ProviderOne Readiness Series
Using Taxonomy and Other
Identifiers to Get Paid
Follow-Up Frequently Asked
Questions (FAQs)
Last Updated 11/3/09
PIC
Crosswalk and Client ID Numbers
Q: Is there somewhere
I can go to print out these links and steps?
A: You can obtain a copy of the Webinar presentation by going to
the Webinar table at the following link: http://hrsa.dshs.wa.gov/providerone/ScheduledWebinars.htm Click on
the link beneath the description of this Webinar.
Q: We are a private
single provider billing system; do we need to have a billing clearinghouse?
Will we need to set up EDI testing?
A: You do not need to have a clearinghouse. You need to complete EDI testing
if you plan to submit or receive any type of batch transaction.
Q: Will there be an
icon for our desktops for ProviderOne?
A: ProviderOne is a Web-based system and you can set it up as one of your
favorites.
Q: What is an
"applet"?
A: It's a link that takes you to information.
Q: What was the Web
site for the scheduled webinars?
A: http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm
Q: Can we still have
the DSHS legacy ID on the claims along with the NPIs?
A: No.
Q: Can we log in to
ProviderOne yet? I’ve been locked out for the past month.
A: You can log in now for Registration. If you are locked out,
please contact: provideronesecurity@dshs.wa.gov Please send one email per issue and state
your issue clearly in the subject line. Be sure to include your ProviderOne ID
or your Tax ID.
Q: Which link can we
use to download this webinar session?
A: You can obtain a copy of the Webinar presentation by going to
the Webinar table at following link: http://hrsa.dshs.wa.gov/providerone/ScheduledWebinars.htm Click on the link beneath the description of
this Webinar.
Q: When is the
ProviderOne go live?
A: Our schedule has changed. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: Should I enter the
ProviderOne ID number in place of the provider number on the claim?
A: Refer to the ProviderOne
Billing and Resource Guide. It will be posted soon.
Q: When should we use
the new client ID number? Can we use it now when we bill through WAMedWeb?
A: Beginning at go-live. You cannot use it now with WAMedWeb. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: No one ever
answers the support phone. It always goes to voice mail and I never get a phone
call back. This is impacting our ability to complete registration.
A: Your call will be returned. There is a back log of calls that we are
responding to.
Q: How do I contact
someone to sign up for the meeting in Spokane?
A: There will be information posted on the training page of the ProviderOne
website. There is a possibility that this date will move.
Q: Can you please
define ACES?
A: It’s the DSHS
eligibility system.
Q: Due to the change
in the go-live date, is the date for last accepted paper claims with old
identifiers changing? Previously we were told it was 11/17/09.
A: The date has changed. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: Do you only need a
taxonomy number if you are only billing through ProviderOne, or do you need it
if you bill through a clearinghouse?
A: You need to use a
taxonomy number on every claim you submit, whether you submit direct data entry, through a clearinghouse or on paper.
Q: How do we go about
getting our taxonomy number?
A: Taxonomy numbers
were assigned based on the services you billed for in the past.
Q: Where will the
taxonomy number be entered on the claim form?
A: Taxonomy and NPI
placement information for electronic and paper claims was published in DSHS
Numbered Memo 08-59 in August 2008. You can read it here: http://hrsa.dshs.wa.gov/download/Memos/2008Memos/08-59.pdf
Q: Who do you call to
get your number?
A: You look in your provider file – you may need to talk with the
person who maintains your provider file to do this. They are also available at
the following link: https://fortress.wa.gov/dshs/npicaphrsa
Q: I have two
taxonomy numbers. Which one do I bill with?
A: You use the one that corresponds with the servicing provider and
the procedure code you are billing for.
Q: Is there a list
for taxonomy codes regarding denturing? How do we obtain them?
A: You will find your taxonomies at the following link: https://fortress.wa.gov/dshs/npicaphrsa
Q: If I am a pharmacy
and I have a patient who gets a maintenance med refill, a compounded
prescription and some blood glucose strips I will be sending on each claim
three different taxonomy codes?
A: If you submit through the point-of-sale system you will not use
taxonomy.
Q: When I type in my
EIN number to get my taxonomy number, nothing comes up. What do I do?
A: Please contact providerenrollment@dshs.wa.gov
[1-800-562-3022 select option 2,4,2]
Q: As a DME provider,
does the claim need a taxonomy for the referring physician (box 17/17a/17b?
A: No.
Q: Do we need the
taxonomy number for each rendering and referring physician, along with the
organizational taxonomy?
A: You do not need a taxonomy code for a referring physician.
Q: Where do we put
the taxonomy number during the registration process?
