ProviderOne
Personal Identification Code (PIC) to Client ID Change
Frequently Asked Questions (FAQs)
Last Updated 11/3/09
How do we bill if we have an old PIC, but no new ProviderOne Client ID?
When will DSHS stop issuing PIC numbers? When will patients receive client services ID?
How do we bill if we have an old PIC, but no new ProviderOne client ID number?
Will Medicaid managed care plans use the new ProviderOne client ID number?
Q: PIC Crosswalk? Between cutoff and go-live, how do we get Client ID for those PICs that don’t get on the crosswalk and we can’t access eligibility until after go-live?
A: Providers will be able to obtain new
client IDs issued after publishing of the client crosswalk through ProviderOne starting at go-live.
Providers may use a 270/271 batch or direct data entry, Interactive Voice
Response (IVR), or a magnetic ID card reader for the new Services Card. Please visit the implementation schedule area of
our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: Once ProviderOne goes into effect, do we submit claims dated prior to go-live with the PIC or the ProviderOne Client ID number?
A: Once ProviderOne goes live, every claim has to use the ProviderOne client ID number. ProviderOne won’t recognize the old PIC. That’s why we will have the PIC-to-Client ID Crosswalk available about 30 days before go-live.
Q: How will we update claims that have been sent to our clearinghouse with a PIC, but have not been sent by the clearinghouse to DSHS?
A: We suggest that you coordinate a schedule with any claims processing company or software vendor you use to only send claims with the current Personal Identification Code (PIC) up to the time of the two-week claims freeze and to send claims with the new ProviderOne client ID number during and after the claims freeze. Verify with your clearinghouse that they can hold all claims with the new ProviderOne client ID until ProviderOne implementation.
Q: How do we bill if we have an old PIC, but no new ProviderOne Client ID?
A: You will need to update claims to be submitted to ProviderOne with the ProviderOne client ID. To assist providers with this transition, DHS has developed a web tool that crosswalks the current PIC number to the new ProviderOne client ID. The tool is available now for testing purposes at https://fortress.wa.gov/dshs/npicaphrsa.
The tool prompts providers to enter their current seven-digit provider Medicaid ID and federal tax identification number. The tool then provides a list of PIC numbers for clients the provider billed between April 2007 and April 2009, along with the corresponding new ProviderOne client ID number. This list or crosswalk is downloadable in several formats.
The crosswalk will be refreshed and available to providers about a month before ProviderOne is implemented so that providers may update their billing systems with the new ProviderOne client ID.
Please note that the current crosswalk is intended for test purposes only. Some of the ProviderOne client ID numbers could change in the final refresh; however, the format and structure of this file will not change.
After implementation, you can access ProviderOne client IDs (nine numeric digits followed by WA) several ways:
· ProviderOne Services Card presented by a client.
· Direct data inquiry in ProviderOne, matching for client name, birth date or Social Security Number. This inquiry is very similar to the current inquiry in WAMedWeb.
· HIPAA single or batch file inquiries in ProviderOne (270/271).
· It will show on most ProviderOne correspondence to clients in the bottom left corner.
Q: When will DSHS stop issuing PIC numbers? When will patients receive client services ID?
A: In short, DSHS will continue to issue client PIC numbers in the current system until the claims “freeze” period begins (approximately 2 weeks before go live). The claims “freeze” is when claims can no longer be submitted to the current legacy system.
New ProviderOne client IDs will be assigned for all existing clients when the final crosswalk is published. Any new clients established after publication of the final crosswalk will have new ProviderOne client IDs assigned in ProviderOne, as part of the final cut-over process in the last two (2) weeks before go live.
The new client IDs not found in the crosswalk (because they were issued after the crosswalk was published) will be available in ProviderOne via standard eligibility inquiry processes (270/271) after ProviderOne go live (see response to Question #3).
During the call Karen De Leon, Implementation Manager, described the cut-over process at length.
