Vendor Notices

subscriber Additional Identification Segment

Effective March 12, 2004: When returning a 271 transaction in response to a 270 request, the value returned in the Subscriber Additional Identification segment will be changed from the current value of 1W to a value of NQ.

REF 01 NQ Medicaid Recipient Identification Number

A Quick Note on Fractional Units of Service

Acceptable values for the units of service field on non-pharmacy claims are whole numbers that are greater than zero. Pharmacy claims billed in the NCPDP 5.1 format may include units billed in whole numbers or fractions as long as the amount is greater than zero.

Important Notice Regarding 837 Institutional Claims

Within the 837-I HIPAA transaction (Inpatient, Inpatient Crossover, Outpatient, Outpatient Crossover, Nursing Home, Nursing Home Crossover claims), up to 999 details may be sent for a single claim. At the time of HIPAA implementation, Alabama Medicaid will be unable to process an 837-I claim with more than 50 details. Until this is corrected and you are notified differently, only claims with 50 or less details will be accepted. All claims with more than 50 details will be rejected. This new business rule does not affect the 837-P and 837-D (Professional and Dental) HIPAA transactions, because these transactions are already limited to 50 details per claim by the HIPAA Implementation Guide.

Claim Status Notice

When checking Claim Status, Providers will see '19000101' displayed in the paid date field if a claim (s) has been adjudicated but has not gone through a check-write cycle. Once the claim (s) process through the check-write cycle, it will display the appropriate check-write date.

Vendors who wish to submit production claims to Alabama Medicaid and EDS must participate in vendor testing prior to being allowed to submit claims to Alabama Medicaid. Testing instructions are provided below for vendors to use when preparing to test with Alabama Medicaid.

Alabama Medicaid - Post-HIPAA Vendor Testing Instructions

Alabama Medicaid - InterChange Test File Processing Publication
for Vendors and Providers - 11/5/07  - Updated 12/12/07

The interChange Vendor Interface Specifications document is intended for vendors to use when developing applications to interact with the Alabama State Medicaid System. Processes to upload and download HIPAA compliant transaction batches via a secure Internet web site are described and sample code is provided within the document.

Click on the following link to download the interChange compliant Vendor Interface Specifications document:

AL_interChange_Vendor_Specifications-V2.0 - 12/24/08 version

 

Data Switch Agreement

Vendors who wish to gain access to the Alabama Medicaid Secure Web Site are required to complete a Data Switch Agreement. Please include the vendor name, address and contact information and FAX all completed agreements to the EMC Helpdesk at          (334) 215-4272.
 

Please Note: If you are submitting a new data switch agreement for the purpose of transmitting to the current Alabama Medicaid Interactive web site, please indicate this request on your fax cover sheet. Otherwise, your request will be processed for the interChange system.

Data Switch Agreement Form - Updated 9-1-07

The Alabama Medicaid Agency Interactive Services website allows providers to verify Alabama Medicaid member eligibility, claim status, and to upload and download claim files.

The Web User Guide provides the user with instructions on how to log on to the website, navigate the website, verify eligibility and claims status, upload and download files, seek assistance for technical issues, and logoff the website.

Click on the following link to access the Web User Guide:

Web User Guide-Updated 2-25-08

Companion Guides

Companion Guides for all transactions are available for download. The information in these guides are subject to change. Please refer to the version number and effective date located in the footer of each document for the latest information available.

Companion Guide updates related to the National Provider ID implementation are now available. Click here to view and download these documents. 

Companion Guide for 837 Crossover-Effective June 2004

Companion Guide For ANSI ASC X12N 270-Effective May 27, 2004

Companion Guide For ANSI ASC X12N 271-Effective September 17 2003

Companion Guide for ANSI ASC X12N 276-Effective July 21, 2005

Companion Guide for ANSI ASC X12N 277-Effective November 25, 2003

Companion Guide for ANSI X12N 278 (Outbound)-Effective September 17, 2003

Companion Guide For ANSI ASC X12N 278 (Inbound)-Effective July 21, 2005

Companion Guide for ANSI ASC X12N 820-Effective June 11, 2003

Companion Guide for ANSI ASC X12N 834-Effective September 17, 2003

Companion Guide for ANSI ASC X12N 835-Effective November 23, 2004

Companion Guide for ANSI ASC X12N 837 D-Effective May 18, 2005

Companion Guide for ANSI ASC X12N 837 I-Effective July 21, 2005

Companion Guide for ANSI ASC X12N 837 P-Effective July 21, 2005

Companion Guide for ANSI ASC X12N 277 Unsolicited-Effective September 17, 2003

Companion Guide for 837 Proprietary Batch-Effective May 20, 2005

The Functional Acknowledgment (997) Transaction-The 997 is used as the first response to receiving a transaction from a provider/vendor. The 997 informs the submitter that the transmission arrived. The 997 transaction layouts can be found in Appendix B of the implementation guides for each transaction. They are available electronically at  www.wpc-edi.com.

The Health Care Payer Unsolicited Claim Status Implementation Guide Version 1.0-The purpose of this implementation guide is to provide standardized data requirements and content for all users of the ANSI ASC X12.317, Health Care Claim Status Notification, referred to by its identifier 277.

Implementation Guide for ANSI ASC X12N 277 Unsolicited