A: The changes made in ProviderOne will appear immediately. Changes that come from an outside system may not appear until the next day. Examples of data that would appear right away include: Hospice, Third Party Insurance, Managed Care, Medicare, Client Restrictions, etc.

Q: If the patient is eligible, for example, with Blue Cross, will ProviderOne still provide the Blue Cross ID number?

A: ProviderOne will include third party insurance information, but not a Managed Care patient ID number.

Q: Can we view the managed care plan to determine if NPN or Healthy Options or CHPW?

A: ProviderOne will return the plan and the program, such as Healthy Options CHPW.

Q: Can we view the Medicare number for the patient from that page?

A: Yes, the HIC will be available in the demographic section. These webinar slides were created before the HIC was added to the demographic section.

Q: If a provider bills a plan using current HRSA information, that info changes while claim is processed by a plan and then encounter data is loaded, will the claim deny and have to be rebilled with newest information?

A: If you are referring to using the PIC as the identifier, that will change with ProviderOne. If you are referring to the eligibility on a particular date, the eligibility data will remain available in ProviderOne and claims/encounters processed accordingly.

Q: If the patient has Medicare QMB, would we be able to see the Medicare coverage effective dates and Medicare HIC number?

A: You will see the HIC number in the demographic section. You will see the QMB eligibility start and end dates in the eligibility section, and you will see any applicable Medicare eligibility start and end dates as they are available in ProviderOne.

Q: Are we able to print off any page of info, such as the restricted providers list?

A: There is a print-friendly button at the top left of the page that will format the page for your printer. If the client has restrictions, they will be listed. You can print the inquiry out.

Q: Once the spenddown is met, will you show which provider and claim this was applied to?

A: ProviderOne will only have balance information in the spenddown section when a client is pending. ProviderOne will not have information related to which bills were used to meet spenddown.

Q: As a hospital facility, will we be able to view a prior authorization for services requested by a specific provider?

A: The provider’s NPI must be on the PA in order for the provider to view it.

Q: Is there a way to see a general table of authorizations for a patient, as there are times that you do not have the authorization number?

A: The provider's NPI must be on the PA in order for the provider to view it.

Q: Spenddown - As part of your system upgrades/enhancements, when will the information be available as to which provider and DOS the spenddown was applied to? This would eliminate the numerous denials received for the incorrect spenddown and reduce the calls to your provider reps.

A: At this time, there is not a plan to implement a change like the one you describe.

Q: Do we still need to call the COB dept if we find a TPL coverage has termed?

A: Yes, just as you do today.

Q: Are expedited authorizations still required?

A: Some services have an expedited authorization (EPA) option – EPAs will still be used in ProviderOne. Any change to EPA will be sent out in a memo to providers.

Q: Will ProviderOne be updated ASAP when correct coverage information for a TPL has been provided?

A: Yes, once it has been verified and updated, the data will be available on the eligibility inquiry in ProviderOne.

Q: COB - Are the requirements still the same as to what is needed for ProviderOne to update your database?

A: We will use much of the same data and in some cases there may be more data needed - and more data available. DSHS will use the same verification process used today.

Q: Are there any future plans to allow authorization inquiries on the ProviderOne site when the auth number is not known? Using the IVR, making that call, then going online to view the pre-auth information seems a bit cumbersome and not the best use of resources, both systems and FTEs.

A: We are not aware of any plans like this. Using the IVR is probably the best option.

Q: When trying to log in to ProviderOne I receive the message 'Warning: Invalid Login password. Try again.' when using the domain, username, and password sent to me by ProviderOne. Is there an email address I can consult rather than calling the DSHS 800 number to find out why it is not working?

A: Security email: provideronesecurity@dshs.wa.gov Please type your issue in the subject line and provide them with your ProviderOne ID, NPI and/or Tax ID. That will help them research your issue quicker.

Q: Is there any way to check on a preauth for dental?

A: Dental will work the same way as described in this training. For more information, please refer to the ProviderOne Billing and Resource Guide. A draft version is at http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html

Q: To obtain the dental pre-auth number, can we only obtain the number by phone or will we be able to get it from ProviderOne?

A: For all provider types, you'll need to get the pre-auth number by phone or by IVR. It won't be available in ProviderOne.

Q: How do you print the eligibility page?

A: There is a print friendly button in the top left hand corner of the page.

Q: I am the only person in my office who will use ProviderOne and will need access to everything. What is "EXT super user?" does this mean I do not have to always go to the specific ext or do I?

A: Since you are the only person in your office, I recommend you give yourself the following 2 profiles, Super User and System Administrator. Here is a link to the ProviderOne profiles: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm#Security_Training_Materials Click on Security and then click on ProviderOne Security Profiles.

Q: Where would we look to see if a client has T-19 v. state-only?

A: When you check client eligibility using the ProviderOne portal, the medical coverage group for the client will be displayed. By checking the ProviderOne Billing and Resource Guide, you will find whether the client is federally funded (Title 19). (See ACES Program Codes.) http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html You also may find the Client Eligibility e-Learning helpful. Here is the Provider Training Web page: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm

Q: In the last webinar we hoped to see the RA report, how to download it and how we can match the check to the RA? That was not shown.

A: You can find information about the Remittance Advice in the new ProviderOne Billing and Resource Guide, which is posted now, in draft form, at http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html Please refer to the chapter titled “The DSHS Remittance Advice” for the information you are looking for.

Q: Will we have the opportunity to do a trial send to make sure our computer programs are running correctly?

A: Testing the direct data entry screens is not part of the current testing plan for ProviderOne. If you send HIPAA batch transactions directly to DSHS, you need to complete our EDI testing.

Q: And that is where and how?

