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Quick Links: ◊Projected implementation dates ◊Contact the ProviderOne Office Providers access ProviderOne at: https://www.waproviderone.org/ Note: To access ProviderOne your organization must provide you access by completing the steps outlined on our Security page.
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What is ProviderOne? The Washington State Department of Social and Health Services (DSHS) is replacing its' current Medicaid Management Information System with a new payment processing system we have named ProviderOne. ProviderOne will be DSHS' primary provider payment processing system. When fully operational, it will pay about 100,000 providers who serve 1 million people who qualify for DSHS services each year. That’s about one out of every five Washingtonians. ProviderOne is being developed with unprecedented cross-administration support within DSHS - more than a thousand DSHS employees have participated in discussion on development and design. The state teams are working with the project's contractor, CNSI, which is based in Rockville, Md. Updates: April 27, 2009 - DSHS Resumes ProviderOne Security and Registration Activities DSHS has resumed provider registration and security activities to support ProviderOne, DSHS’ new Medicaid Management Information System (MMIS), slated for implementation later this year. You may recall that in November, DSHS paused provider registration and security activities to accommodate system improvements that would streamline the overall process. During this pause, DSHS also discovered a data conversion issue that occurred when converting provider records from the current MMIS ID number to the new National Provider Identifier (NPI). These system enhancements and re-conversion of provider data are now complete and providers are invited to resume provider registration and security activities. The level of activity you need to complete prior to implementation of ProviderOne depends on the type of provider you are and the type of electronic transactions you will conduct with ProviderOne. There are up to six (6) activities that you may need to complete, depending on your situation (see below). By resuming provider registration and security, you can now complete the first four (4) activities, if applicable. 1. Security: Every provider who plans to interact with ProviderOne (to complete registration activities, submit claims, check claim status, verify client eligibility information, review your remittance advice, etc.) will need to designate a security administrator who will set up secure access (log-in and password) for your staff. To access security instructions: http://hrsa.dshs.wa.gov/ProviderOne/Security.htm 2. Registration: All clearinghouses and billing agents (commercial organizations who bill on behalf of providers) as well as providers who bill HIPAA batch file transactions on their own behalf must register before ProviderOne implementation. DSHS strongly urges all other providers to register to minimize the risk that claims process incorrectly or that payment is sent to the wrong address or Electronic Funds Transfer (EFT) account. For more information and to access registration instructions: http://hrsa.dshs.wa.gov/ProviderOne/Registration.htm 3. Trading Partner Agreement: Providers who use HIPAA batch file transactions or WINASAP software will need new Trading Partner Agreements (TPA). A new Trading Partner Agreement is needed because current TPAs will no longer be valid once ProviderOne goes live. These agreements are at http://hrsa.dshs.wa.gov/providerenroll/ under the “What’s New” in the upper right of the page. 4. HIPAA File Format Testing: Providers who use HIPAA batch file transactions must test that their file format can pass our Electronic Data Interchange (EDI) gateway to be payable in the new system. The purpose is to ensure file formats are HIPAA compliant. HIPAA Companion Guides have instructions for setting up your files and testing. You will be ready to test once DSHS approves your registration and sends you a submitter number. Companion Guides for each transaction type can be found at http://hrsa.dshs.wa.gov/dshshipaa 5. HIPAA File Content Testing: DSHS strongly urges that all providers who use HIPAA batch file transactions submit a test batch of claims through a full adjudication cycle. This testing will be available in June. However, you must pass HIPAA format testing first. The purpose of this testing is to ensure that file content passes the adjudication process. 6. ProviderOne Training: All providers will have an opportunity to participate in training in the two months prior to ProviderOne implementation. Training will be available in several formats such as webinar training and on-line tutorials. Additional information about training will be made available at a later date. Some providers have unique instructions like Managed Care Organizations, Regional Support Networks, Tribes and Nursing Homes. Please find the appropriate link on our registration page for information http://hrsa.dshs.wa.gov/ProviderOne/Registration.htm System Enhancements DSHS originally paused provider registration and security activities last November to implement system improvements that would streamline the overall process. These system improvements include the following: Added an optional security spreadsheet: Providers with more than three “pay to” NPIs or more than 25 staff who will use ProviderOne will benefit from a new option to administer staff security by uploading a spreadsheet that designates staff security profiles. This option will be available in a couple of weeks. We will notify this list and post the information on our security page when available. http://hrsa.dshs.wa.gov/ProviderOne/Security.htm 2. Added security profiles: DSHS added three additional security profiles that should give providers more flexibility when administering staff security. A complete list of profiles you can use to assign your staff varying levels of access to ProviderOne can be found at http://hrsa.dshs.wa.gov/ProviderOne/Security.htm 3. Improved quality and accuracy of data: DSHS identified an error that would have required file clean up by providers. DSHS corrected the error and reconverted all provider files from the old system. Registration work previously completed by providers was maintained. 