ProviderOne - General
Frequently Asked
Questions (FAQs)
Last Updated 10/15/09
How does direct data entry or direct bill work?
How long can a baby use the mother’s ProviderOne client ID number?
How will we know if the client ID given in the crosswalk is the baby’s or the mom’s?
Q: How does direct data entry or direct bill work?
A: Direct data entry involves submitting one claim at a time through the ProviderOne portal. The ProviderOne claims entry screens have been designed to mimic WAMEDWEB functionality. The ProviderOne Provider System User Manual describes the system steps. It is online at: http://hrsa.dshs.wa.gov/providerone/Provider%20System%20User%20Manual.htm. The manual includes sections on claims submission which cover high-level steps for submitting an on-line Professional, Dental and Institutional Claim to ProviderOne. Those steps are:
·
Using
the EXT Provider Claims Submitter user profile, access the online claim form.
·
Complete
the Basic Claim Info section.
·
Attach
any supporting documentation.
·
Submit
the claim.
Q: Is the level of benefit detail significantly different using ProviderOne web inquiry vs. a Medicaid Eligibility Vendor (EEV via HDX) or the 270/271 inquiry?
A: The details are the same in the ProviderOne direct data web inquiry and ProviderOne 270/271 inquiry. We cannot comment on the level of detail provided by external MEVs vendors.
Q: IP Psych admissions are sometimes Pre-authorized by the RSNs, prior to the patient obtaining DSHS coverage. For example, in the case of an ITA admit where the patient has no prior DSHS coverage, how will the patient be entered into the Provider One Pre-auth system?
A: The situation of an unknown client is not unique to psychiatric admissions. ProviderOne includes functionality to address unknown clients, which we refer to as “the Placeholder Client ID number.” This functionality allows DSHS to bypass any edit that would post on an unknown Client ID number. Once the client has been assigned a Client ID, the hospital will need to call the RSN or their designee to update this record with the correct Client ID number.
Q: How long can a baby use the mother’s ProviderOne client ID number?
A: The current policy will continue: A provider may bill under the mother’s client ID for fee-for-service claims on a newborn up to the end of the month in which the 60th day of life occurs, if appropriate. There may be situations when it is not possible to obtain the baby’s client ID. In these situations, the provider may use the mother’s ProviderOne client ID to bill retroactive newborn claims. In the case of managed care premiums, DSHS must have the baby’s client ID, as managed care does not support billing the baby on the mom’s ID.
Q: How will we know if the client ID given in the crosswalk is the baby’s or the mom’s?
A: The crosswalk contains all clients for whom claims were submitted during the preceding 12 months. If only the mom’s PIC was submitted during that timeframe, only the mom’s client ID will be returned in the crosswalk. The only way that DSHS knows the provider is billing for the baby using the mom’s ID is by a separate indicator on the claim. There is no tie of numbers through the crosswalk.