A: If you need to do EDI testing, the best place to start is at the ProviderOne Provider web page: http://hrsa.dshs.wa.gov/providerone/providers.htm You can click on the HIPAA batch testing link at the left side of the page, and find the "HIPAA Batch Testing - Getting Started" document to learn more. The Web page also contains links to the DSHS HIPAA Companion Guides, which contain the information you will need to format your batch claims properly.

Q: How far back can we check eligibility?

A: When ProviderOne goes live, you will be able to go back 2 years at a time, as far as 4 years.

Q: Will we be able view an inquiry span of more than 12 months?

A: Yes, you can see up to two years of eligibility data in one inquiry.

Q: What is the ACES client ID used for?

A: The ACES client ID is used by the ACES system, which is used in the DSHS Customer Service Offices.

Q: Are there going to be more than just CHP and Molina for managed care plans?

A: Yes, the same managed care plans that are now in place will serve Medicaid clients. Not all plans are available in every part of Washington, though.

Q: How many pathways can we have open at one time?

A: If you mean how many lines of information the pathway or "bread crumbs" will show, I've seen up to 3 lines of information.

Q: How current is the spenddown information?

A: The spenddown information will be current up to the previous day – and in some cases, the same day.

Q: I work for an eye doctor. Is there a spot to show whether they have used the eye exam benefit?

A: That information will be available as ProviderOne accumulates data. It will not be available at the time we go live.

Q: What type of provider would enter a prior authorization request?

A: There are many different providers who use prior authorization.

Q: Can a screen print of the authorization page take the place of a copy of the Initial Certification of Admission (obtained from RSNs) for billing inpatient psych claims?

A: That information is beyond the scope of this webinar, which covers the ProviderOne system. You can consult your billing instructions for more information. In general, ProviderOne will not change processes you use now.

Q: When entering the date range, do you have to enter the / or can you just enter the numbers i.e. 01012009. Does ProviderOne add the / for you or would I need to enter 01/01/2009?

A: You must enter the slash.

Q: When will we be able to view eligibility information on actual patients through ProviderOne?

A: When ProviderOne goes live.

Q: Will only HMOs need authorizations?

A: No, many different providers use prior authorizations.

Q: Will Medicare Part B effective dates be recognized in ProviderOne? Currently they are not, and a special note is required in box 19 of the 1500 form.

A: You may find that information in the ProviderOne Billing and Resource Guide, at http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html It is a draft now, and will be updated.

Q: If you are a dental provider and you don't have a prior auth number, how would you check the status of an auth, such as dentures?

A: The same way you do now. You can call to get that authorization number.

Q: How do you submit a new authorization request online?

A: You don't submit authorization requests online. The process will remain the same as it is now. You will be able to check authorization status online, as described in this webinar.

Q: Will the eligibility screen tell me what RSN I need to work with regarding authorization of inpatient psych admissions?

A: Yes, in the managed care section of the eligibility screen, we will show the RSN you need to contact.

Q: If a prior authorization is linked to the referring doctor instead of us (the performing provider), will we be able to look up the auth through auth inquiry?

A: You can only inquire about a prior authorization that your organization has submitted.

Q: If a patient has a Managed Medicare plan (Medicare Part C), will that information be shown somewhere in ProviderOne?

A: In general, that information will not be available when ProviderOne goes live.

Q: Does Medicare have a spenddown, too?

A: Sorry, that's a Medicare question. Please check with them.

Q: Thought he might go over the ability to now swipe the member’s card to check eligibility.

A: That information can be found at this link: https://www.meddatahealth.com/MedData/ProviderOne

Q: Will the Medicare Part B effective dates be recognized in ProviderOne?

A: ProviderOne will have Medicare start and end dates as benefit inquiries do today.

Q: When you click on “printer friendly,” can it be saved electronically as a .pdf?

A: Yes.

Q: If the patient has Medicare and Molina, is Molina a supplement or is it a Medicare Part C (Med-Advantage) plan?

A: If Molina is returned in the Managed Care section of the inquiry, it is a state managed care plan. If it is in the TPL section, then the provider will have to call Molina to find out the coverage under the private plan. ProviderOne will have limited information about Medicare Part C.

Q: Under Medicare, it just shows the social security number, but we are required to have the alpha letter. What do we do when this is not provided?

A: The Medicare HIC number will be returned for a Medicare client when you inquire using ProviderOne.

Q: Is the plan/pccm ID the patient’s ID with the managed care plan?

A: ProviderOne will not give you the managed care plan’s client ID number for the client.

Q: Is there a way to look up an authorization by patient and date of service when the authorization number is not available to the billing department?

A: You must look up the authorization status using the authorization number. You can get it by calling DSHS if you need to.

Q: What does the spenddown mean?

A: Spenddown means that the client has to incur a certain amount of expenses out of pocket before Medicaid will pay.

Q: How do we know if the Managed Care-Molina is capitated payments or fee-for-service like most Molina physicians are in Kitsap County?

A: I’m a little confused. If a client is fee-for-service, they would not be in a managed care plan.

Q: Sometimes, Molina patients from clinics in Puyallup or Tacoma move to Bremerton. They have Molina cards and DSHS coupons. However, if the patient is still listed with a capitated system in Tacoma, and we see them without checking if their doctor is fee-for-service, we are not paid because the clinic in Tacoma was paid already. Unfortunately, patients are not aware of the difference and we have been stung several times in this manner. Now we always call Molina when we get a new patient.

A: The system will indicate which plan, if any, the patient is enrolled in. The system will not indicate which PCP the patient is assigned to within the plan. You will need to continue to contact MHC directly. Keep in mind that even though a patient has a Molina card or a ProviderOne card, they may not be currently enrolled in Molina or be eligible for benefits through Medicaid. You must check eligibility to get the most accurate picture.