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Washington Medicaid ProviderOne Actions Needed by Physicians Practices

Agenda. Implementation Schedule

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Washington Medicaid ProviderOne Actions Needed by Physicians Practices

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    1. Washington Medicaid ProviderOne Actions Needed by Physicians Practices!

    2. Agenda Implementation Schedule & Phases 6 Steps of Provider Readiness Opportunities for Provider Training Overview of Client Outreach Plan Cutover Schedule Transition to ProviderOne August 13, 2009 2

    3. ProviderOne Implementation Phase 1: Replaces Current MMIS Pharmacy Claims implemented October 2008 Medical and Nursing Home Claims Planned for December 6, 2009 Phase 2: Social Service and Remaining Medical Providers Implement in 4 groups over 2.5 years after Phase 1 implementation Goal: To support continuous services for clients and uninterrupted payments to providers August 13, 2009 3

    4. 6 Steps to Provider Readiness

    5. Activities by Billing Method August 13, 2009 5

    6. Step 1: Set up Security Activity Description Establish user ID and password for staff to access ProviderOne Why is this important? Security: Is required to access ProviderOne via the web to: Look up the new ProviderOne client ID Verify client eligibility Submit claims or check claim status Complete registration and maintain your provider file Access your Remittance Advice (RA) RAs will only be available electronically once ProviderOne is operational Can be set up directly in ProviderOne for smaller organizations Can be set up using the security spreadsheet tool for larger organizations (see slide 8) August 13, 2009 6

    7. Step 1: Set up Security (cont.) Links, Tools and Tips Obtain security for staff completing registration first, add claims submitters and eligibility checkers later: http://hrsa.dshs.wa.gov/providerone/Security.htm Security spreadsheet List of ProviderOne security profiles and descriptions Self-paced Tutorial DSHS ProviderOne Provider Registration and Security Administration Manual (pg 119): http://hrsa.dshs.wa.gov/providerone/documentation/Registration/PRR%20Desktop%20Reference%20guide.pdf Support If you have security questions or login issues, e-mail provideronesecurity@dshs.wa.gov, or call 1-800-562-3022 (select option 2, 4, 1) August 13, 2009 7

    8. Security Spreadsheet an option for larger organizations August 13, 2009 8

    9. Step 2: Complete ProviderOne Registration Activity Description Verify DSHS transferred your data from the current payment system to ProviderOne correctly Why is this important? Registration: Ensures payments are sent to the correct address or Electronic Fund Transfer (EFT) account Allows you to verify NPIs on file inaccurate NPIs will result in denied claims Allows you to verify taxonomy on record incorrect or missing taxonomy will result in denied claims Is required eventually DSHS will terminate providers who have not completed registration and require re-enrollment August 13, 2009 9

    10. Step 2: Complete ProviderOne Registration (cont.) Links, Tools and Tips Focus first on registration for your pay to NPIs, then on performing (servicing) providers: http://hrsa.dshs.wa.gov/providerone/Registration.htm DSHS recommends that you complete registration activities by mid-October as the focus will then shift to training and final cutover Use our E-Learning tool for provider registration: http://hrsa.dshs.wa.gov/ProviderOne/ELearning.htm Support For questions about the registration process, or changing an NPI, NCPDP or Tax ID number, e-mail providerenrollment@dshs.wa.gov, or call 1-800-562-3022 (select options 2, 4, 2) August 13, 2009 10

    11. Step 3: Learn about new client ID requirements Activity Description Understand and make plans for using the new ProviderOne client ID Why is this important? The new client ID: Is required on claims claims without the new ProviderOne Client ID will deny Meets HIPAA privacy rules since no personal identifying information is included Does not change; it belongs to the client for life Is printed on the clients new Services Card Can be downloaded DSHS has developed a crosswalk to map a clients former PIC to the new ProviderOne Client ID (see slide 13) Is required on all adjustments after go live, regardless of when the service was performed 11 August 13, 2009