A: The taxonomies are
pre-populated. There is a drop-down box that you can add taxonomies from.
Q: How many numbers
are in the taxonomy code?
A: It is a 10-character alphanumeric code.
Q: We are general
pediatricians, but DSHS has pre-loaded nearly all the pediatric sub-specialties
in our taxonomy list. Do we need all these?
A: You may not need all of the taxonomies that were assigned to
your organization. You may keep them active on your provider file in case you
need them in the future.
Q: If there is a
specific taxonomy code for our facility, why can't we select it?
A: DSHS assigned taxonomy according to the way your organization has done
business in the past. If you need to add, change, or end date a taxonomy, you
can do that in your provider file.
Q: I tried to change
my taxonomy code in the provider file and was not able to do that.
A: There are a couple of reasons this might have happened. Please check
to see that your provider file was not waiting for a modification to be
approved when you submitted your change request. Check that you chose a
taxonomy from the drop-down box. Check that the start date you were using for
the taxonomy dated after the start date on your business license.
Q: Do both billing
providers and servicing providers need taxonomy codes entered for them?
A: Yes, if there is a servicing provider on the claim.
Q: On WAMedWeb, there
is not an area for taxonomy. Is there an area in ProviderOne?
A: There is a data field for taxonomy in ProviderOne.
Q: If our office
provides different services, do we need to change it on forms before we submit
or will it just know because you have all of them on file for us?
A: You will need to put the appropriate taxonomy on each claim
submitted.
Q: We are a family
practice with 4 doctors. We have the family practice taxonomy number, just one.
We can bill all procedures under that one... office visits, removals of cysts,
etc., right?
A: Your NPI will indicate which provider is performing the
service. The taxonomy needs to be appropriate for each service performed. We
cannot guarantee that the taxonomy/ies you were assigned is the only taxonomy
your organization will need.
Q: Will claims be
rejected if the provider sends the same taxonomy code within the billing and
rendering provider loops?
A: Only if the taxonomy is not appropriate for the service being
billed for. Both billing and rendering provider would need to have the same
taxonomy code assigned to them.
Q: We are a Critical
Access Hospital and there is a taxonomy code for Critical Access Hospitals BUT
your system will not allow me to select that one. So then what do I use?
A: Please contact providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]
Q: If we choose the
wrong taxonomy, will our claims be denied or just paid at a different rate?
A: It could go either way. An incorrect taxonomy will result in a
denial.
Q: If we have
multiple taxonomies for our clinic, where do they go on the HCFA? We have one
for our providers and one for the clinic.
A: Please either use the ProviderOne Billing and Resource
Guide, available 30 days prior to go live, or contact providerone@dshs.wa.gov [1-800-562-3022 select option 2,4,wait]
Q: Taxonomy is new to
me. Is there anywhere I can get further education on what it is and
understanding it in general?
A: This is the link to the eLearning for Registration: http://hrsa.dshs.wa.gov/providerone/ELearning.htm
Q: We are a DME
provider with 7 locations. Each location specializes in certain products for
DME. Each location has its own NPI number, so does every location need an
individual taxonomy number for each product? Example: One of our locations
specializes in ostomy products; do we need to have a taxonomy for ostomy?
A: Each location needs a taxonomy specific to the services they
are going to bill.
Q: How many taxonomy
numbers are needed on a claim? We understand that servicing and rendering
provider needs taxonomy number, but what other one?
A: You need the taxonomy for the billing provider and one for the
rendering provider.
Q: Since Medicare is
primary, and they do not require taxonomy codes, How do we send taxonomy code
on a Medicare claim when it is sent through a clearinghouse? Medicare sends
claim info to DSHS automatically.
A: Put it on the Medicare claim and it will pass on to us.
Q: Does each doctor
have to obtain their own taxonomy?
A: DSHS assigned taxonomy codes based on the way your organization
has done business in the past. You can go to this link to check your
taxonomies: https://fortress.wa.gov/dshs/npicaphrsa
Q: As a BLS Ambulance
Service, we occasionally bill as ALS depending on the service we provide to the
patient. So do we need multiple taxonomies?
A: If there are separate taxonomies for these services, then you will
need to use the taxonomy appropriate to the service.
Q: If two servicing
providers have an identical set of taxonomy codes, what will prevent denial for
concurrent care if these practitioners are performing different services?
A: Their NPI, taxonomy and the codes being billed for.
Q: I logged onto the
taxonomy tool Web site and my doctor's first name is spelled incorrectly. How
do I change so that it matches all claims/tax codes, NPI, etc.
A: The only way to
make corrections is to modify your provider file. The person in your
organization who updates your provider file needs to do this.
