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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

219k

10/31/11

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

Arkansas Medicaid NCPDP D.0 Payer Sheet

NCPDP_D0_payer.doc

597k

4/3/14

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

737k

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

213k

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

271 Rejection Code Crosswalk (This document is a Microsoft Excel spreadsheet.)

271rej.xls

21k