Washington Medicaid – Provider Tips Sheet August 2010 The Department of Social and Health Services implemented a
new payment system named ProviderOne on May 9, 2010. While the implementation has been better than anticipated, the
Department recognizes there are some stumbling blocks for provider
organizations. If you are experiencing problems in the following areas,
please give the tips below a try. If you have other questions that involve provider issues and
Medicaid, please visit the Provider Home Page on our internet site:
http://www.dshs.wa.gov/provider/index.shtml If you still are having difficulties, please call
1-800-562-3022 or visit the ProviderOne website at
http://hrsa.dshs.wa.gov/providerone/providers.htm. Paper Claim Processing Telephone Inquiries Electronic Claim Processing EDI/HIPAA Transactions Prior Authorization Client’s ProviderOne Client ID Number Client Eligibility Taxonomy Common Reasons Claims Deny Remittance Advice Choosing the Appropriate Provider from the “Managed Care
Information” Screen Learning How to Use ProviderOne New Provider Enrollment Billed in Old System but no Idea Where to Start with
ProviderOne? What is Different with ProviderOne? Recorded Webinars Available for Viewing Keeping Informed Paper Claim Processing For a variety of reasons paper claim processing is slow
(taking up to 45 days) and once processed, less than 10% currently result in
payment. If you need to make a
correction and resubmit your claim, that’s a long time to wait for
payment. The Department is urging
providers to try directly entering claims in ProviderOne where you can see
immediate results. You may wonder why the paper processing takes so long and so
few paper claims are paying. While
there is new equipment to automate, it is still a very manual process –
particularly if forms are handwritten.
The Department receives about 13-15,000 documents for processing each
day and is working the bugs out of new equipment that staff are adjusting to
using. Other contributing factors are
that some providers are using old forms that can’t be processed in the new
system; some are not providing the right information or in the right spot on
the form; and some are sending in duplicate claims before they show up on
remittance advice which contributes to the backlog. Tips: · Try billing
electronically! Claims entered on the
web are paying at 60% with payment usually received within one (1) week. Visit
the ProviderOne training page for live webinar opportunities to ask questions,
recorded step-by-step instructions called E-Learning and manuals
http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm · If you have
no option but to bill on paper, follow the Tips for Successful Paper Billing at
http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR018.pdf · Ensure you
are billing correctly. Please refer to the ProviderOne Billing and Resource Guide
and the Billing Instructions to ensure you are billing correctly. The Billing and Resource Guide is a user
friendly guide that takes providers through the processes for billing covered
services. It includes system screen
shots, information required and where to put it. ProviderOne Billing and Resource Guide
http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html Billing Instructions http://hrsa.dshs.wa.gov/Download/BI.html Telephone Inquiries through 1-800-562-3022 The Department is receiving 3 to 4 times the normal volume
of calls. With tough budget times,
there are just not enough staff to meet the call demand. Providers have self-service options for many
of the top call reasons (obtaining the ProviderOne client ID, client
eligibility, claim status, authorization numbers, warrant information, using
the system, and billing correctly). Tips: · Use
self-service options whenever possible to avoid waiting · Refer to
the fact sheet Provider Call Flow to help you navigate self-service options
through the telephone and common extensions
http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR016.pdf · Hints about
calling: If you press “0” to speak to
an agent before self-selecting options, you will wait even longer in a general
queue. Wait times are typically less
early in the morning from 7-8:00 a.m. Electronic Claim Processing Overall, electronic claim processing in ProviderOne is going
extremely well. If you haven’t tried
electronic transactions in ProviderOne, you should give it a try. Providers who try it for the first time
often tell the Department they will not go back to paper. Tips: · Overall,
the system is performing well. But,
with any system of this size there are some bugs to work out. Check our Discovery Log for any known issues
that are open and potential workarounds
http://hrsa.dshs.wa.gov/ProviderOne/documentation/DiscoveryLog.xls · New to
electronic billing? Visit the
Department’s training page for live webinar opportunities throughout July to
see a demonstration and an opportunity to ask questions
http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm · Ready to
give it a try – or just need a quick reminder on a certain step like making an
adjustment? Visit the ProviderOne
E-Learning center http://hrsa.dshs.wa.gov/providerone/ELearning.htm EDI/HIPAA Batch Transactions If you are having trouble with HIPAA batch transactions,
please ensure your transactions are compliant with the federal guidelines and
the ProviderOne HIPAA Companion Guides published at http://hrsa.dshs.wa.gov/dshshipaa/ If you have further questions, send an e-mail to HIPAA-Help@dshs.wa.gov Be sure to provide as many details as
possible, including a description of the concern, your organization’s NPI, etc.
