ModifiedAlaska MedicaidPolicy N/A

Alaska Medicaid fiscal agent transition — provider operational updates

Updates and operational guidance covering utilization limits for adult outpatient therapies, telehealth regulation changes, dental service authorization processes, CoCA billing clarifications, CMN update for incontinence supplies, training, and call center performance affecting Alaska Medicaid providers and contractors.

Policy Summary

PayerAlaska Medicaid

PolicyAlaska Medicaid fiscal agent transition — provider operational updates

Policy CodePolicy N/A

Change TypeMultiple operational and coverage updates (utilization limits, telehealth, billing, forms)

Effective DateNov 1, 2023

Next Review DateN/A

Key ActionFollow new utilization limits and prior authorization process for adult outpatient PT/OT/SLP services beginning November 2023; use updated forms and submit complete documentation for dental and DMEPOS requests.

SourceLink

POLICY UPDATE CHANGES

Utilization limits and prior authorization requirements for adult outpatient therapies go into effect November 2023.

Certificate of Medical Necessity (CMN) for Incontinence Supplies updated and required as of October 1, 2023.

New Alaska State telehealth regulations adopted on 7/13/2023 went into effect 9/1/23 with expanded telehealth flexibilities.

Clarification of Cost of Care Amounts (CoCA) collection and billing requirements for waiver services and residential settings.

Dental service authorization submission and documentation requirements emphasized (forms must be complete; specific signature rules; single-attachment/email/fax rules).

Nov 2023

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.

Coverage Criteria and Operational Rules

Telehealth coverage changes

Telehealth coverage updates and billing guidance:

Alaska adopted new telehealth regulations on 2023-07-13, effective 2023-09-01. The Department is updating internal guidance and system rules to reflect these changes; providers will be notified when system updates are complete and when newly covered services may be billed.

Do not bill newly covered services until Alaska Medicaid announces system readiness.

Key regulatory changes

Adoption of certain Medicaid telehealth flexibilities that were in place during the COVID-19 public health emergency (PHE).
Expanded coverage of synchronous audio-only telehealth modality to increase access.
Updated definitions for telehealth modalities: Synchronous, Asynchronous, and Patient-Initiated Online Digital Services.
Expanded coverage to include select services by direct entry midwives and optometrists; removed exclusion for end-stage renal disease services.

CoCA billing rules

Cost of Care Amounts (CoCA) billing requirements for waiver and residential services:

ALL of the following

Providers of Medicaid waiver services must collect Cost of Care Amounts (CoCA) from recipients who are required to pay CoCA.
Home and community-based providers (not RSL or Nursing Home) must reduce claims to the department by the amount the provider receives from the recipient as payment toward the recipient's CoCA liability.
If a recipient with a CoCA liability does not pay the provider, the recipient remains responsible for any unpaid amounts to the provider.
Recipients residing in Assisted Living Facilities (ALF) and Skilled Nursing Facilities (SNF) are required to pay their CoCA liability amounts to their provider.

Call handling and escalation procedures

Operational criteria and escalation procedures for handling calls, travel requests, and provider enrollment issues:

ALL of the following

SA / Travel operations: monitor call volumes and allocate agents to manage call spikes; refine the mix of phone versus fax handling to improve agent efficiency.
Member, Provider, and Provider Enrollment calls: maintain agent efficiency through recruitment and training; educate callers on available self-service options to reduce call demand.

When to escalate

No faxed response for an Urgent travel request within 24 to 72 hours of scheduled travel.
Received a faxed response that is cut off or contains a blank page.

Coding and Supply Guidance

DMEPOS incontinence suppliesHCPCSCovered

T4537

Incontinence supplies HCPCS code referenced in DMEPOS fee schedule update

Therapy utilization thresholds

ScopeApplies to adult outpatient physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) services.

Threshold effectMembers who have reached therapy threshold limits may continue receiving services without prior authorization until the November 2023 implementation takes effect.

Authorization requirement after implementationUtilization limits and prior authorization requirements go into effect November 2023; after that date prior authorization may be required per limits.

