A: If you will not be receiving or transmitting any HIPAA batch transactions and will be using paper claims or Direct Data Entry when/if you submit any transactions, then there is no need to stay with this webinar.

Q: Will we continue to submit on paper secondary claims for DSHS and, if so, then the only changes would be to make sure taxonomies and new client ID numbers are on them, right?

A: You are correct. The other change is the use of NPI rather than your MMIS provider ID. I'm sending you the link to the numbered memo that tells you where to place the NPI and taxonomy on the claim form. 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 There are couple of links you can click on. If you click on one and just get a postcard click on the other and you'll get an actual memo.

Q: We have been told that our software company cannot talk directly to ProviderOne staff. Is this the case?

A: This is not the case. That does not mean that someone did not tell your software vendor that. If this happens again, please ask them to get the name of the individual they spoke with so we can train that individual.

Q: Who can we contact for help or to see if we are HIPAA ready?

A: I recommend you send an email to: hipaa-help@dshs.wa.gov [1-800-562-3022 select option 2,4,4]

Q: How do we know if we will submit or receive HIPAA batch transactions? Is there a list of what transactions are HIPAA batch transactions?

A: If you submit more than one claim or one client eligibility check at a time, then you submit batch transactions. If you "key" in claims one at a time, this is not a HIPAA batch transaction.

Q: Where do we find the Companion Guides?

A: Companion Guides can be retrieved by visiting http://hrsa.dshs.wa.gov/dshshipaa

Q: What do you suggest I do if I do not understand the Companion Guides?

A: I recommend you contact hipaa-help@dshs.wa.gov [1-800-562-3022 select option 2,4,4]

Testing

Q: Once we complete testing with positive TA1/997, will we get notice that we are ready for production?

A: No. Receipt of a positive TA-1/997 and custom report indicates that your file has proceeded to the next step.

Q: Sounds like we now will receive multiple 997s for each ST/SE. Will we also receive multiple reports for negative 997s?

A: You are correct.

Q: If testing is not passed by cutover, can our facilities still use WAMEDWEB to transmit claims?

A: No.

Q: When does testing absolutely need to be completed? How long will it take?

A: Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm

Q: I'm confused. Do we submit "fake" claims?

A: You need to send test claims - claims that have been modified according to the DSHS Companion Guides.

Q: Are "test claims" real treatment for patients or not? Will we be paid on them? Will we need to submit the way we currently send to get paid?

A: The test claims will not be paid through ProviderOne. You must use real 'identifiers' i.e. ProviderOne client ID, NPI, valid service codes, etc. However, the claim does not have to be one that you billed through the current MMIS system. Your real claims must be billed through the current MMIS system for payment.

Q: If you test using a client NPI number that has not registered, but the NPI is valid, will that reject? If so, how do you know if a client is registered in ProviderOne if a you are a billing agent?

A: Your clients' NPIs do need to be registered in ProviderOne. That is the responsibility of your clients. You may want to check with your clients to verify that they have registered all of their NPIs.

Q: Is the Companion Guide something that we as the providers should be reading or is it something our clearinghouse needs to read?

A: Your Clearinghouse should be reading this. You only need to read it if you will be submitting or receiving any type of batch transaction.

Q: Please clarify that testing on the site will continue until cutover. There is a 2-week blackout period that is unclear if testing is available.

A: Testing is not available during this two-week period. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm

Q: Do you need to sign up for content compliance?

A: Steps 11-14 during registration indicate whether or not you need to test.

Q: I do the EDI for an RSN as well as a Community Mental Health Center. If I pass the format 837 for one, will it satisfy the other? The software being used is the same across the system.

A: Yes.

Q: Do you need to receive the new submitter number before obtaining a SFTP account?

A: Yes.

Q: When will content testing end? How long is it taking for the 835 to be generated after a test file is received?

A: Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm You can test again after go live. 835s are posted each Monday.

