ProviderOne Readiness Series
General Readiness Tasks and
Cutover Schedule Webinars
Follow-Up Frequently Asked
Questions (FAQs)
Last Updated 11/19/09
Client Services Cards, Magnetic Card Readers, and Client ID numbers
Trading Partner Agreements (TPAs)
Clearinghouses
and Billing Agents
Regional Support
Networks (RSNs)
Electronic
Funds Transfer (EFT)
WAMedWeb
Q: I’m new to all of
this. Who do I contact for a basic rundown on what to do, who to bill, how to
bill. I’m very confused.
A: Go to http://hrsa.dshs.wa.gov/providerone/providers.htm for all the details.
Q: Can we get this presentation? Can we have
all the questions asked today and your responses?
A: You can obtain a copy of the Webinar
presentation by going to the Webinar table at following link: http://hrsa.dshs.wa.gov/providerone/ScheduledWebinars.htm Click on the link beneath the description of
this Webinar. The questions and answers and being captured for a Frequently Asked
Questions document. That will be posted to our Web site soon.
Q: If I have received
my ProviderOne Domain Name and my LogonID, how far am I from being done with
the Registration and Security process?
A: Now you are ready
to set up a security administrator, set up someone to do file maintenance, and
get started on your registration.
Q: What is the
IVR?
A: We are referring
to the "Integrated Voice Response" system that will be part of
ProviderOne. You will be able to access it via the same 1-800 number you use
now to call DSHS for Medicaid information. It will replace the current IVR
system.
Q: How do you sign up
for the IVR or do we already have access to it? What is the phone number?
A: 1-800-562-3022,
select 2, and follow the prompts.
Q: When will there be
data in ProviderOne that we can use to review the system (i.e. eligibility
inquiries)?
A: At go live.
Q: Due to changes in
our office info that occurred in the past year, our domain info is incorrect
and we have not even been able to begin. What happens to us if we are not ready
in time? DSHS has not contacted us thus far to deal with our problems.
A: The first step is
to set up security. Email: provideronesecurity@dshs.wa.gov
Q: When will new
Billing Instructions be available?
A: Before go
live.
Q: So a Speech and Language Pathologist (SLP)
would be a servicing provider and our school district would be a billing
provider?
A: Correct.
Q: Does the new
ProviderOne protocol apply to providers such as ours, a free-standing hospice
with very few Washington Medicaid patients?
A: Yes. At minimum, you need to complete security for the
individual who will be accessing Remittance Advice. If you bill by paper, you
will still be able to do that. You will need to use new identifiers on all
claims submitted. That information will be available in the ProviderOne Billing and Resource Guide
that will be available before go live.
Q: How do we access the
Companion Guide, and are all the web addresses listed somewhere?
A: Companion guide:
http://hrsa.dshs.wa.gov/dshshipaa/
For the most
part, all Web pages can be accessed from the ProviderOne main page: http://hrsa.dshs.wa.gov/providerone
Q: Alerts that say
"Over-Ride Status" – what do they mean?
A: Contact providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]
Q: The person who was
handling our ProviderOne transition left our practice. How do I find out where
she left off and how much more we need to do?
A: If you are the
system administrator and will be completing security, but do not know what your
credentials are, please email provideronesecurity@dshs.wa.gov State the nature of your issue in the subject line and put your ProviderOne ID, if
you have it, in the body of your email. If you do not have your ProviderOne ID,
please provide your tax ID. After you have your credentials, make sure the
person who will be handling registration has been assigned the File Maintenance
profile. That person can access ProviderOne and see if your registration has
been approved or where your organization is in that process. If you are
completely lost after you have your credentials, you may contact provider
enrollment at: providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]
You may want to take system training. You can access this at http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm Hope this helps.
Q: How long will you
keep the tutorials available to us?
A: There currently is no plan to remove the tutorials for your
usage. We may update them from time to time.
Q: Is there a
tutorial on how to check client eligibility and submitting claims in
ProviderOne?
A: Yes, there are tutorials regarding these subjects.
Q: What happens if
"go-live" changes after closing us off – i.e. after adjustments
close? Will you turn this back on if go-live changes?
A: If go-live changes, all of these dates will change as well. Please
visit the implementation schedule area of our Web site for updated information:
http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: What is the phone
number for IVR?
A: 1-800-562-3022. The new IVR prompts begin with the implementation of
ProviderOne.
Q: Is the IVR
available now?
A: No. It will be
available at go-live.
Q: Can we access ProviderOne
after we have completed the security and registration tasks, prior to the
deadline date for go live?
A: You can access ProviderOne before go live only to set up your user
accounts (security) and to complete registration. You cannot access ProviderOne
for claims submission or for checking client eligibility.
Q: Any word on the
backlog of applications that have been accepted, but submitter ID letters have
not been sent yet? We cannot test until we receive the submitter number.
A: Contact providerenrollment@dshs.wa.gov
[1-800-562-3022, select option 2,4,2]
Q: I have patients
ask if we accept Molina. What is the difference between Molina and DSHS?
A: Molina is a managed care organization. DSHS assigns some clients to
managed care organizations. If you have patients ask if you accept Molina and
you don't, I recommend you refer that patient back to Molina so that
organization can help this person find a PCP.
Q: Why did you decide
to start the ProviderOne program?
A: Washington’s
current Medicaid Management Information System (MMIS) was built using 1970s
technology. When installed in 1982, the MMIS met the basic needs of the State,
primarily using the fee-for-service business model.
Over the years,
the State’s health care business has become more complex, requiring many system
modifications for each policy, program, or service initiative. In many cases,
the MMIS has been unable to adapt, resulting in inefficient manual work-arounds
for DSHS and providers.
Although the
current MMIS almost exclusively handles Medicaid medical payments, ProviderOne
ultimately will become the primary payer system for a broad range of social and
health care services handled by DSHS.
Q: When will the
ProviderOne edition of the General Information Booklet be available?
A: The
ProviderOne Billing and Resource Guide is currently available in draft form: http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html
Q: How do we know when we have completed
everything correctly?
A: For registration, you will receive a
notice in your ProviderOne in box stating your registration has been approved.
You are complete with security once your system administrator has set up all
the user accounts required by your organization. For testing, please see the
HIPAA Batch Testing – Getting Started information at http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR007%20HIPAAtesting.pdf
Client
Services Cards, Magnetic Card Readers, and Client ID numbers
Q: Will each client have
his or her own Services Card (client ID), or will there be multiple clients on
one card (such as parent and child)?
A: Each client will
have his or her own Services card.
Q: Will there be a
printout available of the Q & As that are being submitted over this
"chat" screen?
A: We will build
these questions and answers into our Q&A that will be available soon on our
Web site.
Q: When will the
clients have their new cards?
A: Clients will
receive their new cards before go-live, with information instructing them how
to use them.
Q: If a patient is no
longer eligible for DSHS, will they still be provided a ProviderOne ID number?
A: We are converting
all clients’ PICs to ProviderOne Client IDs. The crosswalk goes back one year. The following is a link to the applet where you
access your security credentials, taxonomy tool, and client crosswalk: https://fortress.wa.gov/dshs/npicaphrsa
Q: What is the date
that the PIC numbers are no longer used and we switch to the new client ID
numbers?
A: At ProviderOne
go-live, you must begin using the new ProviderOne client ID numbers.
Q: Where do we find
information on the ProviderOne card reader on the Web site?
A: Read the Optional Magnetic Card Readers fact
sheet on our Web site: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/FactSheets.htm
it will give you the general information, and link you to more details if you
need them.
Q: We are able to
look someone up on WAMedWeb now, even if they have never been in before, by
using name and birth date. Is it possible to look someone up with this new ID
card?
A: You will be able
to look up client eligibility in ProviderOne. If they have their Services Card,
you can use their Client ID number. If not, you just need two of the following:
full name, date of birth, Social Security number. This
will be covered in detail in system training for checking client eligibility.
Q: Will there be a
place on the card that has the HMO information?
A: No. You will find
that information when you verify eligibility either through ProviderOne or via
the IVR.
Q: How quickly will cards
be issued for newborns, and how will services or eligibility be processed
before the card is issued?
A: You will bill the same way -- baby on mom's PIC, only with
the new ProviderOne identifiers for mom. How quickly cards are issued depends
on when the local Community Service Office receives information on the newborn.
