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Tips and Trouble Shooting For Completing ProviderOne Registration Webinar Readiness Series September 29, 2009 – October 29, 2009 Webinar Summary

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Tips and Trouble Shooting

For Completing

ProviderOne Registration

Webinar Readiness Series

September 29, 2009 – October 29, 2009


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Webinar Summary

  • Registration in ProviderOne includes reviewing and validating that your provider file has been set up properly and telling DSHS how you plan to submit transactions

  • Webinar Purpose

    • Provide tips and guidance for completing Registration in ProviderOne.

    • Successful completion of Registration is necessary to ensure your payment goes to the correct place and to designate a clearinghouse or billing agent

  • Recommended Attendees

    • Individuals representing provider organizations who are responsible for validating provider information in ProviderOne

October 2009


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Agenda

  • ProviderOne Overview and Schedule

  • Overview of Registration Steps

    • Purpose of each step

  • Information and Tips to Successfully Register

  • Support and Resource links

  • Questions and Answers

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 Services 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

    • Demonstrated that claims adjudication works well – biggest challenge was completing EDI testing

  • 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 to10/29 – see listserv announcement (http://hrsa.dshs.wa.gov/providerone/ScheduledWebinars.htm)

  • System training webinars geared to 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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Registration Pre-requisite

  • This step requires that you first have security access to ProviderOne

    • Your organization’s Security Administrator assigns the profile needed to register in ProviderOne

  • Use the EXT Provider File Maintenance profile to complete provider registration

October 2009


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Business Process Wizard

  • Provider Registration is supported by a business process wizard

  • The wizard supports 17 different steps of Provider Registration

  • Log into the wizard using the EXT Provider File Maintenance profile for registration

  • Use the business process wizard to go through the steps of registration

October 2009


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Step 1 – Provider Details

  • This page contains basic information, such as name

    • Grayed-out values cannot be edited on this page

    • Organizations can edit the organization name on this page

    • Individual providers can edit the name appearing in this step

October 2009


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Step 2 – Locations - Tip

  • Problem: You are an FAOI provider (Facility, Agency, Organization or Institution) – for example, a DME (durable medical equipment) provider or a pharmacy. You do not have beds, as a hospital does. You make a change (such as your phone number) in your provider file. The system prompts you to fill in all required fields. One of the required fields is “number of beds.” Because you do not have beds, you get stuck at this step.

  • What to do: Some FAOI providers (such as hospitals) have beds; they must enter the number of beds when completing this step for their various locations. All FAOI provider types must complete that field in order to exit that screen. Any FAOI providers that do not have beds must enter “0” (zero) in the “number of beds” field. This will allow you to exit the screen.

October 2009


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Step 3 – Specializations

  • This step deals with specialty and subspecialty. These are your taxonomy codes.

  • Problem: The Specialization dates you entered in step 3 are not consistent with the dates you enter later for License and Certification in step 5.

  • What to do: All licenses / certifications in step 5 must have effective dates on or before the start date of the corresponding specializations in step 3.

October 2009


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Step 4 – Ownership Details

  • This step requires that you enter your ownership information on this page. You need to determine if you are an organizational or individual ownership type and then enter the appropriate information.

October 2009


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Step5–LicensesandCertifications–Tip

  • Problem: An error message will appear if you do either of the following:

  • - For your license/certification, you enter either an incorrect type OR effective date.

  • - Enter (or don’t update) a license/certification which has expired (the end date is in the past).

  • What to do: When entering information related to your license or certification, be sure to enter both the correct license or certification type and dates associated with the license or certification. The effective date must be on or before the start date of the specialization.

October 2009


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Step 6 – Training

  • Skip this step as it is reserved for future use by Social Services Providers who will be included in Phase 2 of ProviderOne; it is not functional at this time.

October 2009


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Step 7 - Identifiers

  • This step contains the provider identifiers list.

    • This is where you view and verify or update your identifying numbers.

  • In some cases, you may need to add an identifier on this page.

October 2009


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Step 8 – Contract Details

  • Skip this step as it is reserved for future use by Social Services Providers who will be included in Phase 2 of ProviderOne; it is not functional at this time.

October 2009


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Step 9 – Tax Details

  • This step allows ProviderOne to collect information for W4, W5, and W9 forms.

  • This is where you verify information included in the tax forms.

October 2009


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Step 10 – Invoice Details

  • Skip this step as it is reserved for future use by Social Services Providers who will be included in Phase 2 of ProviderOne; it is not functional at this time.

October 2009


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Step 11 – EDI submission - Tip

  • Problem:You’re unsure what submission method you use – there are four choices.

  • What to do: Select the appropriate method as follows.

  • Your EDI submission method is “Web Batch” if you upload and download batch files using WaMedWeb. This method is often used by providers who submit their own HIPAA batch transactions. It allows a maximum file size of 50 MB.

  • Your EDI submission method is “FTP Secured Batch” if you submit and retrieve batches at a secure web folder assigned to you by DSHS. This method was designed with clearinghouses and billing agents in mind. It allows a maximum file size of 100 MB.

October 2009


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Step 12 – EDI billing software

  • In this step, you enter the EDI billing software information ProviderOne may need in the future if your software company needs to be contacted.