Q: Will Medicaid Managed Care Plans, such as Molina and CHPW-Gau, accept new Client Services ID numbers? Facility claims are billed to DSHS for CHPW.
A: Yes, all enrollment and payments for managed care clients will be based on the new ProviderOne client ID, which means Managed Care Plans will need to recognize the new client identifier as well.
Q: Will DSHS Crosswalk contain Medicaid Managed Care Patients as well? If not, how will we identify these accounts?
A: DSHS is assigning the new ProviderOne client ID to all clients, including those enrolled in Managed Care Plans. The Plans are receiving the client crosswalk as well.
Q: At go-live, can providers continue to provide the PIC on claims and let DSHS process the PIC crosswalk to the new Client ID internally within ProviderOne?
A: It is not feasible for DSHS to “pre-process” or convert claims on behalf of providers or to change the system to accept the old PIC ID. ProviderOne has been designed to utilize a new non-intelligent Client ID as the unique identifier for a client that will not change over time. Claims history is being converted based upon this client ID. The legacy PIC number will not be used in ProviderOne for claims processing purposes. Changing ProviderOne so that providers could continue to use the PIC instead of the new Client-ID would require significant changes for each submission type (paper, DDE, electronic). This includes system changes, Companion Guide Changes, Billing Guide changes, Client Services Card changes as well as changes to all EDI transactions. This would set the project back many months and require financial support that is not available through state or federal sources.
Q: How do we bill if we have an old PIC, but no new ProviderOne client ID number?
A: You will need to update claims to be submitted to ProviderOne with the ProviderOne client ID. To assist providers with this transition, DSHS has developed a Web tool that provides a “crosswalk” of the current PIC number to the new ProviderOne client ID. The tool is available now for testing purposes at https://fortess.wa.gov/dshs/npicaphrsa. The tool prompts providers to enter their current seven-digit provider Medicaid ID and federal tax identification number. The tool then provides a list of PIC numbers for clients the provider billed between April 2007 and April 2009, along with the corresponding new ProviderOne client ID. This list or crosswalk is downloadable in several formats. The crosswalk will be refreshed and available to providers about a month before ProviderOne is implemented so that providers may update their billing systems with the new ProviderOne client ID. Please note that the current crosswalk is intended for test purposes only at this time. Some of the ProviderOne client ID numbers could change in the final refresh; however, the format and structure of this file will not change.
Q: Will Medicaid managed care plans use the new ProviderOne client ID number?
A: Yes. All enrollment and payments for managed care clients will be based on the new ProviderOne client ID, which means managed care plans will need to recognize the new client identifier, as well.
Q: When will DSHS stop issuing PIC numbers? When will clients receive their ProviderOne client ID number?
A: In short, DSHS will continue to issue client PIC numbers in the current system until the claims freeze period begins (approximately two weeks before go live). The claims freeze is when claims can no longer be submitted to the current legacy system.
New ProviderOne client IDs will be assigned for all existing clients when the final crosswalk is published. Any new clients established after publication of the final crosswalk will have new ProviderOne client IDs assigned in ProviderOne, as part of the final cutover process in the last two weeks before go live. The new client IDs not found in the crosswalk (because they were issued after the crosswalk was published) will be available in ProviderOne via standard eligibility inquiry processes (270/271) after ProviderOne go live.
Q: A concern was expressed about the difference between the ProviderOne ID number and the ACES ID number.
A: The ProviderOne client ID is a unique ID for billing purposes that ends in WA. It will replace the current Personal Identification Code (PIC) used for billing today. The ProviderOne client ID number is auto-generated by ProviderOne when a client becomes eligible for services. The ProviderOne client ID number will stay with the client for their lifetime – even if they change their name or are ineligible for services for a period of time. All past DSHS clients have been assigned a ProviderOne client ID and must be used by providers to bill us once ProviderOne is live. This includes adjustments. The ACES ID is generated by ACES and will continue to be used in that system. Today we have the ACES client ID and the PIC. With ProviderOne, we will have the ACES client ID and the ProviderOne client ID.