Q: Do all DSHS
members already have client ID numbers?
A: Yes.
Q: I still see green
coupons nowadays. When will clients start showing us the new Services Cards?
A: On the day ProviderOne is implemented. Please visit the
implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: Can we enter the
new client IDs now or will the claims be denied if they are entered before the
go-live date?
A: If you use the ProviderOne client ID in the current Legacy system,
those claims will be denied.
Q: How are DSHS
clients being notified of this?
A: There is an entire campaign under way to notify clients. They
will be notified by postcard, by inserts in their MAID, there is information
available for providers to place in their office. If you go to http://hrsa.dshs.wa.gov/providerone/providers.htm and look down the left side of the page you
will see a link for DSHS clients.
Q: Are all dates of
issue going to say 12/09 this time, even if they have been eligible for years?
A: The issue date will be the month and year that we issue the new
cards, even if they have been eligible for years. The card will not show any
eligibility dates.
Q: Can we manually
enter the information into the system if the magnetic strips wear out on the
client Services Card
A: Absolutely yes!
Q: Is there an option
not to print a receipt? And why would you need one?
A: This is simply how the card reader works.
Q: Where can we get a
scanning machine for the new cards?
A: Please refer to the
following optional card reader Web site: https://www.meddatahealth.com/MedData/ProviderOne
Q: Will the current
categories of coverage, i.e. QMB, LCP, etc., remain the same and will this
still be identified on the new card?
A: The current categories of coverage will remain the same. This
information will not be identified on the new card. You will need to check
eligibility through ProviderOne or via the IVR system that will be accessible
at go live.
Q: If the client
loses their card, will we still be able to verify eligibility with a DOB and
SSN through ProviderOne?
A: Yes.
Q: When you swipe the
card in the card reader, will it give you the eligibility information, policy
number? We are trying to figure out if we need a screen other than one line in
the subscriber screen to try and capture this information.
A: The swipe device
gives you a printout, the USB device shows up on your screen or the portal. All
formats will provide you with the same information. The machine prints out on a
tape.
Q: When is the
earliest that we can input the new client IDs into our system? Can we still
enter the client’s ID if the billing agent is not ready?
A: That is a
decision you must make with your billing agent. The new client ID will not work
until ProviderOne goes live. Until then, the current client “PIC” number must
be used on claims you send to DSHS.
Q: Do the cards have
to be processed through a terminal like our credit card machine or do we check
online for every visit?
A: ProviderOne will have a number of methods for checking client eligibility. DSHS offers webinar training on this topic, see http://hrsa.dshs.wa.gov/providerone/SystemTraining.htm Here is a link to the e-Learning page, as well: http://hrsa.dshs.wa.gov/providerone/ELearning.htm There is a fact sheet about the magnetic card devices, at http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR008Swipe_Card_Readers.pdf
Q: Could you list the
methods that we can access client IDs in case ProviderOne is down?
A: If ProviderOne is
down, alternative methods for checking eligibility are available:
·
Call the Interactive Voice Response (IVR)
at 1-800-562-3022, enter 1, 5, 5.
·
Call a customer service representative at
1-800-562-3022.
You can find details in the ProviderOne
Billing and Resource Guide at http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html.
Q: What information will be available when
swiping the card on the card reader?
A: You will see the same information you
would see if you accessed ProviderOne. For more information, please go to the
following link: http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide/Client_Eligibility_BSP_Coverage.pdf
Q: I understand there is a “credit card”-like
machine that allows us to swipe the card and get information on the patient. Is
that true, and how do we obtain one?
A: There is a fact sheet about the magnetic card devices at http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR008Swipe_Card_Readers.pdf
Q: If they are not provided a ProviderOne ID
number, how do we re-bill for older claims where the patient has a PIC number?
A: All PICs will be converted to a
ProviderOne Client ID. The crosswalk goes back one year. You can check in
ProviderOne by using the client’s name and date of birth to determine their new
client ID. This topic is covered in detail in provider system training for
checking client eligibility: http://hrsa.dshs.wa.gov/providerone/SystemTraining.htm#02‐Eligiblty_Client_Eligibility,_Benefit_Packages,_Coverage_Limits_and_MNHCR002
Q: One of the questions was answered with the
following: “We are converting all clients’ PICs to ProviderOne Client IDs for
one year.” We are able to submit an adjustment claim within 24 months, so what
about the individuals with claims between 13-24 months. How will the ID numbers
be issued in these scenarios?
A: The crosswalk goes back one year;
however, all PICs will be converted to a ProviderOne Client ID. You can check
in ProviderOne by using the client’s name and date of birth to determine their
new client ID.
Q: Will the clients still receive their HMO
cards, as well?
A: Yes.
Q: Is this change going to affect Molina and
CHPW patients, as well – as far as the PIC number?
A: Yes. All DSHS clients will get a ProviderOne
ID.
Q: As the magnetic strips on the ID cards
wear out, how often will they be replaced?
A: They will be replaced when the client
requests it to be replaced.
Q: What does a magnetic card reader cost, and
how long does it take to get it?
A: Please read the Optional Magnetic Card
Readers fact sheet located at: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR008Swipe_Card_Readers.pdf
Q: We are trying to
decide whether to go with a magnetic card system or checking eligibility in
ProviderOne.
A: We recommend you
take the e-Learning Client Eligibility course: http://hrsa.dshs.wa.gov/providerone/EEligibility.htm You may also want to
read the Optional Magnetic Card Readers
fact sheet at http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR008Swipe_Card_Readers.pdf
Q: Will the crosswalk now available be the same number we will
need to use when ProviderOne goes live?
A: The current crosswalk is intended for test purposes only. Some
of the ProviderOne client ID numbers could change in the final refresh, approximately one month before ProviderOne goes
live; however, the format and structure of this file will not change.
Q: When will the PIC to ID number spreadsheet be available?
A: The PIC to ProviderOne Client ID crosswalk is available now in
test form. Approximately one month before ProviderOne goes live and again just
before go-live, final crosswalks will be available to download.
Identifying Numbers
Q: What is the
"new Client ID" you mentioned?
A: It is the
replacement for the PIC.
Q: What
is our “subscriber ID”? How do we find out?
A: Please email provideronesecurity@dshs.wa.gov. Put "subscriber ID" in the subject line.
Q: What is our “user
name”?
A: Please send an
e-mail to provideronesecurity@dshs.wa.gov with “Need user name and submitter ID” in the subject line. In
the text, include your provider ID from the current MMIS system.
Q: Are the new
ProviderOne IDs the domain names we received upon registration?
A: Yes.
Q: What exactly do
you mean by ProviderOne ID? Are you going to issue new provider IDs to all
physicians?
A: The physician ID is
the NPI you submit to us. Your NPI is the way you do business with us.
Q: Can we use the new
ProviderOne Client IDs prior to go-live?
A: No.
Q: Can we use the new
client ID on claims now?
A: No. You can use
them beginning at go-live.
Q: When will the
PIC-to-Client ID Crosswalk be in effect?
A: The crosswalk is
available to test now. However, the final form will be available 30 days prior
to go live.
Q: The ProviderOne Client ID mentioned for
claims submission – is that the ProviderOne ID required for each group or
should each provider in the group have their own Client ID #?
A: The client ID is the ID for the people you
will be seeing as patients. This replaces the current PIC.
Q: What is the MMIS provider ID?
A: Your current ID.
Q: Is it okay if the
old MMIS number is on the claim or do you want ONLY the NPI for referring
providers?
A: The NPI for the
referring provider is required, along with the new client ID. Taxonomy is not
required for the referring provider.
Q: We have
two offices of our SA Outpatient Services. We have one provider number, but two
separate NPIs for these offices. When registering, only one NPI showed up for
one of our offices. Can the other NPI be added to the provider number, or do we
need to apply for a separate provider number for that NPI?
A: Please
contact Provider Enrollment: providerenrollment@dshs.wa.gov
[1-800-562-3022 select option 2, 4, 2]
Q: How do we get the NPI
numbers added to ProviderOne if they are missing?
A: For NPI questions, I recommend you contact Provider Enrollment
at providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]
Q: How do we get a
ProviderOne client ID?