Q: Just to make sure
that I am crystal clear. We are an anatomical lab with several providers. So
when we send our claims, we will need to include the taxonomy for the lab as
the billing provider and a taxonomy for the rendering (servicing?) provider. Is
that correct?
A: Yes.
Q: If a patient is
Medicare with DSHS secondary, we send Medicare claims electronically. In which
box would we put the taxonomy# in the electronic submission?
A: Refers to Medicare's billing guides.
Q: Currently, we are
having to paper claim all XO claims that are paid by Medicare as primary. With
new system will it XO automatically?
A: Yes it will. Be sure to include your taxonomy code.
Q: We are an eye
clinic where we do both eye exams and see patients for medical reasons such as
eye infections or other medical reasons. We also dispense DSHS eyewear. Would
that be 3 different taxonomies or 1?
A: http://hrsa.dshs.wa.gov/providerone/ProviderTutorials.htm
Q: If a local
physician orders lab work that is done at our hospital – so this physician is
the "ordering" physician - will we have to have a taxonomy number of
the bill for that physician?
A: Taxonomy is not
required for a referring or attending physician.
Q: Just need
clarification.....we are a DME provider. We normally get rendering providers on
our claim, and we are the billing provider. So there will be two tax ID numbers
on the claim. Now if the location specializes in incontinence, wound care, and
urology, how does the taxonomy number work? Would we need an additional
taxonomy number#?
A: Please contact providerone@dshs.wa.gov [1-800-562-3022 select option 2,4,wait]
Q: If a provider has
one NPI with multiple taxonomies associated with it, you cannot send a taxonomy
code with each service line. So do you mean that you would have a taxonomy code
that is associated to the billing provider and the other associated with
servicing/rendering provider?
A: You can send a taxonomy code with each service line. You use the
taxonomy associated with the service.
Q: We are physical
med and rehab. Are there different taxonomy codes that we will need to use when
say we are performing and EMG? Or when doing injections such as therapeutic
Botox injections or cortisone injections?
A: Please check your taxonomy codes and see that the services you
provide are covered by the taxonomies assigned to your organization: https://fortress.wa.gov/dshs/npicaphrsa
Q: How many
taxonomies will be required to use for providers and groups?
A: The answer to this
question depends on each service billed. You will need to use the appropriate
taxonomy for the service you are billing. DSHS has assigned each organization
taxonomy/ies based on the way they have billed
services in the past.
Q: Are taxonomy codes
required for referring doctors?
A: No.
Q: Where are the
taxonomy numbers located on the claim?
A: For instructions regarding Taxonomy and NPI placement information for
electronic and paper claims, refer to DSHS Numbered Memo 08-59 issued in August
2008: http://hrsa.dshs.wa.gov/Download/Memos/2008Memos/08-59.pdf
Q: If DSHS has
assigned more than one taxonomy to a provider in ProviderOne based on how they
have billed in the past, will we be required to use each of those taxonomies
according to the services they are billing?
A: You will be required to bill with the billing provider's
taxonomy, and the servicing provider, if applicable – and the service being
billed for must be allowed for that taxonomy.
Q: How will I find
the proper taxonomy for my providers?
A: In ProviderOne through registration or you can download a
report through the web.
Q: How closely must
procedure code or patient claim and provider taxonomy match? For instance, if a
provider has a woman's health taxonomy and a male patient is being seen, will
the claim be denied?
A: If the service that the provider is billing for is associated to
the taxonomy billed with, the service will be paid. If the service is allowed
for that gender and the taxonomy is allowed for that service, then that claim
should be paid.
Q: ProviderOne has
several taxonomies for each of our providers; do we have to use EACH of these
taxonomies or can we just use ONE? Our system only accommodates one taxonomy.
A: Pick the taxonomy that best describes the line of business or service that
is being billed.
Q: Could you possibly
give the website again that we can go to to get our taxonomy number?
A: The following is a link to the applet where you access your
security credentials, Taxonomy too, and Client Crosswalk: https://fortress.wa.gov/dshs/npicaphrsa
Q: I went to taxonomy
look-up and not all of my ProviderOne domains are there. When will the other
domains be listed?
A: Contact Provider Enrollment at providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]
Q: Does ProviderOne
have more than one Taxonomy per service?
A: Yes.
Q: Please advise
where the taxonomy number would go on the dental claim.
A: Billing provider: box 52A; rendering provider: box 58
Q: What if your group
practice has radiology and outpatient services on the same claim? What taxonomy
do we use?
A: If the taxonomy for outpatient services covers both radiology and
outpatient services, then use that taxonomy.
