.
Category 4 – Claim processed by the MMIS (not processed by Optum)
If the claim was submitted electronically or by web portal submission:
- Provider must indicate the new claim is an adjustment or a void of a previously processed claim.
- Provider needs to include the original Transaction Control Number (TCN) that is being adjusted.
- For web submitted claims through the MMIS system, please see the How to Submit a Professional Claim in Health Enterprise
If the claim was submitted via paper submission:
*Please note, it is the Provider’s responsibility to reconcile any unintentional overpayments as these claims are subject to audit.
MMIS Void Tips
When you are ready to void a claim, remember these tips:
- Faxed requests will not be accepted. Follow submission instructions on form.
- Providers must request to void a claim submitted with incorrect information, including but not limited to:
- Wrong Member ID number
- Wrong Medicaid Contract ID number
- Services not rendered
- Duplicate payments
- A void is a method used to reverse a previously fully adjudicated claim.
- Any claim with a status of P - paid, O – to be paid may be voided.
- Suspended and Denied claims cannot be voided.
If you have questions, please contact Provider Inquiry at 855-293-3568.
Provider Overpayment Options for Voided Claims
When a provider submits a void request, they can expect:
- Reversal of the original transaction;
- Removal of service and payment information from the provider and member history files;
- Require a refund back to Alaska Medicaid for the full claim amount; and
- Reduction in claims paid year-to-date dollar amount on Remittance Advice (RA) summary.
A void implies a prior overpayment and providers must identify the overpayment amount on the Adjustment/Void Request Form
Providers can choose one of two refund methods:
- Submit without a refund check and allow the money to be automatically deducted from a subsequent Alaska Medicaid payment(s).
- Send a check for the refund amount.
If a provider elects to send a check to refund the overpayment amount, the following must be included on the Adjustment/Void Request Form:
- Enter the refund amount in section 4 “Overpayment”
- Check the “Refund check attached” box
- Include the check number
- Make the check payable to the “State of Alaska”
- Check MUST be sent with the Adjustment/Void Request Form
Review Remittance (RA) Advice to Confirm Recoupment of Voided Claims
- Processed voids appear in a separate section of the RA.
- A voided claim will result in a provider overpayment; the amount listed in the RA should be reviewed for accuracy.
- Void Transaction Control Numbers (TCNs) will end in a 1.
Claims Void and Adjustment Training
HMS is ready to assist providers who have claims void and adjustment questions and/or concerns. You can find resources on the Alaska Medicaid website. Also, you can find the claims void adjustment training deck.
Behavioral health providers have a dedicated phone number to call HMS Gainwell at 855-293-3568 with any question.
As a reminder, please visit the Transition FAQ website for additional information.
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