A: You can download the Client crosswalk now for testing. This is
not the final data set. On approximately November 6th (approximately 30 days
prior to go live) the final crosswalk will be available. An update containing
client IDs from November will be available on December 5th. https://fortress.wa.gov/dshs/npicaphrsa
Q: Will the password
expire for access to ProviderOne as for WaMedWeb?
A: Yes. It expires every 120 days.
Q: Taxonomy and NPI
are different from each other, right?
A: Correct.
Q: Is there a
different Domain Name for the Administrator user and yet another for just the
User?
A: Generally
speaking, it will be the same.
Q: I have two NPIs -
individual & organizational. On the DSHS list of Taxonomy codes for our
practice, it lists both the servicing and billing NPI as the same. Are they?
Shouldn't my servicing NPI be the individual NPI and the Billing NPI be the org
NPI?
A: To change an NPI
or Tax ID number, contact providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]
Q: Will you reject
claims after November 20th if they have the legacy numbers in addition to the NPI
numbers and taxonomy codes?
A: We will not
reject the claim, but it will be denied.
Q: What does a
provider who HAD an active provider number, but is now not active with DSHS
supposed to do in order to view past history re: the crosswalk information?
A: If the provider’s
file was converted, they can view this crosswalk information. There are many
factors that went into conversion; it wasn’t based only on active/inactive
status. i.e. whether the provider had billed a claim since 12/2004, whether the
provider was on a lifetime claim, whether the provider appeared as an attending
or referring on a paid claim, or whether the provider was active.
Q: What is the
difference between the EDI submitter number and the ProviderOne ID, and how do
we get them?
A: Your ProviderOne
ID was assigned to your organization as part of data conversion in ProviderOne.
A submitter number is needed if you plan to directly submit HIPAA batch
transactions to DSHS (Web batch or SFTP batch). It is assigned to your
organization after your registration is complete and a Trading Partner
Agreement is received by DSHS.
Q: Do we have to have
a submitter number? We are a small clinic… How do we get one?
A: If you submit
claims one at a time via Direct Data Entry, you do not need a submitter number.
You need a submitter number if you plan to submit HIPAA batch transactions
directly to ProviderOne (Web batch or SFTP batch). You must indicate that you
will submit batches directly when you register. After your
registration is approved and your Trading Partner Agreement received by DSHS,
the submitter number will be sent to you in a letter.
Q: When do we start
using the new group ID and rendering ID numbers that we received when we set up
security and registration?
A: You use these
identifiers when you being submitting transactions through ProviderOne.
Q: When signing up
with ProviderOne, I received individual new user credentials for each person
I’ve set up so far. The passwords came on a separate form. However, I don't
know how to "match up" the username to the password. Would this be
something you can help with or do I need to contact another e-mail?
A: Please contact provideronsecurity@dshs.wa.gov. Please type "Credential questions" in the subject
line. Be sure to provide your MMIS pay-to provider number.
Q: I’m unable to log
in to ProviderOne. It keeps asking for a submitter number and user name. I
don’t have this information.
A: Please email our
security unit at: provideronesecurity@dshs.wa.gov
Q: So I want to make sure I am right. When we
log in to ProviderOne, the account profile is for the administrator. She then
needs to go in and add each person in the office and what their profile type
is. Then once that is done, the file maintenance person will be able to go in
and clean things up and review provider information and go on to registration
and the rest of the 6 readiness steps. Right?
A: You are right on the money!
Q: Can you have two administrators for
Provider One, so someone can be a backup?
A: Absolutely. We recommend doing this.
Q: What if you have multiple companies that
you bill for. Does each person need to be set up in all the companies in order to
view?
A: Each organization that you bill for needs
to complete Security and Registration.
Q: I have logged into ProviderOne and the
user that is in there has a profile as administrator. I was told that I need to
get a new domain name that allows file maintenance before I can go further. Is
that the case?
A: You need the profile that allows you to
complete the file maintenance work. Your system administrator needs to assign
this profile to you.
Q: I just tried again
to log on to the ProviderOne Web site, entering my assigned domain, the
username that was approved, and the password I set up at the beginning of
September. But it is like the screen is frozen. It doesn't say that the
information is invalid, or anything. The screen does not move past this page.
Who do I call for customer support?
A: Please e-mail provideronesecurity@dshs.wa.gov. State that you are locked out in the subject line and provide
your MMIS ID.
Q: What is the web
link to find out how to get our "username"?
A: The following is a
link to the applet where you access your security credentials: https://fortress.wa.gov/dshs/npicaphrsa
Q: I've e-mailed security to be a super user
and all they do is reset my password.
A: Your Security administrator is the person
who sets you up as a super user, not our Security unit. If you are the Security
Administrator you would set yourself up as a Super User.
Q: We are a dental office and I have a
provider ID, domain name, logon and a password. What else will I need?
A: You have what you need to log on to
ProviderOne. You need to set up your users, including someone to complete
Registration.
Q: I am the system
administrator and have locked myself out. Is it possible to have two people as
system administrator?
A: Absolutely. (You
can have more, if you like.) Now I recommend you email our security unit at: provideronesecurity@dshs.wa.gov Please send
only one email per issue. State the nature of the issue in the subject line.
Also include your provider ID if you have it. Otherwise, please provide your
tax ID.
Q: What if we are
trying to register, but cannot get the log-in credentials? Our provider numbers
(tax id and DSHS #) have been entered correctly?
A: Security
email: provideronesecurity@dshs.wa.gov Please include your NPI
and a "locked out" note in the subject line.
Q: My password does
not work and I could never get past the address portion. Medicaid has a
two-week waiting list to get a phone call back. Is there a different avenue to
get your password corrected and get some help?
A: Unfortunately, no.
We have added resources to this unit to help with this back log. They are
logging all requests and are returning calls and emails in the order received.
Please leave only one message per issue. Be sure to indicate the nature of your
issue in the subject line and include your provider ID in the body of the
message.
Q: I have signed into ProviderOne with my
domain sign on and password. I'm able to get in and choose option EXT File
Maintenance. But nothing further than that. I'm trying to start registration.
A: Please start with e-learning for
registration at: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm If you don't find your answer there, please
contact our Security Unit at provideronesecurity@dshs.wa.gov Please type your issue in the subject line
and include your MMIS provider ID in the email.
Q: I'm confused. I am the administrator and
have been trying to add people, but I cannot get into registration to finish
it. Should I be something else or stay as administrator?
A: The System Administrator profile does not
allow for file maintenance. You need the File Maintenance profile to complete
this activity.
Q: I am the system administrator. Is this
access available now before go live?
A: Yes. You set up other users.
Q: Can the system administrator review and
update EFT information at this time? Or does it have to wait until go live?
A: Updating EFT information can be done during
registration. You will need to use a profile that allows access to this, such
as EXT File Maintenance.
Q: I am a system administrator and have added
users to the system successfully, but have not done anything else. I now know
that I need to go into file maintenance; will this be something that I CANNOT
access? Or it should be okay when I go to do this?
A: You need to assign yourself the EXT File
Maintenance profile, or assign this to someone else.
Q: Super users can do the file maintenance and
add people, correct?
A: Super User cannot set up users. They can do
file maintenance and other activities.
Q: I have received a logon id, but when I've
attempted to log on, I don't know what "user name” should be used? I
assumed my name was the user name but that doesn't seem to work.
A: Please contact Security at: provideronesecurity@dshs.wa.gov Please type your issue in the subject line
and include your MMIS provider ID in the email.
Q: Our Office Manager wants only one sign-on
for the whole office. (We are a small office of 11 total employees.) Is this a
good idea or is it mandatory that each person has a different sign-on?
A: Your office manager will need to make this
determination. It is not mandatory by DSHS that each person have their own
sign-on.
Q: If there is only one person needing to use
ProviderOne for the office, do I need to do a spreadsheet?
A: You do not need to use the spreadsheet when
there is one person in your office using ProviderOne.
Q: I have entered the provider addresses in
the security screen, and all looks good, but when I try to go to the next step,
an error message appears stating that I need to complete mandatory steps first.
Despite repeated requests for help, no one has called to walk me through this
issue. Help!
