A: Yes. Whether or not you submitted a claim through the Web to begin with or through paper submission, you can adjust or void a claim through the Web.

Q: Can we adjust a claim once we receive a TCN?

A: In addition to a TCN, a claim must also have a status of “paid” in order to be adjusted.

Q: Why so many numbers in the TCN?

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: Will the procedure codes field accept codes on outpatient claims?

A: Yes, you can enter procedure codes in ProviderOne outpatient claims.

Q: Will our provider claims be logged from the past four years and/or is this going forward?

A: We are converting the past four years’ of claims from the current MMIS. ProviderOne will store four years of claims data going forward.

Q: Can we also use the resubmit denial for one line item that was not paid?

A: If a claim shows as “paid,” but denies one or two lines, only those lines need to be adjusted. You will be “adjusting a paid claim.” Since the claim is paid, you cannot resubmit it, or it will deny as a duplicate claim.

Q: Currently, in WAMedWeb, we can view the last weeks’ worth of RAs. Will this be the same in ProviderOne?

A: The RA .pdf is available for four years. The 835 is available for two years.

Q: How many lines will be available for diagnosis codes when ProviderOne goes live?

A: In Direct Data Entry claims, there are fields for 11 Diagnosis Codes for institutional claims (professional claim submission can hold 8 diagnosis codes), but in HIPAA batches, the number is greater.

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 organization uses a billing 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 claims 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 software company may need to work with both you and your clearinghouse to make sure your claims have the correct new identifiers in the correct data field. 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.