Q: I did follow the guide for encounters, but got errors that appear outside of those guidelines. Who do I contact to try to sort these out?

A: HIPAA testing issues: hipaa-help@dshs.wa.gov [1-800-562-3022 select option 2,4,4]

Q: I am submitting direct data entry to ProviderOne; does that mean I do not need to do ANY testing? After I receive the approval of registration from ProviderOne, can I can start submitting claims directly into ProviderOne after go-live?

A: No testing is required for DDE. You will submit your claims on or after the go-live date.

Q: For testing, is there a contact I can reach for questions since we are almost out of that testing period?

A: If you are referring to EDI testing you can contact the HIPAA testing issues unit at: hipaa-help@dshs.wa.gov [1-800-562-3022 select option 2,4,4]

Q: The website access to the EDI environment is not valid. Is this the correct address? https://www.waproviderone.org/EDI

A: This is from the 827 companion guide: 4. The trading partner submits all HIPAA test files through the ProviderOne web portal or Secure File Transfer Protocol (SFTP). Web Portal URL: https://www.waproviderone.org/edi

Q: Do I need to test even if I use a Clearinghouse for Dental claims?

A: You only need to test if you will be submitting or receiving any type of batch transaction. If you will not submit or receive any type of batch-HIPAA transaction then you do not need to test. You may want to make sure your files are compliant with your Clearinghouse. Contact your Clearinghouse to do this.

Q: What's the lag time between our getting the 997 and the custom report?

A: 24 hours. It usually takes a few minutes however.

Q: I'm currently testing with my clearinghouse, as they requested we be a test provider. Do I need to do anything further with DSHS for testing?

A: No, as long as you are not submitting or receiving any HIPAA transactions.

Q: When trying to send an 837, we get "link not active." How do we get the link active?

A: Please make sure you were using the link made available to you from the companion guide. Many users get this message because they are using the link to the ProviderOne live system, which is not live yet.

Q: What order do I start testing? It looks like I would test the 837 claim first then the 835 should be returned?

A: Yes. We recommend you test the 837 first. Once this is submitted and moves on through processing, an 835 will be processed through our normal payment schedule.

Q: We've received a positive 997 and a positive TA1 in both 837P and 837I testing, but we have not yet received the ETRR. What is the ETRR? Where do we find it?

A: The ETRR is an electronic remittance and response specific to managed care submittals.

Q: Is the test system running on time? Should I expect a TA1 997 the next day?

A: Yes. The file acknowledgments should be returned within 24 hours of submittal.

Q: If a provider is not set up for the 835 electronic, how will they know if their test claims processed successfully, since they do not receive the 835?

A: There is no way in the EDI environment to validate successful processing. We are using this environment to test EDI format.

Q: We submit claims through a clearinghouse, but we receive the 835 ERA. Do we need to do the testing?

A: Make sure during registration that you completed step 16 indicating you want to receive the 835. Verify that in step 14 you did not indicate that you want the 835 to go to the clearinghouse. Step 14 overrides step 16.

Q: Will the 835 be produced once a week during testing? Are 277U and 835s running behind in the test system?

A: The 835 and 277Us will be generated weekly based on a payment cycle.

Q: Can our test files use the old PIC number or do we need the new format only for testing?

A: You will need to use the new ProviderOne client ID for testing. 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 if we receive a TA1 acknowledgement, but never receive a 997 functional acknowledgement?

A: There may be errors within the header of your transaction. Look at the TA1 for errors. If there are no errors identified, please contact the EDI help desk: hipaa-help@dshs.wa.gov [1-800-562-3022 select option 2,4,4]

Q: 2.2 of the 837 Companion Guide, showing uploading batch via web interface, shows tabs across the top of the ProviderOne portal. I only see the first tab (“my inbox”) when I go into ProviderOne. Where do I need to go to see all of the other tabs, such as “admin,” “provider,” “claims,” etc.?