A: I'm not sure what unit you've left messages
with. This sounds like a registration question. Please contact providerenrollment@dshs.wa.gov
[1-800-562-3022 select option 2,4,2]
Q: I have entered all of our dept. users, but they cannot logon
with our domain and assigned username and passwords. What do I need to do?
A: Please contact our Security unit at provideronesecurity@dshs.wa.gov Please put
the nature of your issue in the subject line and include your provider ID in
the message. Each request for help is logged in the order it comes in. Please
contact them only once per issue. We have added resources to this unit to help
with the number of requests that are coming in.
Q: Do the
physicians/providers need to register for security as well as the person
filling out all this information – or just the administrator? Will the taxonomy
just be required for rendering/billing providers or referring providers as
well?
A: The people who need security set up for them are those
individuals who will be accessing ProviderOne to complete their daily job
tasks, i.e. checking client eligibility, submitting claims/adjustments.
Taxonomy is not required for referring providers.
Q: The security
information on the Web states that when using the spreadsheet upload option,
the temporary password will be emailed to each user. I want to verify that is
how it will work as so far, when we have set up users manually, no email has
been sent to the users and a letter has been mailed from ProviderOne. The
letter hasn’t been helpful because we don’t know what password goes with which
user ID setup.
A: Passwords are
sent by email to the person who sent in the spreadsheet. It typically takes 2
or 3 days.
Q: Now that the
spreadsheet is mailed in, what is the next step?
A: Passwords are
sent by email to the person who sent in the spreadsheet. It typically takes 2
or 3 days.
Q: How do you set
yourself up as a super user?
A: Your system
administrator sets you up as a super user. If you are the system administrator,
we recommend you take the Security e-Learning course located at http://hrsa.dshs.wa.gov/providerone/ESecurity.htm.
This course will provide you with step-by-step instructions.
Q: I have a solo practitioner that I cannot
register without a security spreadsheet. However, I don’t know what information
or what spreadsheet is required. This is not a large organization, and I don’t
know why this is required for him.
A: The Security Spreadsheet is not
recommended for smaller organizations. We recommend you complete the security
activities through ProviderOne. If you do not know where to begin, please take
the e-Learning course on Security Administration at: http://hrsa.dshs.wa.gov/providerone/ESecurity.htm
Q: Our practice has
multiple locations under our tax identification number. Do all those need to be
loaded into ProviderOne?
A: Yes.
Q: How would we change to EFT?
A: You can choose this during registration.
Q: Where and how do we verify registration?
How do we get in there to check if it's correct?
A: Please join us for the Registration Webinar
beginning next week. You may also want to take the Registration E-learning at: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm
Q: All of our legacy
domains were transferred into ProviderOne under one NPI. We have two NPIs. How
can I get the second NPI set up in ProviderOne and the appropriate legacy IDs
transferred to it?
A: Please contact providerenrollment@dshs.wa.gov [1-800-562-3022, then select options 2, 4, and 2].
Q: I went through the registration steps, and
submitted my modifications for review. I then realized that I did not change
the Payment Details from Check to EFT, and am now unable to change that. Do I
need to wait until the updates I have made are approved? How long does it take
for approval of changes?
A: You do
need to wait until the updates are approved. We are currently working as fast
as we can to approve these changes. We have added resources to this group.
Q: As providers renew
their Washington State Licenses, will they have to also update this information
with ProviderOne?
A: Yes.
Q: How long does it
take to get registration approved?
A: Lately there has
been a backlog and we have added more resources to this group. At this point, give
it a couple of weeks and then check your ProviderOne in box.
Q: Does registration
need to happen for every professional NPI that we have, or just the NPI group
that each physician belongs to?
A: We recommend that
you begin by registering your group NPI(s), and when that work is complete,
work on registering your individual "performing" providers.
Q: If we have
problems with setting up, can we re-enroll and start from scratch? Or will this
override what we’d started?
A: You may need to
contact provider enrollment: providerenrollment@dshs.wa.gov [1-800-562-3022, then select options 2, 4, and 2].
Q: What if we are
trying to register, but cannot get the log-in credentials? Our provider numbers
(tax id and DSHS #) have been entered correctly?
A: Security
email: provideronesecurity@dshs.wa.gov Please include your NPI
and a "locked out" note in the subject line.
Q: When updating our provider file, it says we
must submit copies of licenses and core provider agreements again. It states we
can fax this information but I'm unable to locate a fax number. What is the fax
number?
A: Their fax # is 360-725-2144. If you are
faxing in a TPA, please put it to the attention of Lisa Cline.
Q: Are we supposed to be reviewing the EFT
information right now? Or will this be available later?
A: This is covered in the Registration
webinars. For those slides, go to http://hrsa.dshs.wa.gov/ProviderOne/Webinars/Registration.pdf
Q: I have checked our domain and found two
legacy DSHS numbers that I cannot verify have been assigned to our tax ID. I
have left two voicemails approximately one month ago and an e-mail about 10
days ago to find out who these belong to and how to remove them from our tax
ID. I don't believe I can move forward until I get this resolved.
A: Due to a spike in calls, it is taking
longer to respond than we anticipated. We have added resources to this group to
handle the backlog. In any event, if you have already left a message for the
Security unit, please do not call them again.
They have logged every call that has come in and are responding in the
order they received the call. We have
added resources to this unit to help keep up with the spike in calls that has
occurred. If you need help with
registration please contact provider enrollment at: providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2].
Q: Will we receive
confirmation that the registration process is complete? Is there a .pdf that
lists all steps needed to complete registration?
A: You will be notified via your ProviderOne in box. You will
find the ProviderOne Registration and Security Administration Manual at: http://hrsa.dshs.wa.gov/ProviderOne/documentation/Registration/PRR%20Desktop%20Reference%20guide.pdf
Q: I was told that
Leader Services will not be helping with the registration process. Is that
true?
A: Leader Services is
helping those school districts that they act as a clearinghouse for.
Q: If we have
completed Registration and the status is Complete in all the areas, is there
anything else a provider must do? Are we set to go?
A: This depends on how you bill. If you are a batch submitter, you
will want to do EDI testing. Please be sure to use the new identifiers. We
recommend you take training.
Q: Generally, how
long does it take for registration to be approved?
A: Generally about 2 weeks.
Q: What will happen
if we don’t answer a question in Steps 1-17 correctly – for example, on
Licenses and Certificate information? Will this impede the approval process or
payment?
A: That depends upon the specific step. For common registration problems and solutions, please see the Ten Common Problems Providers Face in the Registration Process at http://hrsa.dshs.wa.gov/providerone/documentation/Registration/10CommonRegistration.pdf
Q: When asked to
provide provider licenses, etc., where are those to be faxed or mailed?
A: The cover sheet
gives the address to the Provider Enrollment unit.
Q: During
registration, a domain name was assigned. What is the importance of this number?
A: You will use this
domain information each time you log in to ProviderOne.
Trading Partner
Agreements (TPAs)
Q: Do physician
groups who bill through a clearinghouse need a TPA?
A: You only need a
TPA if you will submit or receive a batch transaction...for any of the
transaction types.
Q: If I have been
billing individual invoices via WAMedWeb, do I need to do a TPA?
A: You won't need a
TPA if you only directly enter individual claims into the ProviderOne portal.
Q: Our dental department uploads claims
directly to DSHS via a file. Is this when I would need to complete a TPA?
A: Yes. You will need to submit a TPA prior to
testing (assuming you upload batch transactions).
Q: Is the TPA required
if we submit thru a clearinghouse, but download our own RAs?
A: You only need a
TPA if you will submit or receive a batch transaction...for any of the
transaction types. If you download batch 835s, you will need a TPA.
Q: If we submit
claims through a clearinghouse and receive our remittance advices directly from
ProviderOne, do we need a new trading partner agreement?
A: If you receive a
HIPAA 835 transaction, then you will need a TPA. If you only access the PDF RA
online, you won't need a TPA.
Q: Our clearinghouse sends electronic batches
for us. Do we still need a TPA?
A: You only need to submit a TPA if you will
submit or receive any type of batch transaction.
Q: How are we
notified that the TPA has been accepted and what our new submitter number is?
A: You will receive a
submitter letter.
Q: Can multiple NPI
numbers be linked to one TPA?
A: You can submit one TPA for all NPIs
associated with one Tax ID.