Or, you can call 1-800-562-3022 and follow the appropriate prompts (you may
need your organization’s NPI. Also, a
fact sheet on the available provider telephone options is available at
http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR016.pdf Prior Authorization With ProviderOne there is a new Authorization Form (13-835),
some processes have changed, and there are self-service options to monitor the
status of an authorization. Tips: · Visit our
training page for a recorded webinar or the PowerPoint slides on Prior
Authorization and ProviderOne. The
webinar includes an overview, instructions, and tips on what to do and what not
to do. http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm · Read
frequently asked questions, helpful hints, and authorization instructions for
the most common service types at http://hrsa.dshs.wa.gov/Authorization · You can
check the status of a PA through a 2-step process – obtain the number via
self-service features by calling 1-800-562-3022 and following the prompts. Once
you have the number, you can check the status via ProviderOne (start on slide
25 of presentation
http://hrsa.dshs.wa.gov/providerone/Webinars/MedicalPriorAuthWebinar.ppt) Obtaining the Client’s ProviderOne Client ID Number – the
9-digit “WA” number The ProviderOne client ID number is needed for verifying
eligibility, submitting prior authorizations, and billing. Some refer to it as the “WA” number because
all IDs contain 9 numerals followed by WA. Tips: · The
ProviderOne client ID number is printed on the client’s Services Card – if they
have it (it can take several days to receive after becoming eligible for
services). · If you know
the Personal ID Code (PIC) that was assigned to the client in the old payment
system (even if you did not bill us for the client), we have a web based tool
that you can use to look up the new ProviderOne client ID. It is a simple tool meant only to look up
one ID at time – there is no download feature.
It will not return eligibility or other client information. The tool is available at
https://fortress.wa.gov/dshs/npicaphrsa/FrontDoor.aspx Select “Find P1 Client ID from any
PIC”. You will need your National
Provider Identifier (NPI) and tax ID to access the tool. This tool will not work for new clients who
became eligible for services after April 23, 2010, since these clients were not
assigned a PIC. This is a temporary tool meant only to assist with the
transition. · Use the
eligibility inquiry feature in ProviderOne using the client’s name, date of
birth, or social security number. We are working on an enhancement in ProviderOne that will
return the ProviderOne client ID on the automated telephone system. That feature is anticipated to be available
near the end of July. Client Eligibility You should always verify the services a client is eligible
for. There are several free and low
cost options to verify eligibility through ProviderOne outlined in the fact
sheet below. Tips: · Review Options
for Verifying Client Eligibility
http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR003-Options%20for%20Verifying%20Client%20Eligibility%20050508.pdf
· Visit our
training page for a recorded webinar or the PowerPoint slides on Interpreting
Client Eligibility Information
http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm Taxonomy One of the top reasons claims deny in ProviderOne is for
missing or incorrect taxonomy. Taxonomies are new with ProviderOne and one of
the biggest challenges when billing ProviderOne. Tips: · Review the
recorded webinar or PowerPoint slides on Billing Using Taxonomies on Claims on
our training page http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm · Review the
fact sheet Using Taxonomy in ProviderOne
http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR009%20taxonomy.pdf
· Review the
Numbered Memo 10-22 for details on taxonomy code requirements and where to
place them on a claim at http://hrsa.dshs.wa.gov/download/Memos/2010Memos/10-22.pdf
Common Reasons Claims deny Information about two of the top claim denial reasons are
covered above – ProviderOne client ID and taxonomy. Some other common reasons claims deny is a mismatch on the
client’s date-of-birth or duplicate claims. Tips: · Ensure the
correct ProviderOne client ID and taxonomies are correct and inserted correctly
in the claim. · Verify that
the client’s date of birth on your claim matches the ProviderOne eligibility
inquiry. If the date is different on
the inquiry, your claim will deny. DO
NOT USE the client ID from the test system. In many cases it is for a different
client and as a result the claim denies because the date of birth doesn’t match
our records (because it is for a different person). · Please wait
for your initial claim to pay or deny.
