ModifiedAlaska MedicaidPolicy N/A

Provider guidance for Alaska Medicaid fiscal agent transition and operational updates

Governs operational updates for Alaska Medicaid providers related to the MMIS fiscal agent transition, including new service authorization (SA) requirements for physician-administered drugs (PAD), claim/adjustment guidance, appeals process reminders, DSM use, and provider training; affects Alaska Medicaid providers and billing staff.

Policy Summary

PayerAlaska Medicaid

PolicyProvider guidance for Alaska Medicaid fiscal agent transition and operational updates

Policy CodePolicy N/A

Change TypeOperational update with material PAD SA requirement

Effective Dateas written

Next Review Date

Key ActionRequest service authorizations for specified Physician-Administered Drugs (PAD) through HMS via the SA form submitted by fax or Direct Secure Messaging (DSM).

SourceLink

POLICY UPDATE CHANGES

Service Authorization requirements for specific Physician-Administered Drugs (PAD) are going into effect as of April 1, 2024.

Medicaid Payment Rates, FQHC Productivity, and Rate Setting regulations filed 01/17/24 effective 02/16/24; Advanced Practice Dental Hygienist/Dental Specialist regulations filed 01/31/2024 effective 03/31/2024.

Direct Secure Messaging (DSM) is available for secure submission of SA and enrollment documents; providers may obtain DSM accounts through HealtheConnect Alaska for a $75 annual fee.

Apr 1, 2024PAD SA effective date

01/17/24Regulations filed

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

12 moTimely filing window

Coverage and Submission Criteria

inv-01: Physician-Administered Drugs (PAD) coverage and authorization

Covered when ALL of the following are met:

Service Authorization requirements for specific Physician‑Administered Drugs (PAD) are effective April 1, 2024.

Definition: A physician‑administered drug (PAD) is any covered outpatient drug other than a vaccine that is provided or administered to a patient, billed by a provider, and not self‑administered by a patient or caregiver.

Coverage and billing pathway: PADs administered in a provider's office or clinic must be billed through the medical benefit using the standard buy‑and‑bill (medical benefit) process.

Clinical appropriateness: Physicians and other licensed practitioners are responsible for ensuring treatment appropriateness based on FDA‑approved indications, peer‑reviewed journals, and standards of practice; the same clinical criteria will be used across pharmacy and medical benefits to assure appropriate utilization.

Authorization process: Service authorizations for PADs must be requested through HMS (the Fiscal Agent) using the required form submitted via fax or Direct Secure Messaging (DSM); the PAD SA request form and approval criteria will be posted on medicaidalaska.com and updated periodically.

inv-02: DSM submission and related processes

Accepted methods and requirements for transmitting documentation containing PHI/PII to the Fiscal Agent:

PHI/PII must be transmitted securely per HIPAA; regular (unencrypted) email is not acceptable for sending PHI/PII.

DSM option: Providers may obtain a Direct Secure Messaging (DSM) account via HealtheConnect Alaska (Register Now) or use an existing DSM account to submit documents; once set up, use your DSM email to send documents securely to the Fiscal Agent.

DSM account fees: There is a $75 annual fee per DSM email address for providers.

Routing: Use the Fiscal Agent DSM email addresses designated for specific document types (e.g., ProviderEnrollment@hms.fa.directak.net for enrollment; ServiceAuthorization@hms.fa.directak.net for general SAs; TransportationSA@hms.fa.directak.net for travel SAs; DentalSA@hms.fa.directak.net for dental SAs; DMESA@hms.fa.directak.net for DME SAs).

Coding, Timely Filing, and Example Codes

Examples of PAD HCPCS/J-codes listedHCPCSCovered

J0172	Aduhelm (example mapping listed)
J1426	Amondys 45 (example mapping listed)

Timely filing for adjustments — summary

Timely filing windowProviders have 12 months from the date of service to submit an initial claim.

Returned-to-Provider (RTP) consequenceAdjustment/void requests that cannot be processed are RTPed and must be corrected and resubmitted before processing.

Common RTP reasons to avoidTop reasons include missing/invalid TCN, claim exceeds timely filing, missing required forms, unspecified lines to be adjusted, and attempting to adjust voided/denied claims.

Required documentation for adjustmentsA completed, corrected claim form (AK-05) and specification of lines to be adjusted are required for adjustment processing.