Q: What if we can't
locate our existing trading partner agreement?
A: If by existing
trading partner agreement, you mean the one you have to bill in the legacy
system, it will need to be replaced with one for
ProviderOne.
Q: Where can I find
the blank Trading Partner Agreement?
A: Go to http://hrsa.dshs.wa.gov/providerenroll
and click on Trading Partner Agreement in the “What’s New” box.
Q: Will a new TPA be
required for providers receiving 835 RA only?
A: Yes.
Q: Do I need to fill out
the Trading Partner Agreement if we use a Clearinghouse?
A: No. You only need to fill out and submit a Trading Partner
Agreement if your organization is going to submit or receive any type of HIPAA
batch transaction.
Q: You stated I only
needed one TPA per tax ID. Well, I did 5 – one for each NPI. How is that going
to mess up my testing or anything else I need to do?
A: This should not interfere with your EDI testing.
Q: I sent in a TPA
and didn't need to because we use a Clearinghouse to submit claims...is that a
problem?
A: No. It's not a problem. You may get a phone call asking you if you
meant to choose a different transaction submission method during your
registration process. Not a worry.
Q: We have one
taxonomy number, but multiple NPIs. Does this mean that we only need one TPA?
A: You need one TPA
per tax ID.
Q: Do we need to
complete testing if we are using WAMEDWEB?
A: If you submit
claims one at a time, then you do not need to complete testing.
Q: Is any testing required for providers who
use a clearinghouse and do not submit directly?
A: No, unless you submit or receive other
types of batch transactions.
Q: I submitted a test file this morning. How
long will it take to receive the TA1 & 997?
A: By contract, our vendor is required to
respond within 24 hours.
Q: We use a clearinghouse for claims
submission. Do we need to do any type of testing for payments and RAs?
A: You only need to test if you submit or
receive batch transactions of any type.
Q: Is testing required for 835 only?
A: It is required for any type of HIPAA
batch transaction.
Q: Are we able to
test a claim on ProviderOne already?
A: There is no test environment for Direct Data Entry. Testing must be
done for HIPAA batch transactions in the EDI testing environment.
Q: I was told that we
wouldn't need to test our WAMedWeb connection because it wouldn't be changing.
But now it sounds like it is changing. Do we need to test it?
A: If you currently use WaMedWeb for direct data entry only
and do not submit or receive any HIPAA batch transactions, there is no need to
test. If you submit or receive HIPAA batch transactions then you need to test.
Q: If we are already
currently sending EDI claims, do we need another trading partner agreement?
A: Your current Trading Partner Agreement is with ACS, not DSHS. A
new trading partner agreement is required to submit or receive these
transactions through ProviderOne.
Q: We'd like to do
the pilot test. How?
A: The pilot test has ended. The only testing going on now is the HIPAA
EDI testing.
Q: I am confused
about the EDI testing. I got a note to start testing, but I don’t know where to
go. Is it the Web site HIPAAtesting.htm?
A: Please refer to
the HIPAA Batch Testing – Getting Started information at http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR007%20HIPAAtesting.pdf
Q: Will there be a
webinar for all staff for training on eligibility, authorizations, referrals,
etc.? I didn't see one listed.
A: Yes there will be
training for staff on eligibility, authorizations, referrals, claims submission,
etc. Watch for more information on this “system training.”
Q: Who should attend
these training sessions?
A: Anyone who will be
accessing the ProviderOne system should attend these webinars.
Q: Are you sending
people out to help set up offices?
A: No. If you have
questions, please use the contact information given in the webinar. There also
is an e-learning regarding registration located on the training page at: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm
Q: When will
providers be able to sign up for the systems training?
A: The schedule is currently posted, so you can save the dates and times you
want to train. The links to register will be available towards the middle of
the week of October 12th. Here's the link: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm
Q: Will we be able to
practice looking up client IDs in ProviderOne client eligibility before
go-live?
A: No. There is no
access to the “live” system prior to go live. We recommend you take the
Eligibility Tutorial for a close representation of how the system works. There
also will be training offered specific to this topic beginning October 19th.
The system training schedule will be posted at http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm
Q: How do I find the
tutorial for staff?
A: Go to http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm
Q: Could you please
confirm the website for the tutorials.
A: Provider Training: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm
Q: Will there be any
site trainings? If so, when and where?
A: Times and places
will be announced very soon.
Q: Will the site
training be ProviderOne user training?
A: It will be system
training on ProviderOne: Direct Data Entry Claims, Eligibility Inquiry and
Essential ProviderOne Information.
Q: Will you have your
staff come to our facility to train?
A: There will be more training by Webinar on claims submission, client
eligibility and preauthorization beginning October 19th. Currently there is a
Claims submission tutorial available and the Provider System User Manual is
available at: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm These are very good resources.
Q: Where do we obtain
the information for the training in Spokane?
A: On the training page of the ProviderOne website. More information
will be posted soon.
Q: What training link
do I go to?
A: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm There is an eLearning version of the
registration process available. There is a tutorial you can use to help assist
you set up user accounts (security) as well as a Registration and Security
Administration Manual. There is also a webinar for setting up your user
accounts (security). Check the schedule for live system training webinars. Let
me know if you need assistance finding any of these specific areas on that
page.
Q: Where can we get
training for WinASAP users?
A: They can find the PowerPoint with information about setting up
and doing EDI testing with WINASAP before go-live at the bottom of this web
page: http://www.adsa.dshs.wa.gov/professional/providerone/registration.htm If they have questions about testing, the
HIPAA-help email and phone numbers are in the web page, too.
Q: Which seminar
should we do next if we mainly do reception work?
A: Essentials and Checking Eligibility.
Q: Will the Provider
User Manual give enough information to new users or should all new users sit in
on a tutorial?
A: The ProviderOne
Billing and Resource Guide, the ProviderOne Registration and Security
Administration Guide, and the ProviderOne System User Manual are excellent references.
Tutorials allow you to practice tasks they way you will in the live system, so
we recommend the tutorials, too.
Q: So, we can start
submitting the new patient ID numbers on 11/21/09? They just won't be processed until 12/6/09,
correct?
A: Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: What is the
difference between a HIPAA batch submitter as opposed to the others?
A: All batch submissions must adhere to HIPAA format. Direct Data Entry
is one claim at a time.
Q: Will paper claims
still be accepted?
A: Yes. Be sure to use
the new identifiers on them.
Q: Will we still be
able to send paperwork regarding denture pre-authorizations to the Dental Auth
Dept?
A: Yes.
Q: Will paper claims
be allowed when an EOB from another insurance is required to be attached to the
CMS-1500 in order to receive payment?
A: You will still be
able to submit paper claims. You will need to use the new ProviderOne client
ID, date of birth, gender, and taxonomy. Please participate in the Webinars for
claims submission beginning October 19th.
Q: Where on the
HCFA-1500 are you going to require the taxonomy codes be placed?
A: This is a claims
training question. Please check our Web site for training dates soon.
Q: Where on the paper
claim does the taxonomy code need to be listed?
A: There will be a ProviderOne Billing and Resource Guide
with this information available before go live.
Q: Currently we bill
the DSHS provider number in box 17a and the NPI in box 17b for referring
providers. When you go live with ProviderOne, does the old DSHS provider number
need to be removed?
A: Yes. You will need
to use ProviderOne identifiers on paper claims, as well. There is currently a ProviderOne
Billing and Resource Guide in production that
will show you how to bill on paper. It will be available on about 30 days
before go-live.
Q: Can we still send
paper claims if we need to send primary payment EOB along with it?
A: Yes you can.
There is a function in ProviderOne that allows you to submit backup information
electronically.
Q: You do need to
register with ProviderOne even if you just submit paper claims, right?
A: Yes, you need to
register. Completing registration allows you to:
·
Verify addresses where payments will go.
·
Review performing providers associated
with your organization.
·
Report missing data, such as National
Provider Identifiers, that could affect payments.
·
Learn the DSHS taxonomies associated with
your organization. You will need these for billing.
·
Make sure your license information is up
to date.
·
Avoid a full-scale re-enrollment and
credentialing effort.
Q: Will submission of adjustments still be via mail?
A: In ProviderOne, you may adjust claims online or by using the
paper adjustment form. For more information, please refer to the ProviderOne Billing and Resource Guide
at http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html
Taxonomies
Q: Will taxonomy code
effect provider payment?
