ProviderOne
Cutover and Implementation
Frequently Asked Questions (FAQs)
Last Updated 11/19/09
Have you identified any risks/barriers to a successful conversion?
When will you assess State and Provider preparedness and make a “go/no go” decision?
How long will DSHS stop processing claims while converting to ProviderOne?
Is there a back-up plan for providers who are unable to complete all required activities by go-live?
Q: Have you identified any risks/barriers to a successful conversion?
A: Yes, our greatest risk right now is provider readiness. There are six (6) critical activities that providers need to complete before they can be paid in ProviderOne:
1. Administer security: Activity to establish user ID and password for each provider staff that interacts with ProviderOne for billing, eligibility verification, download of remittance advice, etc.
2. Complete registration: Activity to validate data converted from legacy MMIS to ProviderOne such as NPI, Bill to address, etc.
3. Learn about new client ID: Providers need to use the new ProviderOne client ID rather than the current PIC on all transactions exchanged with ProviderOne.
4. Learn about new taxonomy requirements: With introduction of NPI, providers must use a DSHS recognized taxonomy to designate the line of business when billing rather than the current practice of using a specific 7-digit Medicaid ID to align with a specific line of business.
5. Submit Trading Partner Agreement (TPA): Required for providers who intend to exchange HIPAA electronic batch files with DSHS such as the 837, 270/271, 275/276, etc.)
6. Modify and test HIPAA electronic batch files: Test electronic batch files for compliance with HIPAA formats including the state’s Companion Guide.
Q: Have you developed a mitigation strategy to address any last minute/unforeseen risks to the conversion? Can you share that with us?
A: Yes, DSHS monitors progress on all critical path items leading to cutover and develops mitigation strategies for any areas that are falling behind. The recent increase in outreach to providers is an example of a mitigation strategy for the provider readiness risk identified above.
Q: When will you assess State and Provider preparedness and make a “go/no go” decision?
A: Besides regular weekly status meetings, DSHS has regular formal checkpoints leading to a “go/no go” decision. At these “readiness check-ins” the team reviews readiness metrics for system, vendor, staff and provider readiness and makes a recommendation to executive management. The formal readiness check-ins occur approximately 90, 60, 45 and 30 days before the planned go live. The final check-in is critical as cutover tasks take approximately 30 days to complete and DSHS needs to be confident in the planned implementation date of December 6, 2009, to proceed with cutover tasks starting in early November.
Q: How long will DSHS stop processing claims while converting to ProviderOne?
A: DSHS will stop accepting electronic claims over the two (2) week period immediately preceding implementation. DSHS refers to this period as the two (2) week claims “freeze.”
Paper claims will need to be submitted no later than three (3) weeks before implementation to ensure entry into the system prior to the freeze.
During the claims freeze, the goal is to finish processing as many claims as possible in the current MMIS to final resolution. Partially processed claims cannot be transferred to ProviderOne. Any claim that does not reach final resolution during the freeze period will be denied. After implementation, providers will be required to resubmit the denied claim for re-processing in ProviderOne (see response to Question #24).
We encourage all providers to eliminate any DSHS claim backlog, as we prepare to implement ProviderOne.
Q: What is DSHS’ Back-out Strategy? Will DSHS be able to revert back to the Legacy MMIS if ProviderOne is unable to make payments?
A: DSHS’ approach has been to expand testing to mitigate the risk of a catastrophic failure in ProviderOne requiring abandonment of the system and reverting back to the legacy MMIS. Expanded Integration Testing and User Acceptance Testing, and the addition of Pre-Production Testing with providers, are part of this mitigation plan. That being said, a Back-Out/Contingency Plan is being developed that includes a window after go-live where the current vendor will remain under contract in the event of a catastrophic ProviderOne failure. This element of the Back-Out Contingency Plan will have a very short window for triggering due to the impact not only on state staff but also providers.
Q: Is there a back-up plan for providers who are unable to complete all required activities by go-live?
A: The go/no go decision will consider readiness for providers, but it is impractical to expect all providers to be “ready”. We will give every opportunity to the provider community to complete these tasks along with tools, job aids and support. There is no back-up plan or alternative payment vehicle for providers who do not take advantage of these opportunities.
Q: What effects will ProviderOne implementation have on follow-up activities for the previous two years?
A: With implementation of ProviderOne, ALL claims submissions MUST contain the new ProviderOne client ID number, regardless of when the service was rendered. ProviderOne will NOT recognize the legacy system PIC number. This means that, after ProviderOne implementation, ALL adjustments to previously billed claims and ALL newly submitted claims MUST contain the new ProviderOne client ID regardless of when the service was performed.
Q: Can you please tell me which ANSI code ProviderOne will be using to deny all pending claims at cutover?
A: Paper RA: EOB 0124 – THIS CLAIM DID NOT FINALIZE PROCESSING PRIOR TO THE CUT-OVER FROM OUR LEGACY CLAIMS PROCESSING SYSTEM TO OUR NEW PROVIDERONE CLAIMS PROCESSING SYSTEM. PLEASE SUBMIT A NEW CLAIM.
Electronic RA: A1 – CLAIM/SERVICE DENIED. N142 – THE ORIGINAL CLAIM WAS DENIED. RESUBMIT A NEW CLAIM, NOT A REPLACEMENT CLAIM.