A: The tabs are not in the system. The Companion Guides were developed before this change was made in the system. We will be updating the Companion Guides. Provider functionality is listed down the left side of the page.

Billing Agent/Clearinghouse

Q: We upload batches to Office Ally and they pass them along to DSHS. Are they the ones responsible for batch testing? Do I need to attend this webinar?

A: Office Ally will need to test with us. You may want to work with Office Ally on their testing effort. The claims you send to Office Ally will need to include new identifiers and you can learn about that during this webinar.

Q: If you are a billing agent, are you the only one that needs the TPA (not your clients)?

A: As long as your clients do not submit or receive any batch transactions, they will not need a TPA.

Q: Will clearinghouses be able to see in the ProviderOne system the providers who have designated us as their clearinghouse to submit 837s and receive 835s?

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: If we use a clearinghouse, then they are the ones that are uploading the files thru ProviderOne, correct?

A: Yes.

Q: Where is that list of clearinghouse providers and their status?

A: http://hrsa.dshs.wa.gov/providerone/documentation/BACHStatus.pdf

Q: I submit my claims to DSHS through Availity every day, so do I need to be doing a test batch or do they need to do the testing?

A: Avaiity will need to do the testing. You only need to test if you will either submit or receive any HIPAA batch transactions. You may want to connect with Availity to make sure that your software is compliant with Availity’s while using the new identifiers required in ProviderOne.

Q: We submit claims through a clearinghouse. I am confused as to who is responsible for submitting the test batch? Is this something that I need to contact my clearinghouse for to make sure it gets completed?

A: Your clearinghouse needs to complete this testing. We have list available of clearinghouses and where they are in the testing process http://hrsa.dshs.wa.gov/providerone/documentation/BACHStatus.pdf

Q: I represent a clearinghouse. I know my submitter ID, but not my ProviderOne ID. How do I find out, or get, my ProviderOne ID?

A: As a clearinghouse, your ProviderOne ID is your submitter ID.

Q: Where do I get the Billing Agent/Clearinghouse Provider One ID?

A: Please contact your clearinghouse directly to get their ID.

Q: We will be submitting claims through our clearinghouse, but need to make sure the “content compliance” testing is done through ProviderOne. Do you recommend we send test claims through our clearinghouse for them to submit to ProviderOne on our behalf?

A: Yes. Your clearinghouse would need to obtain your 835 on your behalf.

Q: If our clearinghouse showed “in process” earlier this month and now reports “passed,” does this mean they have passed the format (997) or does it include the 837 content compliance portion (including generating the 835 ERA?

A: Format testing.

Remittance Advice

Q: Will I be able to access RAs through the ProviderOne portal in PDF format if I am submitting through Office Ally, or will I need to access the RA through Office Ally?

A: You will be able to access RAs through the ProviderOne portal in PDF format as long as you have Security Access.

Q: If we didn’t put that we wanted to receive the RA on step 14, can we still go on ProviderOne and look at it?

A: You will be able to go in through the ProviderOne portal and download a .pdf of the remittance advice. You will need to be assigned the correct profile (EXT Provider Download Files) by your security administrator to do this.

Q: If you elect 835 electronic RA, will you still have access to the PDF version?

A: Yes.

Q: Is the electronic 835 available in the test environment?

A: Yes.

Q: So, you must receive the RA electronically? There will be no way to pull a paper RA in?

A: You are correct.

Q: Do we have the option to receive the remittance in paper form also?

A: No.

Q: When ProviderOne is up and going, can we get the Remittance Advice in paper?

A: The remittance advice will be available through ProviderOne only.

Security

Q: Does security have to be completed for everyone prior to EDI testing? These folks will be doing WAMEDWEB searches for eligibility.

A: Security must be completed only for those individuals who will be testing. You can continue setting up security for others after you set up the roles needed for testing.

Q: Can you give any help with the problem that we are currently locked out due to new password issue?