A: Yes. Please
participate in the Webinar for Taxonomy. The schedule is posted at http://hrsa.dshs.wa.gov/providerone/ScheduledWebinars.htm
Q: Taxonomy
codes - If we are pediatrics and do mostly E&M codes, are there different
taxonomies we have to use?
A: We will offer a
taxonomy webinar starting next week. You may want to attend.
Q: If a provider has more than one taxonomy
number, do we need to change the taxonomy based on which specific service is
performed?
A: You will need to bill with the taxonomy
code that corresponds with the service performed and is associated with your
organization.
Q: Will there be a problem on claims for those
providers who have not changed their taxonomy from student status to their
graduated specialty?
A: We encourage you to update your taxonomy in
step 3 of registration.
Q: What box does our taxonomy number go in on
the HCFA?
A: There is a ProviderOne Billing and Resource Guide that will be available that
will cover this. You will find the link on our Web site when it’s available.
Q: Do we use our taxonomy number instead of
our provider number?
A: You will need to use both your taxonomy
number and your ProviderOne provider ID, along with your NPI.
Q: I was signed up for ProviderOne about 6
months ago. I could log in and move around without a problem. Now my account is
frozen. What is a taxonomy number? I tried to get one this morning and the Web
site is frozen.
A: Please email the following address with
your issue and NPI in the subject line: provideronesecurity@dshs.wa.gov The following link will take you to a
document that speaks about taxonomy: http://hrsa.dshs.wa.gov/ProviderOne/Providers/Fact%20Sheets/P1PR009%20taxonomy.doc There is also another webinar that will cover
Taxonomy. Go to: http://hrsa.dshs.wa.gov/providerone/ScheduledWebinars.htm Click on one of the links for using Taxonomy
and Other New Identifiers to Get Paid to register for one of these webinars.
Q: If a provider has
two taxonomy codes, do both codes have to be indicated in ProviderOne in the
registration field?
A: Both codes should
be seen in step 3 of the registration process.
Q: Will referring
provider taxonomy be required?
A: No.
Q: When you have
multiple taxonomies assigned to a provider by the crosswalk, and only one that
you can assign to your provider in your practice management system, how do you
choose which taxonomy should be used?
A: It depends on how
many lines of business you are billing for. If you are billing for multiple
lines of business, you are going to have a problem with only one taxonomy. If
it is one line of business, such as physician services, you should pick the one
that most fits the services you will be billing for.
Q: When I tried to
enter the Taxonomy code for a Pediatric dentist it would not let me. It only
gave me a General dentist option.
A: You will need to
add the appropriate taxonomy during Registration. We did a “best guess” when we
assigned taxonomy codes based on provider type and specialty in the legacy
system.
Q: Our physical
therapists have been assigned numerous (i.e. 10ish) taxonomy codes on
ProviderOne. Should we review these and remove all but one? If all are
applicable, how do we decide which is correct for claims?
A: I do not recommend removing all but one. Choose the taxonomy that
most closely represents the service being billed for.
Q: Where does Taxonomy need to be on the
claims?
A: For where to place NPI and Taxonomy Codes on paper claim,
please refer to Memo# 08-59 issued 8-18-08: http://hrsa.dshs.wa.gov/download/Numberedmemos.html
Q: We are a skilled
nursing facility that also has an outpatient program. Will there be different
taxonomy numbers that we will bill with?
A: Please download your taxonomies and take a look at what
taxonomies have been assigned to your organization: https://fortress.wa.gov/dshs/npicaphrsa
Q: Where
do I find out taxonomy?
A: You
can find your taxonomy in step 3 of the registration process, or you can go to
the following link and find your taxonomy: https://fortress.wa.gov/dshs/npicaphrsa
Q: How do
we get our taxonomy number?
A: The
taxonomy(ies) assigned to your provider file can be viewed in two ways:
1) When you register or maintain your provider file
during Step 3 of the registration business process wizard. See page 75 of the ProviderOne Provider Registration and
Security Administration Manual: http://hrsa.dshs.wa.gov/providerone/documentation/Registration/PRR%20Desktop%20Reference%20guide.pdf
2) Go
to https://fortress.wa.gov/dshs/npicaphrsa/FrontDoor.aspx, click on the Taxonomy Tool, and download the list of
assigned taxonomies for each of your organizational NPIs.
For more information, please see DSHS’ Memo 08-59, at this Web
page: http://hrsa.dshs.wa.gov/download/Memos/Year2008.html
Q: Are we required to have physician’s
taxonomy data on the UB-04, along with the hospital taxonomy number?
A: The attending physician’s taxonomy is not
required.
Q: Our radiologists have been assigned multiple
taxonomy codes in ProviderOne. When submitting a claim, do we use the taxonomy
code with the highest level of specificity for the service billed?
A: If it’s a hospital claim, like
outpatient, use the billing provider taxonomy for the facility, like
282N00000X. If it’s a professional claim, then yes, use the most specific
taxonomy.
Q: Taxonomy = provider tax ID number, right?
A: No. I recommend you attend the webinar on
taxonomy and read the fact sheet at the following link: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR009%20taxonomy.pdf
A:
Q: What date is the
last date for direct data claims on WAMedWeb?
A: Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: We are a school district
and bill for services provided to students by OT, PT and SLPs. Can these all be
billed under our district NPI?
A: Yes.
Q: If a patient does not have coverage in
December, and we are resubmitting a June claim in ProviderOne, what ID would I
use, since the patient does not have the new ID#?
A: You will need to use the ProviderOne ID.
All of this information will be converted from the old system in to
ProviderOne. You will need to use all identifiers for ProviderOne.
Q: What is going to happen to newborn baby
claims using the mother's ID number, if client ID has to match date of birth
and gender?
A: This will be covered in the system training
beginning October 19th.
Q: I enter claims through WAMedWeb. So my
deadline is 11/20?
A: The schedule has changed. Please visit the
implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: I've had to send in a copy of a coupon when
the claims are denied. This happens rarely, but it does happen. Does this new
system hold eligibility information?
A: Yes.
Q: Will there be a problem on claims for those
providers who have not changed their taxonomy from student status to their
graduated specialty?
A: We encourage you to update your taxonomy in
step 3 of registration.
Q: When do we have to start using the ProviderOne
client ID on each claim?
A: Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: Currently when we
have DSHS as a secondary insurance, we submit a paper claim with a copy of the
EOB attached to it. How is this going to
work when submitting through ProviderOne?
A: You can submit
adjustments on paper or through ProviderOne. You will need to use the new
identifiers with all claims/adjustments. Attachments can be sent through
ProviderOne.
Q: Is it okay if the
old MMIS number is on the claim or do you want ONLY the NPI for referring
providers?
A: The NPI for the
referring provider is required, along with the new client ID. Taxonomy is not
required for the referring provider.
Q: Is it correct that
the ProviderOne Client Identifier and Taxonomy information can be submitted to
DSHS from 11/21 forward?
A: Our schedule has changed. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: Is there a list of
the specific changes for electronic claim form requirements due to ProviderOne
implementation?
A: This information
will be included in the ProviderOne
Billing and Resource Guide.
Q: Are modifiers
needed on any DME codes?
A: ProviderOne does
not change any billing rules. If a modifier is required today, unless a billing
rule changes, it will be required at go live.
Q: Can you be a
Direct Data Entry, Paper and Clearinghouse submitter, or are you required to
make one choice?
A: You can choose them all.
Q: Can we still bill
secondary via paper?
A: Yes. You can also
bill secondary through ProviderOne. Claims generally adjudicate faster when they come in electronically.
Q: We have heard
rumors that there will be no eligibility information available during the first
week after the cutover to ProviderOne. Is this true? If so, how will
eligibility be confirmed during this time?
A: That is not true.
You will continue to get eligibility information through WAMedWeb.
Q: So WAMedWeb will continue to be available
for a period of time after go-live?
A: No. All activities will be done through
ProviderOne beginning at go-live.
Q: Can I still enter
into WAMedWeb as "new claim" or only a batch file until 11/20/09?
A: Our schedule has changed. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: On preparing for
cutover, 10/31/09 is the last accepted date for processing claims using the
legacy number; does that mean you will no longer accept the Medicaid provider
number which the provider must have in order to register in ProviderOne?
