Q: Regarding a submitter using DDE, will they be able to "click and paste" client ID numbers, TCN numbers? Especially when in claim inquiry...will this become a future feature if not available now?

A: You can copy and paste in ProviderOne.

Q: In the place of service space, if our facility is FQHC, do we enter 50 instead of 11?

A: You will want to bill the correct place of service per CMS guidelines; whether it be 11 or 50 depends on the actual facility. (Look on the inside page of a CPT book for definitions of places of service.)

Q: Under claim information, where one has the option of entering additional claim data, is MEDICARE PARTS A & B considered additional ins info?

A: IF Medicare pays, then the other payer information might be Medicare Part B.

Q: Why so many numbers for a TCN number?

A: You can find the breakdown of TCN numbers in the ProviderOne Billing and Resource Guide, Key Step 6: http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide/Submit_FFS_Claims.pdf

Q: Regarding dental ADA codes, will or do you see any changes regarding ADA forms for dental in the near future?

A: I have not heard anything about such changes. DSHS will use the standard forms, in any case.

Q: Will there be a template, like in WAMedWeb, or will each claim have to be filled out each time with the same info?

A: Each claim will need to be filled in each time.

Q: Our clinic has three dental locations. Can we upload batches with all three clinics in it under one domain?

A: You can, if you have all three locations under the same NPI. And NPI is the same as a "domain" in ProviderOne. If you have a separate NPI for each location, you will need to submit batches separately for each NPI. When you are billing for multiple domains, you must log out and log back in with the domain you are billing for. You cannot “batch” domains.

Q: Is there a presentation that addresses a clinic that has multiple domains?

A: No, this is the only dental claims presentation.

Q: How will the Prior Authorization process change when ProviderOne goes live?

A: The Prior Authorization process will be very similar in ProviderOne. New forms and phone numbers will take effect. ProviderOne identifiers will be required.

· A new form will be required with each written request. The form is available now at http://www.dshs.wa.gov/pdf/ms/forms/13_835.pdf

· A new fax number will be used (available shortly before go-live).

· A new toll-free phone number and phone tree will be in place (available shortly before go-live).

· Providers may use the ProviderOne portal to check prior authorization status after requests have been submitted.

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: Is there a new form for Prior Authorization requests in ProviderOne?

A: Yes. Providers (including dental practices) may begin using the new form now (http://www.dshs.wa.gov/pdf/ms/forms/13_835.pdf) before ProviderOne goes live. Please use your MMIS ID and the client’s PIC until ProviderOne goes live. Instructions for the form and the submission cover sheet are in the ProviderOne Billing and Resource Guide, chapter on Client Eligibility, Benefit Packages, and Coverage Limits, section 4. A draft version of the Guide is at http://hrsa.dshs.wa.gov/download/ProviderOne_Billing_and_Resource_Guide.html

Q: If they have other insurance, do we need to send paper claims showing what primarily paid, or just fill this out?

A: You can either use Direct Data Entry through ProviderOne or you can submit on paper. Either way, you will need to send in the back-up documentation.

Q: Are “dental models” x-rays?

A: You are correct. X-rays.

Q: What if you do not have digital x-rays?

A: Handle them the same way you do today. You can still mail these in. You will need a cover sheet. The webinar explains how to get a cover sheet.

Q: When submitting an extraction or root canal, will you still have to put in a tooth surface?

A: No.

Q: The TCN # and the claim # on the remittance and status report -- will they be the same? Or do we need to get and keep the TCN # created online even though we're submitting electronically through our clearinghouse, so we are able to track unpaid claims?

A: The TCN is the new claim number.

Q: I have never done any type of batch transaction. How do I get started?

A: You either need to have a programmer that is able to create HIPAA batch transactions or you have software that is capable of producing HIPAA batch transactions. Please start with the following fact sheet, “HIPAA Batch Testing – Getting Started,” at http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR007%20HIPAAtesting.pdf .

Carefully read the Companion Guides for each transaction you plan to use as transaction testing is required before you can submit production batch transactions. There are Companion Guides for each type of HIPAA transaction available at http://hrsa.dshs.wa.gov/dshshipaa.

If you have questions about testing, please contact hipaa-help@dshs.wa.gov or call 1-800-562-3022 select option 2,4,4. A signed Trading Partner Agreement (TPA) is required. You will find the TPA at http://hrsa.dshs.wa.gov/providerenroll/ . In addition, please be sure to update your provider file, Steps 11-14 of ProviderOne registration, to reflect your intention to submit HIPAA batch transactions.

Q: My office uses a dental software company and a clearinghouse to submit electronic claims. Do we still need to batch the electronic claims through the internet, although at the end of the day our claims are batched by the dental software and submitted through the clearinghouse?

A: If you use a clearinghouse to submit your batched claims, you should contact your clearinghouse about preparing for ProviderOne. You may find out online fact sheet helpful: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR007%20HIPAAtesting.pdf

To help your clearinghouse, we have a Web page devoted to HIPAA batch file testing: http://hrsa.dshs.wa.gov/providerone/HIPAAtesting.htm

Your dental software company many need to work with both you and your clearinghouse to make sure your claims have the correct new identifiers in the correct data fields. You will find fact sheets about the new identifiers ProviderOne will require at: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/FactSheets.htm We suggest you work with both the software vendor and clearinghouse.

Q: Can we use the Claim Inquiry if we do not use ProviderOne to submit claims? We send claims electronically via a clearinghouse. If so, how long does it take for claim information to be available?

A: Yes, you can. The method of submitting the claim does not affect your ability to check claim status using the ProviderOne portal. You can search using your NPI, ProviderOne Client ID, and the oldest date of service on the claim. The WAMedWeb is like this today.

Q: If we submit via a clearinghouse, can we resubmit, void or adjust a claim in ProviderOne? Would we need to go through the testing first as Emdeon did the claims submission testing on our behalf?

A: Yes, you can resubmit, void or adjust a claim in ProviderOne that was originally submitted through your clearinghouse. There is no requirement to test the Direct Data Entry method (using the ProviderOne portal).