A: Security email: provideronesecurity@dshs.wa.gov Please send one email per issue and state your issue clearly in the subject line. (State that you are locked out in the subject line.) Be sure to include your ProviderOne ID or your Tax ID.

Q: If I am going to submit all transactions via SFTP, do I need to complete the security requirements?

A: Security gives you access to ProviderOne to update your provider file.

Security Profiles

Q: If I am the system administrator, I will have the needed access, correct?

A: Not necessarily. You must have an appropriate profile assigned to yourself to access RAs. The System Administrator profile does not allow you access to RAs.

Q: Can you tell which profile I will need to assign myself? I am the only person in our office who will be accessing ProviderOne and am responsible for managing all aspects.

A: I recommend that you go to: http://hrsa.dshs.wa.gov/ProviderOne/providers.htm Click on Security and click on the link to the Security Profile page. From there, you can decide which profile(s) will best suit your needs.

Q: I have access to all security profiles as I am the one responsible for all of our claim submission tasks. I have tried logging in under different profiles and cannot find where it says download RA. Can you help me?

A: Assign yourself the upload/download files profile.

Identifying Numbers

Q: Is the submitter number you are speaking of the domain number?

A: The submitter number is the ProviderOne ID. The domain number is the NPI that was federally assigned to your organization.

Q: If we are assigned a submitter number of 7 digits, does the 00 go in front of the 7 digits?

A: No, they go at the end of the 7 digits.

Q: If we have more than one submitter ID within our organization, are we required to do testing on each individual submitter ID to ProviderOne?

A: Yes please.

Q: How can we find out the status of the submitter numbers? We have registered and have not received a response.

A: Please contact Provider Enrollment at: providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]

Q: Are legacy number and MMIS number the same?

A: Yes.

Q: How long does it take to get a submitter number?

A: Your registration must be submitted for approval with your signed TPA. It takes about two weeks.

Q: How do we get our submitter IDs? I have completed all registrations, TPAs, etc. Our software provider said they have gotten three of the five needed, but the numbers they have are 10 digit numbers, not nine as you are saying. Nothing has been sent to the facility to give us these numbers. We cannot test without them. I have called and emailed many time and get no response. Why can't we get them?

A: Contact the HIPAA helpdesk: HIPAA-help@dshs.wa.gov and/or provider enrollment: providerenrollment@dshs.wa.gov

Trading Partner Agreement (TPA)

Q: I'd just like to verify that if we do batch submission via a clearinghouse, but occasionally key individual claims direct to DSHS, that we do not have to complete an additional TPA separate from the clearinghouse TPA. Correct?

A: You are correct. You only need a TPA if you will submit a batch transaction...for any of the transaction types.

Q: The fact that we have received the letter with our domain number does not necessarily mean we have a new TPA on file?

A: You are correct. The submitter letter indicates that we have your TPA on file.

Q: I printed out the TPA and it asked for ProviderOne ID. Is that domain name or logon ID?

A: The ProviderOne ID is the domain name. If you are a provider, we recommend that you use your NPI.

Q: Who must sign the TPA - can our Business Office Director sign, or must it be signed by an administrative representative?

A: That should be determined by your organization.

Q: What address do we send the TPA to?

A: The address is on the TPA.

Q: I faxed the signed trading partner agreements to the number designated on the form a couple of weeks ago but have not heard anything. Does this also need to be mailed hardcopy before they will issue the submitter number?

A: Yes, a hard copy is required.

WinASAP

Q: I am a nursing home, and was told that WAMEBWEB would be available for 6 months after go-live and you are not ready for testing for that at this time. Is that true

A: WAMEDWEB is being replaced by ProviderOne. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm However, WINASAP, the tool many nursing homes use will continue for 6 months. Nursing Homes are encouraged to test claims submission using WinASAP. A separate call with nursing homes is being scheduled.

Q: What is WINASAP? Is it a Clearinghouse?