A: Our schedule has changed. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm You must use your NPI at ProviderOne implementation.
Q: What happens to
extremely old claims that were rejected in the current system; will they time
out in ProviderOne if the claim is over 365 days?
A: Timeliness will roll over to ProviderOne.
Q: I just want to
make sure I understand that claims with dates of service 11/21-12/05 will need
to be billed to ProviderOne on 12/06 or thereafter.
A: Our schedule has changed. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: The last paper
claim date - is that mailed or received at DSHS?
A: It is a “received by” date. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: Will you reject
claims after the cutover date if they have the legacy numbers in addition to
the NPI numbers and taxonomy codes?
A: We will not
reject the claim, but it will be denied.
Q: How far back can
we make adjustments to the claims in ProviderOne - e.g. If I had submitted a claim
in June 09 which needs to be adjusted, will I be able to adjust with
ProviderOne
A: Yes. We converted the last 4 years’ worth of claims. When you
make an adjustment after go live, ProviderOne requires the new identifiers we
just spoke about.
Q: What will happen
with Medicare crossovers? For our clinic, we were told that they would not
accept the Medicare crossover; will this change with ProviderOne? Will we still
do paper HCFAs for the crossover, or will they bring back the electronic
crossover again for all providers?
A: In most cases,
after processing the claim for payment, Medicare will forward the claim
electronically to DSHS and include a message on your Explanation of Medicare
Benefits (EOMB) stating: “This information is being sent to either a private
insurer or Medicaid.” DSHS then processes these crossover claims without any
action on your part. Sometimes, Medicare does not forward claims automatically
to DSHS, so you may have to bill your crossover claim to DSHS with a copy of
the EOMB attached. You will know if Medicare has not forwarded your crossover
claim to DSHS if:
·
It does not show up on your Medical
Assistance Remittance Advice; or
·
The message “This information is being
sent to either a private insurer or Medicaid” does not show up on your EOMB.
For
more information, please refer to the draft ProviderOne
Billing and Resource Guide, Submit Fee for Service Claims to Medical
Assistance, Key Step 4: http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html
Q: How long will a
.pdf Remittance Advice (RA) be left on ProviderOne?
A: 4 years.
Q: I understand that
each NPI will be assigned its own domain. Does this mean we have to remember
each domain and look each provider up for the RA as an individual, or can we
look it up under a group domain?
A: You will look up RAs according to your group domain.
Q: Are all payments electronic?
A: No. You may elect to receive paper checks.
Q: I currently get
paper remittances now. What do I need to do to get signed up for the PDF
remittance?
A: First of all I'm going to assume that you will be the person accessing
your RA. Make sure you are assigned a profile in the security set-up that
allows you to do this activity. To view a list of ProviderOne Security Profiles
go to http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm#Security_Training_Materials Click on Security and then click on
ProviderOne Security Profiles. Your organization must have completed
registration and be approved by provider enrollment.
Q: I will be the one
accessing the RA and I have already been approved for ProviderOne and am
testing claims now. ProviderOne Registration didn't ask me to get electronic
remittance in order to be approved. What do I do now that I'm approved, in
order to get the .pdf RA?
A: We started system training this week and this activity is covered in
that training. If you would like to review this activity, I recommend you
access the eLearning version of one of the claim submission types. The eLearning
version is broken down by activity. You can go to the area that deals with
accessing your RA. http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm
Q: I
did not know we will be required to download the new RA. How do we find out
about this?
A: This information is in the claims training.
Q: Can we download
the RA .pdf if we haven't done 835 testing and received a +997?
A: Yes. You just need to have the correct security profile assigned to
you (or the person who will be downloading the RA) and to have your
registration approved.
Q: Will I still be
able to get my RAs through Medicare Remit Easy?
A: You will be able to get your RAs through ProviderOne.
Clearinghouses and Billing Agents
Q: We are a billing
service, and have multiple NPIs for different clients and specialties. Can we use the security spreadsheet and upload
to DSHS to complete security for all of our clients and employees?
A: No need. Your
provider clients will set up their own security.
Q: As a billing
service, we will be performing this service for each of our clients. Would we
be able to use one spreadsheet for all clients?
A: Please send an
email to our Security Unit at: provideronesecurity@dshs.wa.gov
Put
"Clearinghouse setting up security for client providers with
spreadsheet" in the subject line.
Q: What if our
billing agent doesn't know anything about ProviderOne?
A: Your billing agent
needs to complete security and registration. We recommend you give them a
gentle nudge.
Q: If our
clearinghouse has supplied us with their domain number for registration, can we
assume a TPA has been signed?
A: Yes.
Q: Will clearinghouse
be able to see who has designated them to submit claims and receive ERAs on
their behalf?
A: We’ve researched
this, and no, the clearinghouse cannot see that information. We recommend you
check with your clients directly about their registration.
Q: Do we have to have
a billing agent clearinghouse? Can we just have payment submitted to us by
check like it is now?
A: You do not need a
billing agent or clearinghouse. You can continue doing business as you have
been.
Q: If we use a
clearinghouse, then we do not need to sign a new TPA, right?
A: Correct.
Q: Does the cutover date include clearinghouse
claims?
A: Yes.
Q: Is any testing required for providers who
use a clearinghouse and do not submit directly?
A: No, unless you submit or receive other
types of batch transactions.
Q: If we use a
clearinghouse, do we have to do anything or are they responsible for completing
the TPA?
A: They are
responsible for completing the TPA. You need a TPA only if you will be
submitting or receiving any type of HIPAA batch transaction.
Q: Do you know if the
SSI Clearinghouse has started testing?
A: We have posted
information on our Web site showing the testing status of billing agents and
clearinghouses. The view this information, go to http://hrsa.dshs.wa.gov/providerone/documentation/BACHStatus.pdf
Q: I’m really new to
ProviderOne – I’m the clearinghouse and when I logged in, I didn’t really know
where to go. Do I still go through this training?
A: Link to Clearinghouse testing: http://hrsa.dshs.wa.gov/providerone/documentation/BACHStatus.pdf
Q: Does this new plan
mean that we cannot bill through Emdeon and are required to bill directly to
DSHS ProviderOne?
A: No. You may
continue to bill through your clearinghouse.
Q: So - if I
understand correctly - our clearinghouse would need to change the claims format
with cutover?
A: That is correct. They should be testing now. You can go to the
following link to see where your clearinghouse is in this process: http://hrsa.dshs.wa.gov/providerone/documentation/BACHStatus.pdf
Q: I see my
clearinghouse has not tested yet. Are all the clearinghouses following a
schedule?
A: You may want to contact your clearinghouse and give them a
nudge to complete their EDI testing. BA/CH testing status: http://hrsa.dshs.wa.gov/providerone/documentation/BACHStatus.pdf
Q: The clearinghouse
listed for our practice is McKesson but our clearinghouse is Paypath. How do I
change this info?
A: You may want to make sure that Paypath was not merged with or
purchased by McKesson. You can change this information through the Business
Process Wizard you used to register.
Q: Will
providers need to designate the clearinghouse that will be submitting claims
and receiving electronic remittance advices on their behalf within the
ProviderOne system?
A: Yes. You will designate your clearinghouse in Steps 11 through 14 of the registration business process wizard. You can find details and instructions under Registration at the ProviderOne training Web page: http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm
Q: If I
submit to my clearinghouse and they have successfully passed testing, am I good
to go?
A: We
recommend you set up security and complete registration in order to be ready for
ProviderOne. Also, it’s important that you work with both your software vendor
and your clearinghouse to make sure your claims can be successfully submitted
to ProviderOne. Your claims will need to include the new identifiers that DSHS
will use in ProviderOne: NPIs, ProviderOne Client IDs, and taxonomy.
Q: If we
use a clearinghouse to receive our remits, will we also be able to download the
.pdf remit from ProviderOne?
A: Yes.
Q: On the
associate billing agent/clearinghouse page, how do we know the start date and
when to authorize a “yes” or “no” for each transaction in the registration
process?
A: For a
state date, use the date you want your billing agent/clearinghouse to begin
submitting transactions on your behalf. You can choose today’s date. Your organization
needs to determine which transactions you authorize your billing
agent/clearinghouse to complete.