Clinical requirementAll rendered services must be medically necessary and meet program requirements, including treatment plan requirements defined by regulation.

Provider Actions and Submission Requirements

Prior Authorization

Prior Authorization and Utilization Limits for Adult Outpatient Therapies

Utilization limits and prior authorization requirements for adult outpatient physical therapy, occupational therapy, and speech‑language pathology services take effect November 2023. Providers: ensure all services remain medically necessary and meet program and treatment‑plan requirements. Review posted training and authorization guidance from Comagine (the Department's utilization management contractor) before submitting requests.

Effective: November 2023
Applies to: Adult outpatient PT, OT, SLP
Action: Review Comagine training materials and follow the authorization submission process

Documentation Required

Dental Service Authorization Form and Submission Rules

Use the correct Dental Service Authorization (SA) form and include all required documentation. When updating an existing dental SA, submit the Dental SA Update form (not a new SA form). Combine the completed Dental SA form and supporting documentation into a single attachment when emailing AKSAEscalations. Complete every field on the form (missing Provider ID or Member ID commonly causes rejections).

Definitions and Operational Notes

Definition — Synchronous audio-only telehealth

TermSynchronous audio-only telehealth

DescriptionAn audio-only telehealth modality that permits real-time voice communication between provider and member as an accepted telehealth format under the updated regulations.

Policy contextExpanded coverage of synchronous audio-only telehealth was adopted in the new telehealth regulations effective September 1, 2023.

Telehealth modality definitions

SynchronousReal-time audio and/or video interaction between provider and member; included in modernized telehealth modality definitions.

AsynchronousStore-and-forward or non-real-time transmission of health information between a provider and member or between providers.

Policy Summary

PayerAlaska Medicaid

PolicyAlaska Medicaid fiscal agent transition — provider operational updates

Policy CodePolicy N/A

Change TypeMultiple operational and coverage updates (utilization limits, telehealth, billing, forms)

Effective DateNov 1, 2023

Next Review DateN/A

SourceLink

On This Page

Documentation Required

Common Dental SA Errors and Fax Guidance

Returned or rejected Dental SAs are commonly caused by missing or improper signatures, unacceptable attachment formats, and fax cover issues. Signatures must be handwritten or electronic; initials, stamps, or missing signatures are not accepted. Do not attach JPEG images. Ensure the fax cover sheet includes a fax number that can receive the response. Fax Dental SA requests only once — requests are data‑entered within 1–3 business days and multiple faxes create processing delays.

Do not use JPEG attachments
Signatures must be handwritten or electronic (no initials or stamps)
Fax only once; allow 1–3 business days for data entry and check status in Health Enterprise
Ensure fax cover sheet contains a valid return fax number

Note

Travel and SA Request Handling

Monitor travel/SA request handling. Faxed urgent travel requests should receive a faxed response within 24–72 hours of the scheduled travel. If you do not receive a response in that window, or if the faxed response is cut off or blank, escalate per the instructions below. Be aware the program monitors agent efficiency, balances phone vs fax workloads, and adjusts staffing for call spikes.

Expect fax response for urgent travel requests within 24–72 hours of scheduled travel
If fax response is cut off or blank, or no response within timeframe, escalate
The program tracks agent efficiency and allocates agents between phone and fax as needed

Prior Authorization

Escalation Steps for Travel/SA and Enrollment Issues

Escalate unresolved or problematic SA/travel and provider enrollment issues by emailing the AKSAEscalations inbox. Include the member name, DOB, request type (urgent travel or enrollment), date/time of original submission, method of submission (fax/email), and any attached fax pages received. Use this escalation when you have not received a faxed response within 24–72 hours, when a faxed response is incomplete/blank, or for provider enrollment escalations.

Escalation email: AKSAEscalations@gainwelltechnologies.com
Include: member name, DOB, request type, original submission date/time, submission method, and copies/screenshots of received fax pages (if any)
Use escalation for: no response within 24–72 hours for urgent travel, cut‑off/blank fax responses, provider enrollment issues