Arkansas MedicaidHIPAA X12 transactions supported by Arkansas Medicaid

HIPAA X12 transactions supported by Arkansas Medicaid

Transaction / HIPAA transaction format / Version/Implementation Guide / Mode / Use / Frequency
Eligibility request and response / ASC X12N 270/271 / 005010X279A1 / Batch
Interactive / The 270 is used to request eligibility information in either batch or interactive mode.
When used interactively, the transaction must contain only a single request for eligibility.
The 271 is used to return eligibility information. / On demand.
Claim status request and response / ASC X12N 276/277 / 005010X212 / Batch / The 276 is used to request status of a claim.
The 277 Claim Status Response will be used three different ways:
Response to a 276 claim status request
Response to an 837 claim
Weekly list of pended claims / Request: on demand.
Response to claim status request: on demand.
Claim response: generated in response to a claim file.
Pended claims: generated weekly by MMIS.
Prior authorization request and response / ASC X12N 278 / 005010X217 / Batch / Used to submit requests for prior authorization and receive approved/denied prior authorization responses. / Request: on demand.
Response: returned as requests are approved/denied, will not be returned as a batch.
Institutional claim / ASC X12N 837 / 005010X223A2 / Batch / Used to submit inpatient, outpatient, long term care and institutional crossover claims and reversals. Adjustments are not supported electronically. / On demand.
Dental claim / ASC X12N 837 / 0050X224A2 / Batch / Used to submit dental claims and reversals. Adjustments are not supported electronically. / On demand.
Professional claim / ASC X12N 837 / 005010X222A1 / Batch / Used to submit medical, vision, EPSDT and professional crossover claims and reversals. Adjustments are not supported electronically. / On demand.
Remittance advice / ASC X12N 835 / 005010X221A1 / Batch / Used to report finalized claims. / Generated weekly by MMIS.
Note: 835s are sent only to providers that choose to receive electronic RAs. Web-based .pdf images are available to all providers.
Acknowledgments
Interchange delivery notice / ASC X12 TA3 / Interactive / Used when a system error occurs. / On demand.
Interchange acknowledgment / ASC X12 TA1 / Batch
Interactive / Used when an interchange (ISA) error occurs or for certain functional group (GS) errors. / On demand.
Functional acknowledgment / ASC X12 999 / 005010X231A1(xxxxxx = the Implementation Guide of the original submitted file) / Batch
Interactive / Used when a problem occurs in the functional group (GS) or within the transaction set (ST). During compliance testing, 999’s are also sent when files are error free.
*In interactive mode, a 999 can also be returned when a transaction is sent that is not supported interactively. / On demand.

12/5/111