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Using Taxonomy and Other New Identifiers to Get Paid . Webinar Readiness Series September 29, 2009 – October 29, 2009. Meeting Summary. Webinar Purpose Provide an overview of ProviderOne and new requirements for using federal taxonomy and other new identifiers on ProviderOne claims

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Using Taxonomy and Other New Identifiers to Get Paid

Webinar Readiness Series

September 29, 2009 – October 29, 2009


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Meeting Summary

  • Webinar Purpose

    • Provide an overview of ProviderOne and new requirements for using federal taxonomy and other new identifiers on ProviderOne claims

    • Including taxonomy and other new identifiers on claims in ProviderOne is required or claims will deny

  • Recommended Attendees

    • Individuals representing provider organizations (primarily fee for service) who are responsible for billing DSHS

October, 2009


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Agenda

  • ProviderOne Overview and Schedule

  • Overview of National Provider Identifier (NPI)

  • Overview of ProviderOne Client ID

  • Overview of Taxonomy Code Requirements

  • Questions and Answers

October, 2009


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Overview of ProviderOne

October, 2009


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What is ProviderOne?

ProviderOne is the new DSHS provider payment system

ProviderOne will replace the current Medicaid Management Information System (MMIS) and the Social Service Payment System (SSPS)

ProviderOne is a large undertaking that will be implemented in phases

Overall goal is to support continuous services for clients and uninterrupted payments to providers

October, 2009


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Phased Implementation Schedule

  • Phase 1: Replaces Current MMIS

    • Pharmacy Claims – Front-end Point of Sale (POS) system implemented October 20, 2008 with current MMIS on the backend

    • Medical and Nursing Home Claims – The next possible go-live date is January 10, 2010. This will include pharmacy claims

  • Phase 2: Replaces Current SSPS and some manual payments

    • Implemented over 2.5 years after Phase 1

October 2009


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Significant Activities To Date

  • User Acceptance Testing (UAT) by state staff from July 2008 – March 2009

    • Executed 5,000+ test cases with multiple iterations or nearly 20,000 total tests

  • Pre-production (pilot) test with providers June – August 2009

    • 6,000+ claims processed with senior state staff comparing results with legacy MMIS (only minor defects in claim edits, all of which are now resolved)

    • Demonstrated claims processing is working well – biggest issue was with HIPAA format compliance

  • Announced final go-live date this summer

    • Experienced spike in provider contacts resulting in a backlog of calls

October, 2009


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Lessons Learned

  • Need improved provider communication and instructions to ensure continuity of payments

  • Readiness webinars one of several strategies to augment communications

    • Five (5) webinar topics to help transition to ProviderOne

    • 30 different webinar sessions to choose from 9/29 to 10/29 – see listserv announcement (http://hrsa.dshs.wa.gov/providerone/ScheduledWebinars.htm)

  • System training webinars geared toward using ProviderOne after go live

    • Address how to bill, how to verify client eligibility, how to download remittance advice (RA), etc. (http://hrsa.dshs.wa.gov/providerone/SystemTraining.htm)

October, 2009


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Readiness Webinars - Summary

October, 2009


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6 Steps to Provider Readiness


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Using New Identifiers to Get Paid

October, 2009


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New Identifiers in ProviderOne

  • Claims in ProviderOne must:

    • Use the National Provider Identifier (NPI) for billing and servicing (if applicable) providers instead of the current Medicaid Provider ID

    • Use the new ProviderOne client ID instead of the current Personal Identification Code (PIC)

    • Use the new taxonomy codes for billing and servicing (if applicable) providers

  • Claims and adjustments that do not include these new identifiers will deny

    • New identifiers required on all claims and adjustments submitted to ProviderOne, regardless of the date of service, or those claims will deny

October, 2009


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Using the New ProviderOne Client ID

October, 2009


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Use new ProviderOne Client ID

  • The new ProviderOne Client ID:

    • Is required on all claims after go live, regardless of the date of service

      • Claims without the new Client ID will deny

    • Is required on all adjustments after go live, regardless of the date of service and even if the original claim was paid by the current MMIS

      • Adjustments without the new Client ID will deny

    • Meets HIPAA privacy rules as no personal identifying information is included

    • Does not change; it belongs to the client for life, even if eligibility information changes

    • Is printed on the client’s new Services Card

  • DSHS has developed a PIC-to-ProviderOne Client ID crosswalk tool

October, 2009


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Use new ProviderOne Client ID, cont.

