Also, providers should be making plans to use the new identifiers, including the ProviderOne client ID and national taxonomy codes, as required for payment in ProviderOne.

Live System Training Available Now

System Orientation opportunities are offered in a variety of formats so you can select the type that best fits your organization (manuals, live webinars, recorded webinars available on demand, tutorials, etc.).  Please visit our training page http://hrsa.dshs.wa.gov/providerone/Provider%20Training.htm

ProviderOne Billing and Resource Guide

A ProviderOne Billing and Resource Guide is under development as well as updated billing instructions to assist you once ProviderOne is operational.  You can view a draft version of the ProviderOne Billing and Resource Guide at

Updates:

November 2, 2009 - Key transition dates

A timeline of key cut over and transition dates is published.  Dates are based on the next possible implementation date - January 10, 2010.  Key dates include when the last adjustments and claims will be accepted for processing in the legacy system, and when the first ProviderOne payment cycle will be.  Click here to view the Key Dates for Cut Over and Transition.

October 23, 2009 - Important ProviderOne Schedule Announcement

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

Oct 6, 2009 - The Short-Cut Guide to Getting Ready for ProviderOne Now Available!

This new document easily outlines the six steps for ensuring readiness for medical, dental, and vision billing providers.

Word Format

PDF Format

Oct 5, 2009 - Testing Status of Billing Agents and Clearinghouses

If you use one of these businesses to bill Medicaid claims for you, it is important for you to know if they have successfully tested HIPAA batch transactions.  To be ready to submit your transactions the first day ProviderOne is operational - Dec. 6, 2009 - they must successfully complete HIPAA batch transaction testing by Nov. 20, 2009.  The HIPAA test environment will be unavailable from Nov. 20 to Dec. 6 while we transition to the new system.  Organizations can resume testing after Dec. 6.

Click here to see billing agent and clearinghouse testing status

Sept 27, 2009 - Webinars available to assist you with readiness activities!

ProviderOne has scheduled a series of topic specific Webinars to help you through the readiness steps outlined in the chart above.  During webinars you have an opportunity to ask questions.  Please visit our webinar page to learn more http://hrsa.dshs.wa.gov/providerone/ScheduledWebinars.htm

Sept 14, 2009 - Verifying Eligibility with ProviderOne - Optional Card Reader Website Available

With ProviderOne, clients will be issued a permanent plastic Services Card that will replace the paper Medical Assistance ID card (MAID).  Because the Services Card will not show eligibility information, providers will need to check eligibility each time they deliver a service.  There are free and low cost options to check eligibility.  No matter which option providers choose to verify eligibility, the eligibility information returned will be the same.

Optional Card Reader Website https://www.meddatahealth.com/MedData/ProviderOne
The new Services Card has a magnetic strip on the back that gives providers the option to purchase a card reader and monthly subscription service as one method to access the most up-to-date client eligibility information.

To ensure providers would have at least one option for a reader compatible with the Services Card, the vendor for ProviderOne - Client Network Services, Inc. (CNSI) or a designee - is required to make readers available for purchase.  CNSI has designated MedData to make card readers ranging from $100 to $400 available for purchase, as well as specifications on card readers that will work with ProviderOne.  The Services Card uses a single track format that is readable by many commercial card readers.  However, the software loaded on the device will need to be reconfigured to submit transactions and your vendor may charge you.  Providers are encouraged to shop for the model and vendor that best meets their needs.  DSHS does not favor, endorse, or recommend Magnetic Card Readers over any other inquiry method, and does not favor, endorse or recommend any magnetic card reader model or vendor over any other model or vendor.

For providers choosing the card reader option, you will need a card reader that is configured appropriately, and will be subject to a monthly subscription fee to access the secure network that connects to ProviderOne eligibility data.  MedData is the designated secure network vendor for ProviderOne.  If you choose to use the card reader technology to check eligibility, you will need a monthly subscription only available through MedData.  The fee for this service is $15 a month for each reader with unlimited transactions.

All inquiries about the card readers, including reader specifications, compatibility questions, and subscribing to the eligibility service should be directed to MedData.  DSHS does not provide, endorse or sell card readers.

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 Available!

Ensure You are Enrolled and Payable in ProviderOne

This issue is packed with critical information for you to ensure your provider organization will be payable when ProviderOne goes live Dec. 6, 2009.  We suggest you print a copy for future reference.  The recommended date that you complete the provider readiness activities outlined is Oct. 15, 2009.

 Topics in this edition include:

• Going Live Dec. 6, 2009

• Security and Registration Update

• Using Taxonomy Codes in ProviderOne

• New Companion Guides

• We’re Listening: Here Comes the HIC

• What’s Up With the Pilot?

• Optional Card Readers

• Training Page Now Available

• Planning Ahead for the Transition

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

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

July 29, 2009

2009 ProviderOne Implementation Questions

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.

1. 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

2. 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

3. 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

4. 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

5. 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).

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://maa.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://maa.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://maa.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://maa.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://maa.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://maa.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://maa.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.   

National Provider Identifier (NPI) Reporting