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Documents for vendors

Documents for Vendors

Companion Guides

The following documents are companion guides to the National Electronic Data Interchange Transaction Set Implementation Guides, ASC X12N. They are intended for vendors that design software or systems for submitting health care transactions electronically to Arkansas Medicaid. These documents supplement but do not supersede requirements outlined in the ASC X12N implementation guides.

The Health Insurance Portability and Accountability Act (HIPAA) requires Arkansas Medicaid and other covered entities to comply with the electronic data interchange standards for health care as established by the Secretary of Health and Human Services. The ASC X12N implementation guides were established as the standards of compliance. These companion guides provide the supplemental requirements specific to Arkansas Medicaid, as permitted within the transaction sets. The transactions described in these guides are compliant with ACA 1104 standards.

To develop and test a system for Arkansas Medicaid transactions, follow both the applicable implementation guide and its companion guide.

Companion guide files are in Microsoft Word format. If you click a link but the document doesn't open, download Microsoft Word Viewer free so you can view and print the documents.

  • To view, click the link to the guide. The document opens in a new window. To return to this page, close the window.
  • To print, click the link to the guide. The document opens in a new window. Use the menu of that window to print (click File, then Print).
  • To save a copy to your computer, right-click the link to the guide and then save the file to your hard disk.

Transaction Version File Name File Size Last Update
270-271 Eligibility 5010/D.0 270-271.doc 430k 9/4/13
276-277 Claim Status 5010/D.0 276-277.doc 206k 10/31/11
278 Prior Authorization 5010/D.0 278.doc 204k 11/15/11
Benefit Enrollment and Maintenance Request and Response 5010/D.0 834.doc 151k 9/23/13
835 Payment/Advice 5010/D.0 835.doc 221k 3/12/15
837 Dental 5010/D.0 837d.doc 167k 10/31/11
837 Professional 5010/D.0 837p.doc 340k 12/20/13
837 Institutional 5010/D.0 837i.doc 373k 12/27/13
NCPDP Payer Sheet for Claims Submitted
Before 3/14/15
Arkansas Medicaid NCPDP D.0 Payer Sheet (HP) NCPDP_D0_payer.doc 596k 11/18/14
NCPDP Payer Sheet for Claims Submitted
On and After 3/14/15
Arkansas Medicaid NCPDP D.0 Payer Sheet (Magellan) NCPDP_D0_Payer_Spec.doc 725k 2/4/15
AR BreastCare 5010/D.0 arbrstcr.doc 161k 10/31/11

HIPAA Testing for Submitters

The following document is essential for vendors who are preparing to test HIPAA-compliant transactions. 

Document File Name File Size
HIPAA Testing for Submitters htest.doc 147k

Optional Transactions

The following transactions, while not all required by HIPAA, can provide valuable information to your providers:

Document File Name File Size
Census Report Data Requirements (for Long Term Care)
Contains the record layout used to submit census data. LTC facilities are required to submit census data on their patients.
ltcdata.doc 176k
Census Report Accepted Response Format (for Long Term Care)
Contains the record layout for the census report accepted response. Vendors will receive this response if census data was submitted successfully.
ltcaccept.doc 98k
Census Report Rejected Response Format (for Long Term Care)
Contains the record layout for the census report rejected response. Vendors will receive this response if census data was unsuccessfully submitted. For error codes and descriptions, see "Other vendor resources."
ltcreject.doc 100k
Supplemental Data for Rejected Transactions and Error Codes
Contains the record layout for a supplemental rejection transaction. Vendors will receive this response in addition to a 277 transaction when a claim is rejected. This supplemental response provides Arkansas Medicaid specific codes and error descriptions that, coupled with the 277 response, can be useful in determining the root cause of the claim rejection.
tandrej.doc 739k
Supplemental Eligibility Response and Error Codes
Contains the record layout for a supplemental eligibility response. Vendors will receive this response in addition to a 271 transaction when a batch of 270 transactions is submitted. This supplemental response provides additional eligibility information not supported within the 271 transaction.
elig.doc 218k

Other Vendor Resources

The following documents contain additional information that may be useful to vendors:

Document File Name File Size
Application to Request Access to the Arkansas Medicaid Database DMS-0812.pdf 640k
Web Batch Submission Instructions bbs.doc 915k
Census Report Error Codes and Description (for Long Term Care) ltcerror.doc 44k
HIPAA X12 Transactions Supported by Arkansas Medicaid x12tran.doc 53k
Miscellaneous Error Codes miscerror.doc 40k
Unique IDs Required by SeeBeyond Software sbid.doc 42k
X12 General Requirements and Special Processing x12gen.doc 35k
Third Party Liability Major Coverage Codes tplcodes.doc 62k
Third-Party Liability Unit Contact Information DMSTPL.doc 31k
271 Rejection Code Crosswalk (This document is a Microsoft Excel spreadsheet.) 271rej.xls 21k