ProviderOne

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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.

ATTENTION PROVIDERS: Please select the provider button on the left side of this page for important readiness activities, information and resources.

Updates:

October 23, 2009 - Important ProviderOne Schedule Announcement

Please click here to read an important implementation schedule announcement from ProviderOne Project Manager John Anderson.

Sept 8, 2009 - Required testing for HIPAA batch file transactions

Organizations who plan to submit HIPAA batch file transactions to ProviderOne must successfully pass format testing before you will be able to submit these transactions in ProviderOne. Time is limited. We want to ensure all providers who use these transactions are aware of this critical task and the prerequisites so that payments are not delayed at go live. It took pilot providers an average of 4 weeks of trial and error to pass this testing!

Please visit our webpage http://hrsa.dshs.wa.gov/providerone/HIPAAtesting.htm to learn more.

July 29, 2009 - New Issue of ProviderOne Countdown Newsletter for providers is Available

Access this issue at http://hrsa.dshs.wa.gov/providerone/Providers/Newsletters/DSHS_P1_Countdown_Issue6.pdf

To read previous issues, visit our newsletter page http://hrsa.dshs.wa.gov/providerone/ProviderOne%20Countdown.htm

July 16, 2009 - Phase 1 Implementation Announced!

DSHS plans to implement Phase 1 of its new payment processing system – ProviderOne – on Dec. 6, 2009. As you may know, the ProviderOne project had several checkpoints built into its framework to look at work complete, lessons learned and the work ahead to reassess when the system could be put into operation. This latest re-baseline effort was our final checkpoint.

Phase 1 will move medical and nursing home claims processing from the current payment processing system to ProviderOne. ProviderOne will replace the current Medicaid Management Information System (MMIS) and the WAMedWeb.

DSHS' goal is to implement ProviderOne while maintaining continuity in payments to providers and services to clients. To accomplish this, provider organizations are responsible for completing their own readiness activities to ensure future payments are not at risk.

This is different than the HIPAA transition where there was a period of time after implementation to transition to the new format. ProviderOne will be National Provider Identifier (NPI) compliant, use new client identifiers and require providers to use DSHS approved taxonomy that indicates a provider's type and specialty. ProviderOne cannot process claims using the legacy system identifiers. Claims submitted to ProviderOne without these new identifiers will be denied.

To ensure continuity in payment, DSHS urges you to complete the following readiness activities by October 15, 2009 so you are prepared to focus on ProviderOne system training and final transition activities.

Set up your staff who will need access to ProviderOne registration, maintaining any changes to your provider file, checking client eligibility, accessing remittance advice, reviewing and adding DSHS taxonomies, and submitting transactions. For more information and to get started, visit ProviderOne Security: http://hrsa.dshs.wa.gov/ProviderOne/Security.htm

Complete ProviderOne registration for each "pay to" NPI to ensure we have the correct information that could affect payments. You should verify information on where your payments will be sent and report missing data such as NPIs. You should also indicate how you will bill DSHS so we know if you will need a Trading Partner Agreement. You can also learn the DSHS taxonomies associated with your organization and add additional taxonomies you will need for billing us. Specific registration instruction vary by billing submission method and are available at: http://hrsa.dshs.wa.gov/ProviderOne/Registration.htm

Learn how you can retrieve the new ProviderOne client ID numbers before and after ProviderOne is put into operation. Read our fact sheet DSHS is Changing to a New Client Identifier at: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/FactSheets.htm

Learn about using taxonomies in ProviderOne. Read our fact sheet Using Taxonomy in ProviderOne at: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/FactSheets.htm

Modify and test HIPAA batch files to ensure formats comply with the new ProviderOne requirements. All transaction types must successfully test before you can submit or receive transactions – including batch eligibility inquiries (270/271). Providers who have started testing are experiencing high rates of first time failures. It's critical file structures and systems are modified and pass testing so you can get paid in ProviderOne. Each transaction type has a HIPAA Companion Guide wit instructions on modifying files and testing. We strongly urge you to carefully read and follow the Companion Guides to be successful. The guides are posted at: http://hrsa.dshs.wa.gov/dshshipaa/

We will continue to keep you up to date on progress and activities through this website and our email list (join or leave at http://listserv.wa.gov/archives/providerone_provider_readiness.html).

Email Distribution Lists:

Provider: The ProviderOne project has established an email distribution list dedicated to provider readiness activities. The project will send messages when training materials are posted on our web site or to announce upcoming workshop or training events. Please pass this link on to providers or anyone that may be interested in receiving updates on provider readiness activities. You may join or leave this list anytime at: http://listserv.wa.gov/archives/providerone_provider_readiness.html
Client Advocates/General Interest: The ProviderOne project has established an e-mail distribution list dedicated to our community partners - advocacy groups, state and local agencies, and other interested parties around Washington. This list will be used to provide periodic ProviderOne project updates about current timelines and the new client Services Card that will replace the Medical Assistance ID card when the first phase of this project is implemented. Join or leave at http://listserv.wa.gov/archives/providerone_communications.html

If you have questions, please:

PROVIDERONE RESPONSE TEAM

It’s important to us that you have access to staff who can answer your questions about ProviderOne. However, we want you to know that we are experiencing a high volume of contacts and are currently reallocating and training additional staff to assist you. For the quickest response, we suggest you use email when possible and include key information in the subject line.

Security questions and login issues provideronesecurity@dshs.wa.gov [1-800-562-3022 select option 2,4,1]
Registration process, change an NPI or Tax ID number providerenrollment@dshs.wa.gov [1-800-562-3022 select option 2,4,2]
HIPAA EDI Gateway, setting up SFTP, or missing/bad 997 file [1-800-562-3022 select option 2,4,3]
HIPAA testing issues hipaa-help@dshs.wa.gov [1-800-562-3022 select option 2,4,4]
ProviderOne general questions providerone@dshs.wa.gov [1-800-562-3022 select option 2,4,wait]