Why is the Division of Behavioral Health (DBH) changing claims processing vendors?
DBH’s contract with its current Administrative Service Organization (ASO) vendor, doing business as Optum Alaska, expires on 12/31/2024. To streamline Department of Health (DOH) policies and procedures and offer providers a more efficient claims processing experience, DOH has chosen to reintegrate Behavioral Health Medicaid claims back into the state-owned Alaska Medicaid Management Information System (MMIS) instead of rebidding the contract to maintain a separate ASO.
Who is the new fiscal agent?
DOH partners with HMS Gainwell as the fiscal agent for MMIS Medicaid claims processing.
How will DBH keep providers informed?
DBH is using DOH’s GovDelivery subscription listserv to distribute transition update memos and communications via email and/or SMS text message. Complete the account setup prompts and navigate to the DBH section to subscribe to “DBH Communications”. GovDelivery subscriptions may be updated at any time on the Subscriber Preferences Page; questions and concerns about the subscription platform should be submitted to subscriberhelp.govdelivery.com.
Transition Communications Library:
Alaska Medicaid, in partnership with HMS Gainwell, also hosts monthly virtual town hall meetings. If you have previously registered to attend a Town Hall meeting, you do not need to do anything. Registration will be continuous unless an attendee contacts us to be removed from the invitation list. For anyone who has not previously attended, register by sending your name, agency affiliation and AK Medicaid Provider ID to Marilee.reinhartdavieau@gainwelltechnologies.com. Registered attendees will receive meeting invitations with web conference link access the day prior to the scheduled Town Hall.
What do providers need to do to prepare for the transition?
Start updating your clearinghouse or billing system now to ensure readiness for submitting claims to the MMIS. Review the Claims Processing FAQ information below and refer to the Alaska Enterprise 5010 837P Companion Guide to understand technical requirements.
Submit ongoing and outstanding claims to Optum timely PRIOR to your transition date to avoid delays and potential billing issues post-transition.
Visit this FAQ webpage for frequent updates.
Claims Processing
When can providers start billing Behavioral Health Medicaid claims to the MMIS?
Beginning October 1, 2024:
For the following provider types and specialties: Independent Psychologists, Licensed Clinical Social Workers (LCSW), Licensed Professional Counselor (LPC), and LMFT Licensed Marital and Family Therapist (LMFT)
New Claims (date of service October 1, 2024, or later): submit to MMIS
Old claims (date of service prior to October 1, 2024): submit to Optum
The last date to submit any Alaska Medicaid claims to Optum is October 31, 2024.
Beginning November 1, 2024: For all provider types and specialties, including those listed above, plus Autism, Mental Health Clinics, 1115 Waiver Services (1115), and State Plan Community Behavioral Health Service (CBHS).
All Claims (regardless of date of service): submit to MMIS
What Behavioral Health Medicaid claims dates of service are billable to the MMIS?
Claims processing must adhere to all established market rules during transition, including timely filing limitations. During transition, providers must make every effort to submit claims for payment to the appropriate claims processing vendor. Post-transition, providers may bill all unprocessed claims to the MMIS within 1-year of the date of service provision.
How will billing procedures be affected?
Beginning November 1, 2024, all claims that are currently billed through Optum must be billed through the MMIS. Beginning in October, HMS Gainwell will be ready to assist with billing questions. You can contact HMS Gainwell at 800-770-5650 (option 1,1) for provider inquiries.
General training resources and information on billing through the MMIS is available through the Alaska Medicaid Health Enterprise Provider Portal. DBH is working with HMS Gainwell on training schedules and topics with an expected rollout for provider registration in mid-August. Training schedules and registration links will be posted as they are available.
Will the transition cause delays in claims processing and payment particularly those billed through a clearinghouse?
No delays are expected; however, providers may notice a difference in submission response and reimbursement timelines once claims are processed in the MMIS.
In the MMIS, claims received by Monday 12pm AKT are batched for weekly adjudication, with final processing expected on Tuesday evening. Providers may view adjudication results on their RA documents by the following Wednesday. Depending on provider’s payment preferences, paper checks are mailed and electronic fund transfer (EFT) deposits are made on Fridays. System delays impacting these timelines will be communicated as soon as possible via RA messaging.
Providers experiencing delays should promptly contact HMS Gainwell at 800-770-5650 (option 1,1) for further assistance.