4. Added the ability to register multiple domains: Providers can now register multiple NPIs simultaneously while DSHS is in the review and approval process. 5. Made it easier to view taxonomy: DSHS made it easier to view the taxonomy assigned to you during conversion (see step 3 – Specializations in the ProviderOne wizard while registering). You will need to include the taxonomy associated with your organization when submitting a claim. If you started security and registration activities before they were suspended, you can
resume where you left off. Registration work completed before these activities were
paused has been preserved. February 11, 2009
February 2, 2009 - DSHS issued the following message to the Provider Readiness e-mail distribution list today. ProviderOne Update: To keep you informed about ProviderOne progress, following is information about:
Security and Registration Activities At the end of November DSHS suspended ProviderOne security and registration activities in response to concerns from providers about the level of effort needed to complete them. During this pause, DSHS identified some potential options to streamline these activities. We are currently working through the feasibility of these options and resolving some data conversion issues. We know how busy providers are and value the care you provide to our clients. We want to make the process easier for you before we restart. We believe it will be approximately mid-to-late March before these activities resume. Information will be provided on this website and through the Provider Readiness e-mail distribution list when we identify a date. Thank you for your patience. Our intent is to ensure these activities work toward our goal of uninterrupted and accurate provider payments at go live. Re-projecting the Go-Live Date for Medical and Nursing Home Claims From the start of the ProviderOne project, our approach has been to reassess our implementation date at planned checkpoints using the best information available on our progress, lessons learned, issues, risks, and the work remaining. It is important that this next and final checkpoint target a go-live date that is as accurate as possible so that our providers and staff can prepare appropriately. In order to accurately re-project the go-live date we must finish the current phase of User Acceptance Testing (UAT). During UAT DSHS has been rigorously testing ProviderOne claim processing and thousands of different scenarios. This is a critical step in ensuring that ProviderOne will be able to accurately process transactions the way it was designed to. As expected, through UAT we've identified some system modifications that are necessary before we can begin pre-production testing and start a pilot test with a sample group of providers. Until we've finished UAT and addressed these modifications, we cannot accurately re-project a go-live date. DSHS anticipates announcing the final go-live date this spring. In the meantime and for planning purposes, stakeholders should work toward a go-live date in late summer or early fall. Once the final go-live date is announced we will provide periodic progress updates up to implementation to keep you informed. November 24, 2008- ProviderOne Security and Registration Activities temporarily Suspended to Streamline Readiness Activities: Over the past couple of months providers have been making a good faith effort to complete the security administration and registration activities in ProviderOne. We have heard from many of you that the effort needed to complete these activities is taking longer than anticipated and that you want a more efficient registration process. As a result, DSHS is suspending both the security administration and registration tasks in ProviderOne to explore other options for accomplishing these tasks that might reduce the work effort for providers. If you are in progress with either of these activities, please do not call our call center, we will contact you directly in the next few weeks with information about next steps. The information you have entered will not be lost. Our intent is to ensure all providers are payable and that your staff have adequate access when ProviderOne is implemented. Over the coming weeks, we will be working with our vendor to explore what we have learned from you, where the system or processes can be adjusted to make things easier, and consider every possible way to streamline these tasks. Thank you for your patience and work thus far! We know how busy providers are and appreciate the services you provide to DSHS clients. We will notify providers through this email distribution list as soon as we have determined next steps and can communicate a date when these important activities will resume.
