Medicaid and Incarcerated Member FAQs
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Guidance for Alaska Medicaid providers and the Department of Corrections on whether medical services for incarcerated individuals should be billed to Alaska Medicaid or billed to the DOC, and related operational steps for authorizations, transports, denials, and post-release responsibilities.
No material clinical or coverage changes in this revision.
Billing Responsibility and Coverage Determinations
Billing responsibility criteria
Determinations for billing responsibility based on member eligibility, encounter type, and transport context. Bill to the entity indicated when ALL/ANY conditions below are met.
Includes specialists seen during the admission
Bill to DOC when ANY of the following apply
- Member is not eligible for Alaska Medicaid
- An ER visit does NOT lead to an inpatient stay
- Transport includes pickup or dropoff at a DOC facility
Inter-hospital transports or medivacs should be billed to Alaska Medicaid
Standard Alaska Medicaid authorization and billing rules apply; providers must file within timely filing limits or provide primary insurer documentation. DOC acts as payer of last resort
ALL of the following
When a claim is denied for incarceration but the member was not incarcerated on the date of service or services meet billing-to-Medicaid criteria
- Claims suspended for incarceration exceptions on remittance advice
Allow HCS, DOC and DPA to verify and update incarceration dates; future submissions will not suspend unless reincarcerated
HCS updates hospitalization dates monthly; wait approximately 45 days after discharge before submitting a claim to Alaska Medicaid to avoid unnecessary denial
Authorization and Provider Requirements
Obtain standard Alaska Medicaid authorizations when billing Medicaid
If services are billed to Alaska Medicaid, all standard Alaska Medicaid authorization requirements apply; any authorization that would be required for a non‑incarcerated member is also required for an incarcerated member.
Key Terms and Billing Requirements
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