Home care billing · AK
Home care billing in Alaska
Short answer
Home care billing in Alaska is fee-for-service, and every personal care, Community First Choice and home health claim travels with its EVV data: the Alaska Administrative Code bars a claim submitted without the visit record behind it.
The department sets personal care time in a service level authorization lasting no more than 12 months, waiver services through a care coordinator's support plan, and home health through prior authorizations of 60 days or less, and each claim has to reach the department's contractor within 12 months of the date of service. A dedicated Remitwright biller pairs every claim with its EVV record and authorization, serving Alaska agencies remotely. Rules for other states are on the home care billing by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Key facts for Alaska home care billing
| Fact | In Alaska | Source |
|---|---|---|
| Programs that pay | Alaskans Living Independently Waiver (0261.R07.00); Adults with Physical and Developmental Disabilities Waiver (0262.R07.00); People with Intellectual and Developmental Disabilities Waiver (0260.R07.00); Children with Complex Medical Conditions Waiver (0263.R07.00); Individualized Supports Waiver (1566.R01.00); Personal care services (7 AAC 125); Community First Choice (7 AAC 127); Home health (7 AAC 125.300-125.350) | 1 |
| How it is delivered | Fee-for-service | 18 |
| EVV | State system with approved alternatives | 5 |
| Medicare home health and hospice | National Government Services, Jurisdiction 6 | 19 |
Programs that pay for home care in Alaska1
Alaskans Living Independently Waiver (0261.R07.00)
Adult day, care coordination, respite, host home care, environmental modification, meals, nursing oversight and care management, residential supported living, specialized medical equipment, specialized private duty nursing and transportation, for people 65 and older and people with physical disabilities ages 21 to 64 who meet a nursing facility level of care.
Adults with Physical and Developmental Disabilities Waiver (0262.R07.00)
Adult day, care coordination, day habilitation, employment services, residential habilitation, respite, host home care, environmental modifications, intensive active treatment, meals, nursing oversight and care management, residential supported living, specialized medical equipment, specialized private duty nursing and transportation, for adults 21 and older with autism, developmental disabilities or intellectual disabilities who meet a nursing facility level of care.
People with Intellectual and Developmental Disabilities Waiver (0260.R07.00)
Care coordination, day habilitation, employment services, residential habilitation, respite, environmental modifications, host home care, intensive active treatment, meals, nursing oversight and care management, specialized medical equipment, specialized private duty nursing and transportation, for people of any age with autism, developmental disabilities or intellectual disabilities who meet an ICF/IID level of care.
Children with Complex Medical Conditions Waiver (0263.R07.00)
Care coordination, day habilitation, employment services, residential habilitation, respite, environmental modifications, host home care, meals, nursing oversight and care management, specialized medical equipment and transportation, for medically fragile children and young people ages 0 to 21 who meet a nursing facility level of care.
Individualized Supports Waiver (1566.R01.00)
Care coordination, day habilitation, employment services, residential habilitation, respite, adult host home care, intensive active treatment and transportation, for people of any age with autism, developmental disabilities or intellectual disabilities who meet an ICF/IID level of care.
Personal care services (7 AAC 125)
Physical help with bed mobility, transfers, locomotion, dressing, eating, toileting, personal hygiene and bathing, light and main meal preparation, housework, laundry and shopping, plus medication assistance, respiratory equipment maintenance, wound care, escort to medical appointments and passive range of motion.
The covered activities are set out in 7 AAC 125.030, and the department pays only for the activities named in the recipient's service level authorization under 7 AAC 125.024. An agency-based program may start services before that authorization only in the narrow discharge and caregiver-absence cases in 7 AAC 125.150, all listed in the sources.
Community First Choice (7 AAC 127)
Community First Choice personal care, meaning physical help with the activities in 7 AAC 125.030, supervision and cueing for recipients who need cognitive or behavioral support, and help gaining, keeping and building the skills to do daily activities independently, plus personal emergency response and chore services, for Medicaid recipients who meet an institutional level of care.
Covered services are listed in 7 AAC 127.040, and under 7 AAC 127.025 a recipient is not eligible for Community First Choice services while receiving personal care under 7 AAC 125.010 to 125.199, both listed in the sources.
Home health (7 AAC 125.300-125.350)
Intermittent or part-time skilled nursing, home health aide services, supplies for use in the home, and physical therapy, occupational therapy and speech-language pathology, recommended by a licensed physician, advanced practice registered nurse or physician assistant as part of a plan of care.
Under 7 AAC 125.300 and 125.310 the department pays a home health agency certified for Medicare where it provides care, and a rural health clinic or federally qualified health center may bill limited skilled nursing where no certified agency serves the recipient's home; every service after the initial evaluation visit needs prior authorization under 7 AAC 125.320, all listed in the sources.
How the program is delivered
Fee-for-service. Under 7 AAC 145.005 the department pays for a covered service only when an enrolled provider submits the claim, the recipient was eligible when the service was rendered and any required prior authorization was given, and claims go to the department's contractor.18 No health plan sits between the agency and the department: CMS's 2024 managed care state tables, listed in the sources, contain no Alaska section, so waiver, personal care and home health claims all go to the state's contractor.
