Tips and Trouble Shooting

1

• 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

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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

4

• Overview of ProviderOne

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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

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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

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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

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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/ScheduledWebi
  nars.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/Sy
  stemTraining.htm)

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Readiness Webinars - Summary
10
6 Steps to Provider Readiness
11

• Completing Registration

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Registration Pre-requisite

• This step requires that you first have security
  access to ProviderOne
• Your organizations Security Administrator
  assigns the profile needed to register in
  ProviderOne
• Use the EXT Provider File Maintenance profile to
  complete provider registration

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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

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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

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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.

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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.

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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.

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Step 5 Licenses and Certifications 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 dont 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.

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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.

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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.

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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.

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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.

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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.

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Step 11 EDI submission - Tip

• Problem Youre 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.

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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 arent 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.
  

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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.

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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).

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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.

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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.

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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

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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 wizards 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).

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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

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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 ProviderOnes fact
  sheet Web page http//hrsa.dshs.wa.gov/provideron
  e/Providers/Fact20Sheets/FactSheets.htm
• You may download a report of your taxonomies. The
  tool is available at https//fortress.wa.gov/dshs/
  npicaphrsa

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Important Links
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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
  provideronesecurity_at_dshs.wa.gov
• 2 for changes to NPI or Tax ID number or
  registration questions if you do not submit
  electronic batches, providerenrollment_at_dshs.wa.gov
  
• 3 for HIPAA set-up questions (SFTP site,
  missing/bad 997 file, etc.)
• 4 for HIPAA testing questions or
  hipaa-help_at_dshs.wa.gov
• For registration questions (only if youre an
  electronic batch submitter), providerrelations_at_d
  shs.wa.gov
• Stay on the line for general questions or
  providerone_at_dshs.wa.gov
• 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.

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More Information Sources

• Visit ProviderOne internet http//hrsa.dshs.wa.go
  v/providerone/providers.htm
• Newsletters
• Fact Sheets
• QA
• 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_provid
  er_readiness.html
• E-mail questions directly to
• providerone_at_dshs.wa.gov
• Call toll-free telephone line (1-800-562-3022)
• Select 2, then option 4 (see previous slide
  for prompt options)

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Questions?http//hrsa.dshs.wa.gov/provi
derone/providers.htm