  • Download a crosswalk file of current PIC to new ProviderOne IDs

    • Includes both IDs for clients billed by provider in the last 2 years

  • Access the crosswalk at:

    • https://fortress.wa.gov/dshs/npicaphrsa

  • The crosswalk is currently a test file

    • Final data for payment purposes will be available approximately 30 days and again immediately before go-live

    • The format of the test file will not change

    • Potential for client data to change (if client source system [ACES] consolidates client records, for example)

October, 2009


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PIC-to-Client ID CrosswalkClients Seen in Last 24 Months

Application will return crosswalk data for all PICs associated with your MMIS ID number.

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Click here to export to CSV or XLS.

October, 2009


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Use new ProviderOne Client ID, cont.

  • Links, Tools and Tips

    • Read “DSHS is Changing to a New Client Identifier” fact sheet at: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR010_Client_Identifier.pdf

    • Access the client crosswalk at: https://fortress.wa.gov/dshs/npicaphrsa

  • Support

    • For general questions, including questions about the new client ID, contact the Provider Response Team at [email protected] (1-800-562-3022, select options 2, 4, wait)

October, 2009


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Using the new Federal Taxonomy

October, 2009


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What is Taxonomy?

  • Taxonomy is a general term referring to a classification system

  • Provider Taxonomy refers to the national taxonomy code set designated by the HIPAA National Provider Identifier (NPI) rule

  • National provider Taxonomy is a 10-digit alpha-numeric code

    • First 2 digits refer to provider type

    • Next 2 digits refer to provider specialty

    • Next 5 digits refer to provider sub-specialty

    • Last digit is reserved for future use and displays as an “X”

October, 2009


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Why is taxonomy important?

  • Taxonomy is required on all ProviderOne claims and adjustments regardless of date of service – claims that are missing taxonomy will deny

  • Taxonomy is required for billing and servicing (if applicable) providers regardless of date of service – claims that are missing taxonomy will deny

  • Taxonomy submitted on the claim must match the taxonomy associated with the provider in ProviderOne

  • The procedure code submitted on the claim must be compatible with the taxonomy submitted on the claim

    • For example, DME services require a DME taxonomy, inpatient services require an inpatient taxonomy, etc.

October, 2009


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How did DSHS assign my taxonomy?

  • The current payment system uses provider type and specialty behind the scenes when processing claims

    • Each legacy Medicaid Provider ID is associated with a specific provider type and specialty

    • Providers learned over time to use the different Medicaid Provider ID that represents each line of business

  • DSHS mapped each historical provider type and specialty to the national taxonomy code set

  • DSHS then assigned the new national provider taxonomies to each provider based on their historic type and specialty

October, 2009


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How do I learn the taxonomies DSHS assigned to me?

  • There are 2 options for viewing taxonomy assigned to you

    • View, update and print your taxonomy during registration (see readiness Step 2)

    • Download a report using a Web-based tool at https://fortress.wa.gov/dshs/npicaphrsa

      • The report shows the taxonomies associated with your tax ID as of August 1, 2009 – to be refreshed 30 days before go live

      • Use the report to view taxonomy, but can only update taxonomy in ProviderOne

  • For more information, read the fact sheet at

    • http://hrsa.dshs.wa.gov/providerone/providers/Fact%20Sheets/P1PR009%20taxonomy.pdf

October, 2009


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Why does DSHS require taxonomy on claims?