Q: We
utilize a clearinghouse for claims submission. What will they need to test in
advance? Is there information on this somewhere?
A: Clearinghouses
have been receiving communications about ProviderOne. You may want to check
with your clearinghouse to make sure they are or have been testing with us. To
find a list of clearinghouses/billing agents stating where they are in this
process, go to: http://hrsa.dshs.wa.gov/providerone/documentation/BACHStatus.pdf
Q: Has McKesson tested?
A: You may check the status of your
clearinghouse or billing agent at http://hrsa.dshs.wa.gov/providerone/documentation/BACHStatus.pdf
Q: We do the majority
of our billing through a clearinghouse, but sometimes we have to mail in a
paper claim. Will we require a TPA?
A: You only need to
submit a TPA if your organization is going to transmit HIPAA batch transactions
of any kind. If the only type of transaction your organization will submit is
via paper, then you do not need to submit a TPA.
Q: Will the
eligibility response also identify recouped managed care premiums when a
patient's eligibility changes for past months?
A: The recouped
premiums won’t “show.” The eligibility will, however, reflect that the client is
no longer enrolled during the time period the premium was recouped for.
Q: Will ProviderOne
be accessible for client eligibility 24 hours per day every day?
A: Yes.
Q: If a client has
lost their card will we be able to access their new ID number through Provider
One?
A: Yes, you can do
that in the same way you do using WAMedWeb today.
Q: Will non-attending providers be able to
verify eligibility and check claims status online?
A: All staff who are set up in ProviderOne
with the appropriate profiles will be able to complete these functions.
Q: What will be listed as far as client
eligibility? For instance, will it show if a client is eligible for vision
benefits?
A: There will be system training beginning
October 19th. Checking client eligibility is one of the topics we will be
offering training for. There is a section that shows the Benefit Service
Package. Please look at your listserv either tomorrow or Friday. The system
training schedule will be posted then.
Q: Should we keep a hard copy of eligibility
verification?
A: That is up to you.
Q: How will we know if a patient is receiving
services thru Molina or Regence or another HMO?
A: You will check on eligibility through
ProviderOne. The MCO will be named.
Q: When will there be
data in ProviderOne that we can use to review the system (i.e. eligibility
inquiries)?
A: At go live.
Q: If the client’s
date of birth does NOT agree with your information, what then?
A: You can either
have the client contact the Community Service office or you can contact their
Community Service office. This is the same process as we have today.
Q: So if we are
unable to verify the patient’s eligibility at the time of service, are we to
turn them away?
A: You can verify their eligibility through IVR, through
ProviderOne, or through the call center. You may want to take the Checking
Client Eligibility training: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training
Q: When will the new
system be available to do eligibility look-ups?
A: At implementation. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: If I schedule a
patient today for service to be provided in two weeks, do I need to recheck
eligibility on the date of service? Can I check eligibility the day before,
even if I don’t have the card?
A: Yes. However, we
recommend you check the eligibility on the date of service.
Q: For eligibility,
if the patient is with Molina, will ProviderOne provide a link to Molina’s Web
site to verify the client’s PCP?
A: No.
Q: Will ProviderOne
be able to upload local CSO data, like paperwork turned in, status of
application, etc.?]
A: Local CSO data will not be available in ProviderOne.
Q: If the eligibility
comes back as Molina, will it tell you if it is an IPA or fee for service?
A: No.
Q: When will the
eligibility information be loaded into ProviderOne for viewing?
A: Providers will be
able to view eligibility information using ProviderOne when ProviderOne goes
live.
Q: Will other
benefits show in ProviderOne, such as vision, i.e. whether they have an exam or
hardware available?
A: That information
will be available as ProviderOne accumulates data. It will not be available at
the time we go live.
Q: We see children in
the hospital and confirm coverage a couple of days prior. This new system will
only allow us to confirm coverage the day of the appointment. This will create
an incredible amount of last-minute cancellations. Is DSHS
concerned about providers possible having to stop providing services due
to loss of income?
A: The ProviderOne
system allows you to continue to confirm coverage a couple of days prior. DSHS
has always suggested that you confirm coverage on the date of service. Client eligibility
rules have not changed. Generally speaking, coverage spans end on the last day
of the month. The system does not preclude your organization from continuing to
do business as you have in the past. In ProviderOne, you can check eligibility
at any time, as well as on the date of service.
Q: For a client under
a 72-hour ITA hold, we create the PIC with the letter Q as the TB. What is
going to happen now with the new ID when more often than not the client does
not have DSHS?
A: There will be a
training especially for RSNs on November 9th regarding Prior Authorization.
This topic will be discussed during that training.
Q: Does the new
trading partner agreement include pharmacy claims submitters that have been
using ProviderOne since last year?
A: If you only submit
pharmacy claims, you don't need a TPA. If you submit batch claims for other
reasons, you would need a TPA.
Q: Nursing homes and
pharmacies are included in Phase 1. We are a dental office. Do we still need to
meet the deadlines for registration and security, or will there be another
deadline for dental providers?
A: Yes, you are part
of phase 1.
Q: Our dental department uploads claims
directly to DSHS via a file. Is this when I would need to complete a TPA?
A: Yes. You will need to submit a TPA prior to
testing (assuming you upload batch transactions).
Q: We use CNP and LNP
to see if a client is eligible for Dental. Will the indicators change?
A: No.
Q: Medicare has patient IDs with suffix of WA.
Will that be a problem when a patient has Medicare and Medicaid?
A: This should not be a problem. Be sure to
include DSHS requirements when you submit to Medicare.
Q: Can you explain the
difference between billing providers and servicing providers?
A: Servicing providers are the providers who
provide a service to a patient. The billing provider is the provider who
submits the claim.
Q: So a Speech and Language Pathologist (SLP)
would be s servicing provider and our school district would be a billing
provider?
A: Correct.
Q: Do servicing providers need to be set up in
the system if they will be billing through a third-party Web system? It seems
like they will not ever need to log on to ProviderOne.
A: A servicing provider does not need
security. They do need to be registered, however.
Q: We have grown
since a year ago. Have new provider IDs been ported into the database?
A: As new providers are added to our current system, they are being keyed in
to ProviderOne.
Q: None of this makes
sense to me. We are a small school and have used Leader Services for our
Medicaid submittal. I just want to know what we have to do to be enrolled. One issue
is we cannot get on without using Internet Explorer. We are a Mac
platform-based school district. Please recommend which webinar is best for our
purposes. Thanks.
A: ProviderOne can only be accessed through Internet Explorer. Please
stay in this webinar. She will go through the steps you need to take to be
ready for the implementation of ProviderOne. You may also contact Leader
Services as I understand they have been assisting their providers through these
processes.
Q: Is there a specific
Taxonomy number for School Districts?
A: I recommend you download the taxonomy report to see what
taxonomies have been assigned to your School District.
Q: We are a school
district. Do we need to have a card reader to read the magnetic strip, or can
we simply use the number printed on the card?
A: Card readers are
not required to verify client eligibility. There are a number of free and
low-cost options for inquiring about client eligibility in ProviderOne. These
options are described in detail on this fact sheet: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR003-Options%20for%20Verifying%20Client%20Eligibility%20050508.pdf
Electronic Funds
Transfer (EFT)
Q: How do we sign up
for EFT?
A: You do this through the provider portal for ProviderOne. If
you want to do this today please contact Provider Enrollment providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2] There is a form you need to complete to make
this change today.
Q: How often will the
spenddown information be posted?
A: Updates are made
daily, based on the updates we receive.
Q: Will nursing homes
still receive the institutional award letters after go-live?
A: Yes.
Q: If we are using
WinASAP, but want to go live with ProviderOne, can we still submit adjustments with
WinASAP after the ProviderOne cutoff?
A: Nursing homes
that use WinASAP will be able to continue to use WinASAP in ProviderOne for a
time after go-live.
Non-nursing
homes will need to use ProviderOne directly for claims submission and for
adjustments to claims submitted prior to go-live, as they will not be supported
for WinASAP use.
WAMedWeb
Q: What happens to
the claims that are in process in WAMedWeb at cutover?
A: Any claims that
are not through adjudication will deny, and they will need to be rebilled in
ProviderOne with the new identifiers.