A: WINASAP is nursing home billing software. We recommend users of WINASAP test also.

Q: We are an outpatient chemical dependency treatment facility and I bill using WINASAP. I'm thinking this is an appropriate webinar for me, yes?

A: WAMedWeb will not be available after go live. You will need to use ProviderOne. If you submit or receive any type of batch transaction you will need to complete EDI testing. This webinar may very well apply to you.

Q: How can I find information about registration and testing for a nursing home that uses WinASAP?

A: A PowerPoint with information about setting up and doing EDI testing with WinASAP before go-live is at this page: http://www.adsa.dshs.wa.gov/professional/providerone/registration.htm Phone and e-mail contacts are at that link, too, if you have questions about ProviderOne security, registration, or testing.

Registration

Q: We have finished the registration process and submitted the Trading Partner Agreement a few months ago, but have not yet received the DSHS letter with Submitter Number.

A: We had a bit of a backlog of submitted registrations, but brought in more resources in the last week to address this. You should be receiving your submitter letter very soon.

Q: How long after you have completed the registration process do you receive your letter?

A: Currently it may take up to two weeks. We have added resources to this work unit so that these can be processed faster.

Q: I am with a large organization and therefore we are our own billing agent/clearinghouse for our 837D claims. I have my submitter ID and my domain ID, and TPA, do I need to do registration with my domain ID that is associated with my submitter ID?

A: The fact that you have your submitter ID indicates that you are already registered.

Q: I have registered all of our domains and received the letter. What if I decide to no longer do web batch and exclusively use web-interactive - and therefore not do the HIPAA testing - what do I need to do to become "certified?"

A: Please update your Provider File via the Business Process Wizard. You do not need to test to submit claims using web-interactive (Direct Data Entry).

Q: Can we make changes if we have completed registration and sent in enrollment? We may need to make changes to step 14 in order to receive 835 RA reports.

A: Once your registration is submitted, you just need to wait until your registration is approved by Provider Enrollment. Once it is approved, then you can make any necessary changes using the same business process wizard.

Q: I do have some company-specific questions regarding our registration status - and moving from multiple offices to single submitter/clearing house setup. I was directed towards your webinar for these answers. Is there a specific email address I can forward these questions to?

A: For registration questions specific to your organization, you will need to contact Provider Enrollment at providerenrollment@dshs.wa.gov We do not have access to your provider file. I do not know why you were told to participate in an EDI webinar for registration questions.

PIC Crosswalk

Q: We are having issues with providers being able to provide the new client IDs to begin testing. Are there alternative client IDs that we can use?

A: There is a web crosswalk tool that providers can use to get from their clients' PIC codes to new ProviderOne client ID numbers. The list is downloadable, so they can use it for testing purposes. See https://fortress.wa.gov/dshs/npicaphrsa

Q: How do we find out what our patients’ new ID numbers are for testing?

A: 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: When will the new client IDs be available? We'd like to do content testing, but will need those client IDs to do so.

A: The crosswalk to the new client IDs is available now; however, there will be two more updates prior to go live. The link to this crosswalk is: https://fortress.wa.gov/dshs/npicaphrsa

Training

Q: By any chance is there a "hands-on training"?

A: There will be "system" training by Webinar on claims submission, client eligibility, and preauthorization beginning October 19th. Currently there is a claims submission tutorial available, along with the Provider System User Manual, at: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm These are very good resources.

Taxonomy

Q: On the Taxonomy Tool my NPI shows; however, "No Servicing Providers found" is on the bottom of the page. What does that mean?

A: Registration questions? Please email providerenrollment@dshs.wa.gov Include your current ID in your email. Or call 1-800-562-3022, then select options 2, 4, and 2.

Q: Does taxonomy and provider number have to be on every claim line? Or just in box 17a?

A: All new identifiers are required on all claim types. Taxonomy codes are required for billing and rendering providers.