  • Historically, DSHS used unique Medicaid Provider IDs to differentiate between a provider’s different lines of business

  • With NPI rules, providers may obtain as many or as few NPIs as they want – DSHS cannot mandate the number of NPIs

  • With ProviderOne, taxonomy will be used to differentiate between a provider’s different lines of business

    • For example, taxonomy will be used to differentiate between radiology and emergency room services for a provider with a single NPI

October, 2009


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Where do we enter the taxonomy on the claim?

Please see the DSHS numbered memo 08-59, issued on August 18, 2008 at: http://maa.dshs.wa.gov/download/Memos/2008Memos/08-59.pdf

The 8-page memo gives detailed information related to this topic

October, 2009


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Examples of Taxonomy

October, 2009


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How will I know which taxonomy to use?

Select the taxonomy that best describes the line of business or service that is being billed

In the previous example, the provider will use their radiology taxonomy when billing radiology services and their outpatient taxonomy when billing outpatient services

View taxonomy descriptions in ProviderOne (see step 3: Specialties during Registration) or on the taxonomy report that you can download from the Web (https://fortress.wa.gov/dshs/npicaphrsa)

October, 2009


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Why are only some of the federal taxonomies used?

Only those taxonomy codes that represent DSHS covered services were selected from the thousands of federal codes

DSHS considers additional codes twice a year (January and July) when updated by the National Uniform Claim Committee (NUCC)

Providers can request additions to the DSHS-recognized codes at the same time as the NUCC updates, with the first requests considered in July 2010

DSHS will be publishing a process for requesting additions to the DSHS-recognized taxonomies later this year

October, 2009


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What about taxonomy and Medicare Crossover claims?

  • Providers must include taxonomy on claims submitted to Medicare for DSHS clients

  • Medicare will verify that the taxonomy is from the valid national code set, then pass the claim on to DSHS

  • DSHS will process the claim validating that:

    • The service is compatible with the taxonomy; and

    • The taxonomy is associated with the provider in ProviderOne

October, 2009


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What else do I need to know?

  • DSHS and other payers do not have access to the taxonomies you selected at the national level

    • Taxonomies associated with you in ProviderOne were assigned by DSHS, not those you selected at the national level

    • Taxonomy changes you make in ProviderOne during registration are not reflected in the national database (or vice versa)

  • You can add taxonomies to a servicing provider during registration, but do not end date a taxonomy

    • Another billing provider may use that taxonomy for that servicing provider

October, 2009


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How do I get more information?

  • Links, Tools and Tips

    • Download a report of DSHS-approved taxonomies assigned to your billing and servicing provider IDs at:https://fortress.wa.gov/dshs/npicaphrsa

    • Read the fact sheet “Using Taxonomy in ProviderOne” at: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR009%20taxonomy.pdf

  • Support

    • For general questions, including questions about the new national taxonomies, contact the Provider Response Team at [email protected] (1-800-562-3022, select options 2, 4, wait)

October, 2009


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Need Assistance?

  • Telephone and e-mail support system implemented to address questions – 1-800-562-3022, option 2, 4, then press:

    • 1 for security questions and login issues, or [email protected]

    • 2 for registration questions, change to NPI or Tax ID number, or [email protected]

    • 3 for HIPAA set-up questions (SFTP site, missing/bad 997 file, etc.)

    • 4 for HIPAA testing questions or [email protected]

    • Stay on the line for general questions or [email protected]

October, 2009


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Additional assistance

  • Visit ProviderOne internet: http://hrsa.dshs.wa.gov/providerone/providers.htm

    • Newsletters

    • Fact Sheets

    • Q&A

    • Training Resources

    • Security and Registration instructions and resources

  • Join the e-mail distribution list for ProviderOne Countdown Newsletter & updates

    • http://listserv.wa.gov/archives/providerone_provider_readiness.html

  • E-mail questions directly to:

    • [email protected]

October, 2009


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Questions and Answers

http://hrsa.dshs.wa.gov/providerone/providers.htm

October, 2009


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