Provider Actions, Authorizations, and Secure Submissions

Prior Authorization

PAD Service Authorization and Provider Training

Service authorizations are required for specific Physician-Administered Drugs (PAD) effective April 1, 2024. Providers must request PAD SAs through HMS using the SA request form submitted by fax or Direct Secure Messaging (DSM). PADs administered in a provider office or clinic must be billed through the medical benefit using the standard buy-and-bill process. Provider training on PAD SA requirements is offered Feb 20–Apr 5, 2024; register via the Learning Management Site.

SA requirements effective April 1, 2024
Submit SA requests to HMS via the PAD SA form by fax or DSM
Bill office-administered PADs through medical benefit (buy-and-bill)
Provider training sessions Feb 20–Apr 5; register on Learning Management Site

Documentation Required

Submitting documentation via DSM to Fiscal Agent

Key Definitions

Physician-Administered Drug (PAD) — definition

DefinitionA physician-administered drug (PAD) is any covered outpatient drug other than a vaccine that is provided or administered to a patient, billed by a provider, and not self-administered by a patient or caregiver.

Covered outpatient drug criteriaMay be dispensed only upon prescription; has an NDA/ANDA/BLA; is listed in the Medicaid Drug Rebate Program; and is approved under the Federal Food, Drug, and Cosmetic Act.

Administration and billingPADs administered in a provider's office or clinic should be billed through the medical benefit using the standard buy-and-bill process.

Examples of form/typesIncludes both injectable and non-injectable drugs administered in a clinician setting.

Direct Secure Messaging (DSM) — definition

Definition

Policy Summary

PayerAlaska Medicaid

PolicyProvider guidance for Alaska Medicaid fiscal agent transition and operational updates

Policy CodePolicy N/A

Change TypeOperational update with material PAD SA requirement

Effective Dateas written

Next Review Date

Key ActionRequest service authorizations for specified Physician-Administered Drugs (PAD) through HMS via the SA form submitted by fax or Direct Secure Messaging (DSM).

SourceLink

On This Page

If you choose not to use DSM, mailing or faxing remains an available option for submitting documents to the Fiscal Agent.

Once you have a DSM account, send Provider Enrollment documents and Service Authorization requests to the Fiscal Agent using the designated Fiscal Agent DSM email addresses. The Fiscal Agent provides separate DSM addresses for Provider Enrollment and for General, Travel, Dental, and DME Service Authorization submissions.

Obtain a DSM account (HealtheConnect Alaska) and use your DSM email to send documents to the Fiscal Agent
Provider Enrollment: ProviderEnrollment@hms.fa.directak.net
General SA: ServiceAuthorization@hms.fa.directak.net; Travel SA: TransportationSA@hms.fa.directak.net
Dental SA: DentalSA@hms.fa.directak.net; DME SA: DMESA@hms.fa.directak.net

Denial Risk

Security requirement for PHI/PII

Do not send PHI or PII via regular email—anything containing PHI/PII must be transmitted securely per HIPAA (for example, via DSM). Mailing or faxing remain acceptable alternatives if you prefer not to use DSM.

Regular email is not secure enough for PHI/PII
Use DSM (HIPAA-compliant) to transmit PHI/PII; DSM accounts available via HealtheConnect Alaska
If you choose not to use DSM, you may continue to mail or fax documents

Direct Secure Messaging (DSM) is a HIPAA-compliant, encrypted email system for sending personal health information (PHI) securely between validated HIPAA-covered entities; it encrypts message bodies and attachments.

Validation guaranteeAll DSM users are validated and assigned a specific DSM email address, assuring the receiver is a HIPAA-covered entity.

Use caseIntended to facilitate secure transmission of sensitive information (message bodies and attachments) between covered entities.

Where are we in the process?

Implementation statusThis has been implemented — it is in use now.

ScopeApplies to DSM processes and related submission workflows described in this update.

ImplicationProviders may begin using DSM and related procedures per the guidance in this policy.

Direct Secure Messaging (DSM) account

Account providerDSM accounts are available through HealtheConnect Alaska (register via the website or contact support).

Annual feeThere is a $75 annual fee per DSM email address for providers.

Account reuseExisting DSM accounts may be used once set up to send documents securely to the Fiscal Agent.

Support contactHealtheConnect support: support@akehealth.org or 907-770-2626 (option 1) for account assistance.