Claims

Q: If I submit a claim or correction for a service before ProviderOne go live, do I send the current format, and only send the ProviderOne in the new 837 format for service date effective with go-live and forward?

A: Regardless of the service date, any claim/adjustment you send after the cutoff date will require the ProviderOne identifiers...NPI, taxonomy, client ID and so forth. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm

Q: Can claim correction/adjustments be done within ProviderOne as we do for Medicare/CMS?

A: Claim corrections and adjustments can be done in ProviderOne. After go live, all claims/adjustments, regardless of the date of service, must be submitted to ProviderOne.

Q: At last check run, claims in system will be denied back to provider. What reason code will be used? Will we need an ICN number to rebill these claims in the new system or should they be resubmitted as new claims not rebills?

A: All claims submitted to ProviderOne require all of the new ProviderOne identifiers, regardless of the date of service. The code will indicate the claim must be rebilled in ProviderOne.

Q: Cutoff for claims in current MMIS – is this the same as the go-live date?

A: Claims will not be processed during the two-week period before go-live. We are converting information from the Legacy system in to the ProviderOne system during this time. This information is covered in detail during the General Readiness to cutover webinar.

Q: Where do we submit transactions between cutoff and go-live?

A: Test transactions cannot be made during this time period. Claims need to be submitted to ProviderOne. They will be held until go-live.

Q: Can claims be entered manually on ProviderOne? Or does it have to be by batches?

A: At go-live, Direct Data Entry – one claim at a time – will be available. Testing is for batch files only.

Q: Will ProviderOne accept DDE and batch files from cutoff to go-live and hold for adjudication?

A: The ProviderOne portal will not be available during this time period for DDE and batch. SFTP files can be sent and we will hold them.

Q: Claims will still be assigned an ICN in P1, correct? Will it be the same format as the ICN in MMIS?

A: They will be assigned an ICN in a different format.

Q: Will ProviderOne accept paper claims?

A: Yes, please use all the new identifiers.

Q: When submitting a secondary claim, do we have to attach the EOB, invoices or other documents? If so, do we mail the HCFAs?

A: ProviderOne will allow secondary claims with electronic attachment.

Inquiries

Q: For the 270/271 files, can we submit those ourselves if we usually use a clearinghouse for our 837 files? If so, do we need to get our own submitter number?

A: Contact provider enrollment: providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]

Q: How long will it be after a 270 is submitted via SFTP before a 271 is given back?

A: In the production environment, it is a relatively immediate response. It may take longer during testing.

Q: I submit batches of 270 inquiries at the end of each quarter. After go-live, will I be able to inquire about the eligibility of a client for September 2009 using their (old style) PIC?

A: You will need to use the client's ProviderOne ID after go live.

Timing

Q: What is the cutoff date to submit claims in the WAMED system?

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: Are we able to send claims from between cutoff and go-live when we are billing through a clearinghouse?

A: The system will not accept claims during this time period. You can send them to your clearinghouse during this time however we cannot accept claims during this time period.

Magnetic Card Reader

Q: So how do we get the magnetic reader for the ID cards?

A: https://www.meddatahealth.com/MedData/ProviderOne/

Client ID Numbers, Services Cards

Q: Our DSHS patients have not received their new ID cards yet. When they get them, can we use these new ID numbers immediately and continue billing as usual OR do we need to wait for ProviderOne to be up and running for billings/testing before the new ID numbers can be used?

A: You must wait until ProviderOne goes live before you use the new client ID. Please continue to bill as usual until go live. Having said that, if you are completing EDI testing you will need to use all of the new identifiers, i.e. NPI, taxonomy, new client ID.

Q: You talked about clients being issued credit card type ID cards. Is this the way they are going to present, or will they still have the paper ID but showing the new numbers?

A: Clients will be issued a magnetic strip ID card (Services Card) that shows their ProviderOne client ID. This will replace the paper medical coupon.