  • Problem: You aren’t sure what your EDI Billing Software is, and do not have the information required to complete this step accurately, so you inadvertently enter incorrect information in the fields.

  • What to do: In Step 11, if you chose either “Web Batch” or “FTP Secured Batch” as your EDI Submission Method, you must complete this step. If you do not have the software information on hand, you should contact your IT system support personnel for this information before proceeding.

October 2009


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Step 13 – EDI Submitter Details

  • In this step you identify your Billing Agent(s) or Clearinghouse(s) and what transaction(s) you give them authority to do.

  • Problem: Your claims for DSHS payment are submitted through a Clearinghouse or Billing Agent. You enter the wrong EDI (electronic data interchange) submitter information in ProviderOne. If you enter information for one Clearinghouse but that agent has handed off the function of submitting claims to another agent, ProviderOne does not have the necessary information to send outbound files (i.e., 835, 271, 277) to the correct agent.

  • What to do: Verify with the Clearinghouse or Billing Agent they are indeed the agent who submits your claims and you have the correct EDI submitter number. Make any necessary changes in ProviderOne.

October 2009


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Step 14 – EDI Contact Info

  • If you selected “Web Batch” AND/OR “FTP Secured Batch” in Step 11, this step requires that you add contact information for someone within your organization. This will give DSHS someone to contact regarding HIPAA batch transactions that you submit or acquire directly from ProviderOne.

  • Designate authority for receiving the 835 (electronic remittance advice) in this step. The 835 can only be received by one (1) organization (either the provider or a Billing Agent/Clearinghouse).

October 2009


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Step 15 – Servicing Provider Info

  • In this step, you verify that DSHS has all information about your individual servicing providers.

  • Problem: Your provider type is FAOI (Facility, Agency, Organization or Institution). Some FAOIs have individual servicing providers; some do not. When you reach Step 15, the system indicates this is an optional field for FAOI providers. You decide to not complete this step, as it is an optional field. However, your FAOI does have servicing providers working with it, so skipping this step will result in information missing from your provider file.

  • What to do:Although Step 15 states it is optional for FAOIs, if you have individual servicing providers you must complete this step.

October 2009


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Step 16 – Payment Details

  • In this step, you inform ProviderOne how you wish to receive payment from DSHS.

  • Problem: You open the “payment details” screen to review the information. EFT (electronic funds transfer) information is shown on this screen. You click “OK”, so the system expects you to enter new EFT information. Failure to do so gives you a system error and you cannot exit this screen until you satisfy the system requirement of entering the accurate EFT information.

  • What to do: If you open the “payment detail” page to review the information and there is EFT information on file, click on “cancel” – do not click on “OK”. Clicking “OK” will require you to re-enter the EFT account information.

October 2009


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Step 16 – Payment Details cont.

  • Problem: You select “835,” which gives you a message that an email is required, yet there is no place on that page to enter an email address.

  • What to do: You do not enter an email address on this page – it should have already been entered in Step 2 of the registration process. If you did not enter an email address at Step 2, go back to that step to enter your email address.

  • If you designate authority for receiving the 835 (electronic RA) in Step 14, remember:

  • 835 can only be received by one (1) organization (billing agent/clearinghouse or provider) – Step 14 or 13 designation takes precedence over selections in Step 16

October 2009


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Step 17 – Submit for Review

  • All of the fields in Steps 1 through 16 which are “required” for your provider type must be marked “complete” in the business process wizard, to open Step 17. Any step that posts a message in the wizard’s “Step Remark” field must be addressed before you will be able to open Step 17 and submit your registration.

  • Problem: You complete all the required registration steps but fail to click the “submit provider modification” button. The result is DSHS will not receive your registration information. Also, you may think you need to gather and send to DSHS all items on the “Application Document Checklist.”

  • What to do: To complete your registration, you MUST click the “submit provider modification” button. Also, the only items listed on the “Application Document Checklist” that you need to send to DSHS are a copy of the required licenses or certifications from Step 5, along with the Document Cover Sheet. If you are an electronic submitter, you also must submit a Trading Partner Agreement (TPA).

October 2009


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Step 17 – Submit for Review (cont.)

  • DSHS will review your updates

  • The changes will become effective as they are approved

  • DSHS will notify you of the approval of your changes via Alert Messages on the main Provider Portal page

October 2009


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General Registration Tips

Remember to register all organizational NPIs

Be sure to note your taxonomy in Step 3 – taxonomy is required on claims in order to receive payment

A taxonomy fact sheet is at ProviderOne’s fact sheet Web page: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/FactSheets.htm

You may download a report of your taxonomies. The tool is available at https://fortress.wa.gov/dshs/npicaphrsa

October 2009



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Getting Support

  • 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 changes to NPI or Tax ID number or registration questions if you do not submit electronic batches, [email protected]

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

    • 4 for HIPAA testing questions or [email protected]

    • For registration questions (only if you’re an electronic batch submitter), [email protected]

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

    • Email is the preferred method to request support, with the specific problem noted in the subject line, such as “locked out.” This allows support staff to identify the problem at a glance and respond more quickly.

October 2009


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More Information Sources

  • 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:

  • Call toll-free telephone line (1-800-562-3022)

    • Select “2,” then option “4” (see previous slide for prompt options)

October 2009


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

October 2009


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