How will Optum transfer service authorizations to the MMIS?
Optum’s service authorization information will not be transferred to the MMIS. Service authorization requirements for all claims currently processed by Optum are suspended through June 30, 2025. On July 1, 2025, HMS Gainwell will absorb responsibility for service authorization management and will not use historical information in their process. Extracts of Optum’s historical authorization decisions will be retained by the Division for informational purposes only.
How will Optum transfer historically processed and transition timeline claims to the MMIS?
Transfer of Optum processed claims information to the MMIS has been ongoing throughout the contract DBH is coordinating development of comprehensive ASO systems extracts to support provider transition activities and allow DBH uninterrupted access to historical information for post-transition audit and claims review and adjustment.
Claims submitted to Optum on or before October 31, 2024, will be adjudicated for the final payment by Optum. Providers will receive claim decision information and payments from Optum as they do today.
Claims submitted to Optum on or after November 1, 2024, will be automatically denied and must be resubmitted by the provider to the MMIS. The following message will populate when such claims are denied:
Reason Code: 109 - Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
Remark Code: - Misrouted claim. See the payer’s claim submission instructions.
DBH is working with Optum to ensure claims submitted on or before October 31, 2024, are reconciled by December 31, 2024. Post-transition, HMS Gainwell will be able to work claims with prior dates of service in conjunction with DBH using historical claims data.
Where should paper claims be submitted during the transition?
For dates of service prior to November 1, 2024, paper claims should be submitted to Optum* no later than October 31, 2024, at the following address:
Optum Paper Claims Submission
Optum Behavioral Health
P.O. Box 30760
Salt Lake City, Utah 84130-0760
*Optum will no longer accept paper claims that are post-dated after November 30, 2024.
For date of service on or after November 1, 2024, paper claims should be submitted to HMS Gainwell at the following address:
Alaska Medicaid
P.O. Box 240769
Anchorage, Alaska 99524-0769
What clearinghouse directions are needed to connect with the MMIS?
Start updating your clearinghouse or billing system now to ensure readiness for MMIS claims submission. Review the directions below and refer to the Alaska Enterprise 5010 837P Companion Guide to understand technical requirements.
Alaska Medicaid Electronic claim submission and electronic payment information:
Electronic Remittance Advice (ERA)
Alaska Medicaid Payer ID: 77200
EDI Support
Local:
907.644.6800 (option 1, 3)
Toll Free:
800.770.5650 (option 1, 3)
AKHIPAASupport@Conduent.com
Payer ID 77200 is used in the following data elements: S03 group receiver ID; NM109 of the claim receiver loop M1*41 1000B; NM109 of the NM1*P4 payer loop 2010BB
Where should appeals be submitted during the transition?
On or before November 30, 2024,Optum Alaska will process all appeals for claims with date of service prior to November 1, 2024.
Optum Behavioral Health
Attn: 1st Level Appeals and Complaints
911 W. 8th Avenue, Suite 101
Anchorage, Alaska 99501
Fax: 855.508.9353
On or after December 1, 2024, appeals for all claims dates of service will be processed by AlaskaMedicaid/HMS
Provider Resources
When will training take place?
DBH is working with HMS Gainwell on training schedules and topics with an expected rollout for provider registration in mid-August.
Mark your calendars for the Behavioral Health transition Medicaid Town Hall Meeting on Monday, August 19th. Register by sending your name, agency affiliation and AK Medicaid Provider ID to Marilee.reinhartdavieau@gainwelltechnologies.com.
Will there be one-on-one training available?
DBH is working with HMS Gainwell on training schedules and topics with an expected rollout for provider registration in mid-August. Training schedules and registration links will be posted as they are available.
How do providers update their EFT information?
Mail documents to the following address:
Division of Behavioral Health/MPASS
3601 C Street, Ste. 878
Anchorage, AK. 99503
Where can providers view MMIS payment information?
Will providers be able to conduct claims testing in the MMIS?
No; DBH and the Division of Health Care Services are working closely to ensure robust testing of MMIS claims processing rules against the expected payment outcomes. At this time, providers should expect that all claim submissions are processed in a live, production environment. However, providers may send any suggestions for scenario testing for DBH consideration to mpassunit@alaska.gov.
*Last updated 7/26/2024