Electronic visit verification
State system with approved alternatives. The Alaska Administrative Code requires providers of personal care, Community First Choice personal care, home health and waiver specialized private-duty nursing to use an EVV system that the department provides or approves; an agency that uses its own system or vendor must capture, at the time of service, the agency name, the rendering provider, the recipient, the location, the date, the start and stop times and the type of service, and report them to the state's EVV system.5 The same rules bar a claim submitted without the EVV data that supports it, require the provider to affirm the accuracy of each EVV submission and to review and resolve exceptions at least every calendar quarter, require repayment of any identified overpayment within 90 days, and, for an agency not on the department's system, require aggregate data to be uploaded daily or at another frequency the department sets. CMS lists Alaska compliant for personal care EVV by January 1, 2021 and for home health EVV as of January 1, 2023, in the status tables listed in the sources.
Services under EVV5
- Personal care services under 7 AAC 125.010 to 125.199 (7 AAC 125.070)
- Community First Choice personal care under 7 AAC 127.040(a)(2) (7 AAC 127.053)
- Home health services under 7 AAC 125.310 (7 AAC 125.350)
- Specialized private-duty nursing under the home and community-based waivers (7 AAC 130.285)
Authorizations
By the department, through a service level authorization. After the assessment, the department computes the total personal care time it will pay for with the Personal Care Services: Service Level Computation and writes an authorization naming the specific activities of daily living, instrumental activities and other services the personal care assistant may perform; it pays for no activity outside that authorization, the authorization takes effect only when the department approves it, and it runs for no more than 12 months (7 AAC 125.024). Community First Choice personal care follows the same pattern under 7 AAC 127.090 and pays only for services identified in the department-approved support plan.3 Waiver services run through a care coordinator, who submits a support plan at least once every 12 months, within 60 days of the level-of-care notice or 30 days before the plan year ends, and submits an amendment within 10 business days of a change in circumstances or service units; the department answers within 30 business days (7 AAC 130.217). Home health beyond an initial evaluation visit needs the department's prior authorization, requested on its form with the practitioner's written statement, and no authorization period may exceed 60 days (7 AAC 125.310 and 125.320).
Where the claims go
To the department's contractor, no more than 12 months after the date of service (7 AAC 145.005(c)). The department may extend that deadline only when the provider had reason to believe the recipient was ineligible and eligibility was later established by a court, hearing authority or the department, with the claim filed within 12 months of the notice of that decision; a recipient's failure to tell the provider about the decision is not good cause, and a claim not in the required form or format is denied, with an appeal under 7 AAC 105.270.18 For personal care, the department pays on the documented and verified total time the personal care assistant spent performing services under the approved service level authorization, and every claim must carry the assistant's rendering provider identification number (7 AAC 125.195, listed in the sources). Personal care, Community First Choice and home health claims also need their EVV data submitted with them.
Medicare home health and hospice in Alaska
National Government Services, the A/B MAC for Jurisdiction 6, processes Medicare home health and hospice claims for Alaska, along with American Samoa, Arizona, California, Guam, Hawaii, Idaho, Michigan, Minnesota, Nevada, New Jersey, New York, the Northern Mariana Islands, Oregon, Puerto Rico, the US Virgin Islands, Wisconsin and Washington.19 For Alaska Medicaid, 7 AAC 125.300 pays a home health agency only if it is certified for Medicare in the jurisdiction where it provides care and enrolled under 7 AAC 105.210, while a rural health clinic may bill limited skilled nursing where no certified agency serves the recipient's home. Under 7 AAC 125.310(d) Medicaid pays home health for a Medicare-eligible recipient when Medicare will not, because the recipient does not need intermittent or part-time skilled nursing or is not confined to the home.
Common rejections in Alaska, and the fix
Claim submitted without the EVV data that supports it
The fixThe regulations bar personal care, Community First Choice and home health claims sent without their EVV data. Your biller matches every claim line to a verified visit in the EVV system before release and holds lines whose visit is missing or still carries an exception.
Personal care activity outside the service level authorization
The fixThe department does not pay for any activity that is not named in the recipient's service level authorization. The biller loads the authorized activities and total time for each client and checks the visit record against them, asking the agency to request an amendment when needs change.
Claim reached the contractor more than 12 months after the date of service
The fixThe 12-month limit is extended only for eligibility established later by a court, hearing authority or the department. The biller files as soon as the EVV record is verified and tracks any retroactive eligibility notice as its own 12-month clock.
Home health visit billed without a current prior authorization
The fixOnly the initial evaluation visit is paid without prior authorization, and no home health authorization period is longer than 60 days. The biller records each authorization's end date and asks the agency for the renewal request, with the practitioner's statement, before the period runs out.
Personal care claim missing the assistant's rendering provider number
The fixEach personal care claim must carry the personal care assistant's rendering provider identification number. The biller keeps the roster of assistant numbers current and checks that every line has the number of the assistant who did the visit.
Community First Choice billed while the client receives 7 AAC 125 personal care
The fixA recipient is not eligible for Community First Choice services while receiving personal care under 7 AAC 125. The biller confirms which program each client is enrolled in and bills the visit under that program only.
Waiver units delivered past the support plan without an amendment
The fixThe care coordinator must submit a support plan amendment within 10 business days of a change in circumstances or service units. The biller flags units running past the approved plan and alerts the agency so the amendment goes in on time.
Remitwright serves Alaska home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from Alaska agencies
Can our Alaska agency use its own EVV system?
Which of our services need EVV data before we can bill?
How are personal care hours set for an Alaska client?
Can we start personal care before the service level authorization arrives?
How long do we have to file an Alaska Medicaid claim?
Does Alaska Medicaid pay home health when Medicare will not?
Which programs pay for home care in Alaska?
Is home care in Alaska paid through managed care or fee-for-service?
Which Medicare contractor pays home health and hospice claims in Alaska?
How does a remote biller keep our Alaska claims tied to EVV?
Next step
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