Q: On slide 20, how
do we know which taxonomy codes are approved/compatible for a given CPT?
A: Please look at the taxonomies that were assigned to your
organization. Use the taxonomy code that is compatible with the code you are
billing for.
Q: We are an
Orthopaedic practice, with subspecialties. We understand that you assign the
taxonomy by CPT code per claim, so how can an Orthopaedic surgeon, hand
subspecialty taxonomy, cover radiology also?
A: You can bill per line or per header.
Q: What if the coder
chooses the wrong taxonomy?
A: The claim will
deny.
Q: We received a
National taxonomy code for family practice. I noticed that in ProviderOne, the
taxonomies assigned were not only for general family practice but also for
specialties within the family practice. Do we need to use the specialty codes
or can we use the general code?
A: In most cases, either way will work. You may need to use a
specialty taxonomy in some cases.
Q: How do we KNOW
what codes are covered by a taxonomy? Is there a source we can reference?
A: We do not have a reference resource that links specific
taxonomies to specific codes.
Q: Will all of the
taxonomy and client ID numbers be in the ProviderOne system already when it
goes live?
A: Yes.
Q: Which loops do the
taxonomy codes go into in the 837 file? I understand 2000A PRV for the billing/pay-to
provider and 2310B PRV for the rendering provider. Is that correct?
A: You are correct.
Q: For dental claims,
taxonomy codes go into box 58 and ProviderOne IDs go into which box? NPIs go
into box 49 or 54?
A: For dental claims,
put the group NPI in 49 and taxonomy in 52A.
Servicing Provider NPI in box 54 and servicing taxonomy in box 58.
Q: If our
radiologist performs an interventional procedure on a hospital outpatient,
which taxonomy code is correct?
A: Use
the hospital outpatient taxonomy.
Q: We are
a pharmacy that dispenses durable medical equipment. We have several taxonomy
codes associated with our business according to ProviderOne. Will we be able to
use the Community Retail Pharmacy taxonomy for all that we dispense, or will we
have to be more detailed?
A: We
recommend, as a rule, to use the code that is most applicable to the service
you’re billing.
Q: Does the assigned
taxonomy replace my DSHS provider number? How do I find out what my taxonomy
number is?
A: It does not
replace your DSHS provider number. You will have to use your NPI as your
provider number.
Q: So we will NOT be
using the DSHS provider number once we go live?
A: That is true. At go-live, you will use your NPI and taxonomy.
Q: If we add a
taxonomy to our claims before the go-live date, will the claims be denied?
A: Yes. MMIS does
not accept taxonomy.
Q: If we are using
WINASAP, do we need to change the PIC to the client ID number?
A: Yes.
Q: Do skilled nursing
facilities have to do test billing when using WINASAP?
A: Yes. There will be
training soon and testing before go live for Nursing Homes. Testing is required.
Q: Is there a new
version of WinASAP that goes with ProviderOne?
A: Go to: http://www.adsa.dshs.wa.gov/professional/providerone/registration.htm There is step-by-step information on how to
indicate WinASAP.
Q: Let me understand
you correctly: If we direct bill – no batching – do we still need to run a
test?
A: You do not need to
test if you bill one claim at a time.
Q: Where do I go to
do the testing?
A: Go to: http://hrsa.dshs.wa.gov/providerone/HIPAAtesting.htm for more information.
Q: Are we going to
have the ability to use this billing system with mock clients/patients before
the launch date?
A: No. However, you can access a tutorial regarding checking
client eligibility and claims submission that will give you a good feel for
using this system: http://hrsa.dshs.wa.gov/providerone/ProviderTutorials.htm
PIC
Crosswalk and Client ID Numbers
Q: When will the
production crosswalk file be available?
A: Approximately 30 days prior to go-live.
Q: Can providers who
bill through RSNs also get this crosswalk directly or do they just get it from
their RSN?
A: They will get it from their RSN.
Q: When will the new
client ID actually be available in the ProviderOne Portal?
A: At go live.
Q: When I put my
ProviderOne ID and tax ID in the crosswalk, I get an error that reads
"Provider number and tax ID combination could not be validated! If you are
using an SSN for your Tax ID please be sure to mark the checkbox to indicate
this. Please try again."
A: Please contact: providerone@dshs.wa.gov [1-800-562-3022 select option 2,4,wait]
Q: When I tried to
get to the crosswalk, it said NOT FOUND.
A: Will you try again using the copy and paste feature? https://fortress.wa.gov/dshs/npicaphrsa
Q: Will the crosswalk
file of PIC to ProviderOne ID also be available for transportation
brokers?
A: Yes, as long as you have billed DSHS before.