If your claim is in process, it is being worked by our claims team and
has not finished processing yet. Please
wait to call about these claims until they pay or deny. Remittance Advice The Department is exploring what can be changed on the new
ProviderOne Remittance Advice (RA) – available electronically only. A workgroup is being formed to explore
changes based on comments from providers that the RA is too long, there is
missing data that was provided on the old RA that providers find useful, and
overall usability. Tip: · Learn how
to view/download remittance advice through E-Learning. You will need to select
Professional Fee-for-Service Claims, Institutional Fee-for-Service Claims, or
Dental Fee-for-Service claims and then “View and/or Download the Remittance
Advice.” It only takes about two minutes to review! http://hrsa.dshs.wa.gov/providerone/ELearning.htm Choosing the Appropriate Provider from the “Managed Care
Information” Screen ProviderOne’s Benefits Inquiry screens show enhanced managed
care information. We have included more information than you’ve seen before,
including regional support networks (RSNs) and chronic care providers; some of
it is not applicable to clients only accessing medical services. This has caused some confusion for providers
when trying to coordinate managed care services. Tip: · Read
Choosing the Appropriate Provider from the “Managed Care Information”
Screen
http://hrsa.dshs.wa.gov/providerone/documentation/RSNs-ManagedCare.pdf Learning How to Use ProviderOne Maybe you are just beginning to learn the new system or just
need a refresher. Several options are
available. Tips: · E-Learning
– watch, listen and learn how to use various features of the system. The nice thing about these sessions is you
don’t have to spend hours watching – each step can be viewed separately and the
run time is indicated so you will know how long it will take. For example, the step for
viewing/downloading remittance advice is 2 minutes 17 seconds! You can access E-Learning topics at http://hrsa.dshs.wa.gov/providerone/ELearning.htm · Tutorials
http://hrsa.dshs.wa.gov/providerone/ProviderTutorials.htm · ProviderOne
System User Manual
http://hrsa.dshs.wa.gov/providerone/Provider%20System%20User%20Manual.htm New Provider Enrollment With ProviderOne there’s a new web site for providers to
self-enroll as a new Medicaid provider. Tip: · Visit
enrollment website http://www.dshs.wa.gov/provider/enroll.shtml Once there, providers will be walked through
the online application process, and given a list of documentation they’ll need
handy in order to enroll. The Department of Social and Health Services will continue
to process paper applications already received and any new paper applications
received by July 1, 2010. After July 1, enrollment applications must be made
online. Billed in Old System but no Idea Where to Start with
ProviderOne? Maybe you only bill Medicaid every now and then and haven’t
done any of the preparation steps to ensure you can bill, be paid correctly,
and obtain your remittance advice in ProviderOne. Tip: · Start with
the Department’s Short-Cut Guide to Getting Ready for ProviderOne on the web at
http://hrsa.dshs.wa.gov/providerone/documentation/6-step%20guide%20to%20post.pdf
What is Different with ProviderOne? You can read about the key changes that occurred with the
ProviderOne implementation at
http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR012.pdf Recorded Webinars Available for Viewing The Provider Relations Team is offering a variety of
webinars to assist providers during ProviderOne stabilization. Recordings of these live training events can
be viewed at the links below: · Interpreting
Client Eligibility Information https://www2.gotomeeting.com/register/866444371 · How to Bill
Successfully in ProviderOne – Direct Data Entry for Medical Providers
https://www2.gotomeeting.com/register/399418274 · How to Bill
Successfully in ProviderOne – Direct Data Entry for Dental Providers
https://www2.gotomeeting.com/register/196992267 · Prior
Authorization and ProviderOne https://www2.gotomeeting.com/register/417014579 · Billing
Using Taxonomies on Claims https://www2.gotomeeting.com/register/646613282 · Adjusting
Claims in ProviderOne https://www2.gotomeeting.com/register/423946027 · How to
Navigate the Interactive Voice Response (IVR) System
https://www2.gotomeeting.com/register/187138019 Upcoming topics include: · How to Bill
Medicare crossovers in ProviderOne · How to Bill
using paper given the new Paper Intake Process. For more information, please visit
http://www.dshs.wa.gov/provider/index.shtml and select “training” on the left
side of the screen. Keeping Informed The Department has a robust provider website for ProviderOne
with general updates, questions and answers, fact sheets, tips, training,
reports, system discoveries and more at
http://hrsa.dshs.wa.gov/providerone/Providers Tips: · Review the
Discovery log for known issues and workarounds
http://hrsa.dshs.wa.gov/ProviderOne/documentation/DiscoveryLog.xls · Reports are
available for providers by tax ID on experience in the old system as well as
ProviderOne. Daily dashboard reports
are available as well http://hrsa.dshs.wa.gov/ProviderOne/reports.htm · Sign up for
an email list for ProviderOne http://listserv.wa.gov/archives/providerone_provider_readiness.html