October 20, 2008 -
ProviderOne Pharmacy Point-of-Sale system
Operational Click here to read the full text of the announcement to pharmacies. October 13, 2008 - 7-Day Notice of New ProviderOne Pharmacy Point-of-Sale system Implementation on October 20, 2008 DSHS issued a reminder that the Department of Social and Health Services (DSHS) will implement the new ProviderOne Point-of-Sale (POS) System on October 20, 2008. All pharmacies that submit pharmacy claims to DSHS should prepare now for the change to the new POS to ensure they are prepared and avoid interruption of DSHS payments and service to your customers. Detailed information about the new ProviderOne Pharmacy Point-of-Sale system implementation – including a checklist to help you prepare – can be found on DSHS’ website: http://hrsa.dshs.wa.gov/ProviderOne/PharmacyPOS.htm. Click here to read the full text of the memo to pharmacies. Sept. 24, 2008 - Billing Providers Register Now for Training on ProviderOne Security Administration! If you do not submit transactions to DSHS, or have already attended a security webinar, no action is required. Security administration is an important prerequisite to the next billing provider activity - ProviderOne registration! It's critical billing providers begin setting up security now because both activities will need to be completed in a short period of time. The first step is to have the security administrator for your organization attend a webinar on security administration. This important training will provide a comprehensive overview of the activity, including how to obtain your initial set of security logon ID's and passwords. It's also a great opportunity to ask questions about the system application and process. Sept. 19, 2008 - 30-Day Notice of New ProviderOne Pharmacy Point-of-Sale System Implementation on October 20, 2008, and Revised Billing Instructions: DSHS notified pharmacies that it plans to implement the Pharmacy Point of Sale system on October 20, 2008. August 15, 2008 - Schedule update and resources available!
August 14, 2008 - Pharmacy Point of Sale: A new page on our website has been established for pharmacies preparing for our new point of sale system. Click here to visit the new page. August 4, 2008 - Implementation date for medical and nursing home claims: We are not on target for a Dec. 2008 implementation. Please click here to visit our projected implementation dates page for important updates. July 28, 2008 - DSHS issued this message to pharmacies today: Change to ProviderOne Pharmacy Go Live Date DSHS is getting ready to switch over to its new Pharmacy Point of Sale (POS) system. The new system will be put into operation only when it is fully tested, DSHS staff are prepared, and the pharmacy readiness activities have been performed. On June 18, 2008, DSHS sent the following message to pharmacies and prescribers through email, a faxed memo, and postcard:
DSHS did identify problems during the testing process. Corrections are being made and the system is being retested to ensure accurate claims processing. DSHS will reassess the 'go live' date over the next two weeks. DSHS will notify providers of the new 'go live' date by sending a 30-day notice to pharmacies through numbered memo, email, and fax. We appreciate your patience as we work to ensure that the system is fully ready to process your claims before we go live. If you have any questions, please email us at providerone@dshs.wa.gov or call us at 1-800-562-3022 (select option 2, then 4). July 24, 2008 The first set of questions and answers from recent workshops on client eligibility are now posted on our provider Q&A page. Click here to access the Spring 2008 Client Eligibility Volume 1 questions and answers. June 18, 2008
May 29, 2008
Current Status of the ProviderOne Project Click here to view a presentation on the current status of the ProviderOne project as of December 2008. This presentation will be updated quarterly. Provider Readiness Email Distribution List
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