Q: When you say that
the format for the crosswalk file of the Client ID will not change, what does
that mean? Is there any way you can add our Patient Account Number to the
crosswalk? The information in the crosswalk
file is vague and difficult to look up patients to match to our system.
A: Your Patient Account Number cannot be added to the
crosswalk.
Q: If we are a group,
will our client list come over in one large print out by group or will each
physician have his own list?
A: The list will come over based on the provider number you place in
the applet.
Q: It appears that
the crosswalk begins with Provider and ends with Client. So Provider is the
physician and Client is the patient? Do Provider IDs still need to go onto
claims? [
A: You are correct in that provider is the physician and client is
the patient. You must use the Provider's NPI on all claims.
Q: Can you use the
new client ID before the go-live date?
A: No.
Q: Will you be
covering dental areas of concern also? Is there a new client ID for us also?
A: All DSHS clients will have a ProviderOne ID that must be used to bill with
at go live.
Q: Will we be able to
search the PIC-to-Client ID Crosswalk listing by letter of the alphabet? Right
now, we have to scroll through the whole list to do a look up.
A: Export the list and you may be able to sort.
Q: Who do you talk to
if you can't bring up your crosswalk to do any of these activities? I have
talked to 5 different people and emailed two people and no one knows the answer
to it.
A: Email providerone@dshs.wa.gov [1-800-562-3022 select option 2,4,wait]
Q: Will there be no
payments during cutover? And what if the cutover is not successful and takes
longer?
A: There will be no payment during that time. We do have
contingency plans. MMIS will remain in the background. We could fall back on
that system.
Q: It would be
helpful to visualize claim examples if they become available.
A: Please check out the tutorial for claims submission. There will be
system training by Webinar on claims submission, client eligibility and
preauthorization beginning October 19th. Currently there is a Claims submission
tutorial available and the Provider System User Manual is available at: http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm These are very good resources.
Q: Do you consider
glasses DME or Medical?
A: Please refer to your Billing Instructions.
Q: You
have stated that we will not be able to check history through ProviderOne or
the IVR for one to two years. I asked yesterday about denials for same/similar
equipment (the five year rule). Will the client history on this not be carried
over from MMIS into Provider One?
A: While claims history was brought into ProviderOne, the ability
to do a limitations check against the history will not be available until we've
had time to build the history in ProviderOne.
Q: So between cutoff
and go-live, how do we check eligibility?
A: You can use
WAMedWeb until go-live to check eligibility.
Q: As an FQHC, we had
an FQHC Medicaid number. Do we utilize that number now that ProviderOne is in
place? If so, how?
A: Please use your ProviderOne ID, NPI and FQHC taxonomy at go live.
Q: We have a group ID
number and many dentists that work here at the school with their own provider
ID. I have completed registration for our school group number; do I need to
register all the dentist information as well, or does it automatically get
transferred by DSHS?
A: The provider file
information for your group practice, including your servicing providers, has
been copied to ProviderOne from the current legacy MMIS. To complete your
registration, you need to register the servicing providers during Step 15.
There are two reasons for this:
1.
Verifying that DSHS is aware of all the
servicing providers associated with your group practice – and making any needed
corrections.
2.
Confirming that the details about each
servicing provider are correct – and making any needed corrections.
This is
important to keeping your practice payable when ProviderOne goes live.
From
the ProviderOne Provider Training page, http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm,
you can find several resources. You may find the registration e-Learning most
useful in this case because it explains the step and walks you through an
example of Step 15: http://hrsa.dshs.wa.gov/providerone/ERegistration.htm.
Q: Are the new
plastic ID cards still to be mailed out for November? Are the clients also
going to receive paper MAID cards until go live?
A: The plastic ID cards will be mailed out by region approximately 30 days before go live. Clients will continue to receive the paper MAID until go live. Please visit the implementation schedule area of our Web site for updated information: http://hrsa.dshs.wa.gov/providerone/Projected%20Schedule.htm
Q: Clients who have
Community Health Plan of Washington and DSHS MAID cards have two separate
cards. Will that stay the same and we just have to check eligibility, or will
the new DSHS cared reflect what plan they have?
A: The DSHS Services
Card will only indicate the client’s name and ProviderOne client ID number. You
can check eligibility to find out which health plan the client is enrolled in.
Q: How do we get a
scanner?
A: Optional Card Reader Website: https://www.meddatahealth.com/MedData/ProviderOne
Q: Will the scanner show
managed care programs and HMOs when checking eligibility?
A: The scanner will provide you with the same information that you will
find in ProviderOne.
Q: If you can verify
coverage online, is there any reason a card reader is necessary?
A: It is just offered as an option, but is not necessary.