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Alaska Medicaid managed care: what plans must pay

Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Alaska's plan contracts, statutes and notices. For 0 of 20 service lines, plans must follow a rule tied to the state's published rates.

Lines with a binding rule
0of 20
Plans on record
3
Directed payments
0amounts in the workspace
Capitation cells
—not published

Who sets the rate, by service line

The main rule Alaska's managed-care plans follow for each service line, in plain language.

Service lineMain rule for plansRatesAlso applies
Physician & professionalNot classified yet12,427
Equipment & suppliesNot classified yet3,431
RadiologyNot classified yet3,304
Lab & pathologyNot classified yet2,811
Hospital outpatientNot classified yet2,521
Hospital inpatientNot classified yet1,375
DentalNot classified yet504
Behavioral healthNot classified yet188
Other home & community servicesNot classified yet110
Therapy (PT/OT/speech)Not classified yet95
PharmacyNot classified yet81
TransportationNot classified yet34
Vision & hearingNot classified yet30
IDD servicesNot classified yet25
Nursing facilityNot classified yet18
Clinics (FQHC/RHC)Not classified yet13
ABA / autism servicesNot classified yet8
Personal care & attendantNot classified yet4
Private duty nursingNot classified yet1
OtherNot classified yet1
The plan rule on every Alaska rate you bill. With the contract citation for each one.

Alaska Medicaid managed-care plans

3 plans on record across 3 programs.

Alaska Medicaid coverage group: all Medicaid enrollees (FFS; no MCO)Alaska Medicaid (all enrollees, FFS)
Alaska CHIP coverage group: Denali KidCare (FFS; no MCO)Denali KidCare CHIP
Alaska Medicaid behavioral health and 1115 BH waiver claims administration (non-risk administrator; ASO)Optum (Division of Behavioral Health ASO)

Frequently asked questions

Do Alaska Medicaid plans have to pay the state fee schedule?

The plan contracts we reviewed do not tie plan payment to the state's rates for most lines; plans negotiate rates with providers.

Where do these rules come from?

From Alaska's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.

Can I see what each plan actually pays?

No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.

← All Alaska Medicaid rates