Alaska Medicaid: ACS
Please follow the Enrollment Instructions below to become an electronic submitter for Alaska Medicaid
The following process must be completed prior to initiation of electronic claims submission or inquiry.
Providers, please click the following link to access their online enrollment form:
Trading Partner Enrollment Agreement (online form)
Billing Services please print and fill out this form:
Billing Agent Submission Agreement
Electronic Remittance Advice Registration form
Electronic Remittance (835) Authorization Form
If the above links do not work properly, please download them from:
If you have any questions regarding any of the documents, please call the ACS EDI Technology Support Center at 800-770-5650 (option 1, 4)
We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.
Trading Partner Enrollment Agreement
Please call our office at 602-439-2525 option 1 for assistance completing this online application.
Electronic Remittance (835) Authorization
Please Select “Self” if you will be using ClaimShuttle to submit claims directly from your office
Please Select “Billing Agent” if you will be using a Billing Service and would like your Billing Service to receive your Electronic EOB’s.
Please enter your Business or Practice Name, Contact Name, and Phone number
Please enter the Provider’s name, State PIN, and corresponding NPI #
Please have an Authorized Representative for your office or the Provider sign and date this section
Billing Agent Submission Agreement
Billing Services, please enter your business name in the first paragraph
- Enter your Fax number, the authorized representative's name, title, date, and signature
NOTE: Each of the Providers you will be billing for must complete a Provider Electronic Remittance (835) Authorization in order to authorize you to send their claims and receive their EOBs. Instructions on how to fill out this form is listed above.
Submitting your Forms
It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:
HIPAA Provider Support Team
P.O. Box 240808 Anchorage, AK 99524-0808
Fax number: (907) 644-8126
If you fax these documents, please be sure to mail the originals.
It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.
Waiting for a Response
Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)
After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 907-644-6800.
Once you have received your Submitter ID and Password from ACS Health, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to ACS Health.
Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.