ProviderOne
System/Fields
Frequently Asked Questions (FAQs)
Last Updated 10/15/09
Can you send us a list of HIPAA Level 7 message changes in ProviderOne?
Can the ProviderOne eligibility lookup screen be cleared?
Will ProviderOne provide access to eligibility end dates?
Q: Are there plans to Stress and Performance Test the new system? We are concerned about the freeze between 11/20-12/6.
A: A performance and load test was performed using simulation tools. The results exceeded DSHS performance standards in the vendor’s contract.
Q: Can you send us a list of HIPAA Level 7 message changes in ProviderOne?
A: HIPAA Level 7 standards are specific to Claim Attachment transactions, e.g. the 275 transaction. At this time, the 275 claims attachment transaction is not in use, so we are not using the HIPAA Level 7 standard. Upon federal adoption of the Claim Attachment transactions, DSHS will implement based upon federal guidelines and prescribed standards.
Q: Can the ProviderOne eligibility lookup screen be cleared?
A: The “submit” and “close” buttons do not clear the page; the “exit” button does. This means the eligibility inquiry works both ways – it will retain data, or it can be cleared.
If you submit an inquiry and then have to make a change to the client or want to enter a new inquiry date, the original data is retained. If you receive the inquiry results needed and want to inquiry on a new client, you can select the “exit” button, which will bring you back to the inquiry page with the fields blank.
This flexibility means if you have mis-keyed or forgotten to add data, you don’t have to rekey everything, and can refer back to see where the error may be. Also, you can look for another data or span of dates without rekeying the client data.
Q: Please confirm that providers will have access to client “recertification dates” in the new ProviderOne system.
A: In ProviderOne, “recertification dates” are known as “ProviderOne Review End Dates.” These will not be available through an eligibility inquiry when ProviderOne is launched. It will be provided to the plans (Managed Care Organizations and Regional Support Networks) on the 834 roster. Returning the ProviderOne Review End Date on eligibility inquiries is currently being considered for a future enhancement to ProviderOne.
Q: Will ProviderOne provide access to eligibility end dates? A comment was made that the current WAMedWeb does not show end dates or recertification dates. Provider association reps were clear that having access to Eligibility start dates, termination dates and recertification dates would be REALLY helpful. They would also appreciate state dates for GAU and Spenddown. Lastly, they requested access to the Program Code. Please confirm which of these information points will be available in the new system and how providers can access this information.
A: Eligibility inquiries in ProviderOne will show all start dates and end dates, when applicable. If the end date is not know because it is open-ended, it will show 12/31/2999.
General Assistance Unemployable (GAU) and Spenddown start dates will also be given with an eligibility inquiry as they are today. If a client is pending Spenddown, additional information will be provided about pending Spenddown balances prior to a client becoming active. All the information referenced will be provided using any of the eligibility inquiry methods available.
Recertification dates, known as ProviderOne Review End Dates in the new system, will not be returned on an eligibility inquiry, but will be provided on the 834 roster. We are considering returning the ProviderOne Review End Date on the eligibility inquiry as a future enhancement to ProviderOne.
“Program Code” as it is known today in WAMedWeb will not be in ProviderOne.