    12. Step 3: Learn about new client ID requirements (cont.) Links, Tools and Tips To obtain the crosswalk, go to https://fortress.wa.gov/dshs/npicaphrsa This is a test file The format doesnt change Final data for payment purposes will be available 30 days before go-live For more information, read the fact sheet DSHS is Changing to a New Client Identifier, at http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR010_Client_Identifier.pdf Support For general questions, including information about the new ProviderOne client ID, contact the Provider Response Team at providerone@dshs.wa.gov (1-800-562-3022, select options 2, 4, wait) 12 August 13, 2009

    13. PIC-to-Client ID Crosswalk Clients Seen in Last 24 Months 13 August 13, 2009

    14. Step 4: Learn about new taxonomy requirements Activity Description Understand and make plans for using new national taxonomies Why is this important? Taxonomy: Is required on claims claims that are missing taxonomy will deny Is required on claims for billing and servicing providers (if applicable) Identifies a providers type and area of specialization for the services being billed Was assigned by DSHS in ProviderOne based on the way youve done business with us in the past Can be viewed, updated and printed by provider during registration process Will soon be available in a downloadable report (watch for more details) 14 August 13, 2009

    15. Step 4: Learn about new taxonomy requirements (cont.) Links, Tools and Tips DSHS is developing a Web tool for providers to download their DSHS-approved taxonomies For more information, read the fact sheet Using Taxonomy in ProviderOne at: http://hrsa.dshs.wa.gov/providerone/Providers/Fact%20Sheets/P1PR009%20taxonomy.pdf Support For general questions, including questions about the new national taxonomies, contact the Provider Response Team at providerone@dshs.wa.gov (1-800-562-3022, select options 2, 4, wait) 15 August 13, 2009

    16. Step 5: Submit new Trading Partner Agreement, if needed Activity Description Submit a Trading Partner Agreement (only if your organization sends/receives HIPAA electronic batch files directly to/from DSHS) Why is this important? A Trading Partner Agreement: Is required for exchanging HIPAA electronic batch files directly with DSHS (all transaction types 837, 835, 270/271, etc.) Is a required step in registration for electronic batch submitters registration will not be approved until a TPA is submitted Must be printed, signed and mailed to DSHS, if needed Is required for WINASAP users as well Links, Tools and Tips Find the new Trading Partner Agreement posted under Whats New at http://hrsa.dshs.wa.gov/providerenroll/ Support For questions about Trading Partner Agreements, e-mail providerenrollment@dshs.wa.gov, or call 1-800-562-3022 (select options 2, 4, 2) 16 August 13, 2009

    17. Step 6: Modify & test HIPAA electronic batch files, if needed Activity Description Test electronic batch files for HIPAA format compliance (only if your organization sends/receives HIPAA electronic batch files directly to/from DSHS) Why is this important? Electronic/HIPAA testing: Ensures file structures have been modified and pass format testing before you can submit transactions to ProviderOne after go live Is required for each HIPAA transaction type (837, 270/271, etc.) Is described in the HIPAA Companion Guide for each transaction type Allows both format and content to be tested for your own purposes Took pilot providers 4+ weeks to pass dont delay this process Links, Tools and Tips Carefully read and follow the Companion Guides posted at: http://hrsa.dshs.wa.gov/dshshipaa/ Support For help with HIPAA testing issues, e-mail hipaa-help@dshs.wa.gov, or call 1-800-562-3022 (select options 2, 4, 4) 17 August 13, 2009

    18. Upcoming Provider Training Links, Tools and Tips Carefully read and follow the Companion Guides posted at: http://hrsa.dshs.wa.gov/dshshipaa/ 18 August 13, 2009

    19. Plan for Educating Clients Educational materials being developed Fact sheets and letters Informational inserts with MAID mailings Services Card video and brochure for DSHS offices, providers, and advocates On-hold telephone messages for DSHS offices and call centers Public service announcements Materials will be available to providers to assist in the education effort, such as: Flyers Fact Sheets Posters 19 August 13, 2009

    20. Client Services Card Features 20 August 13, 2009

    21. Preparing for Cutover 21 August 13, 2009

    22. Need Assistance? 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@dshs.wa.gov 2 for registration questions, change to NPI or Tax ID number, or providerenrollment@dshs.wa.gov 3 for HIPAA set-up questions (SFTP site, missing/bad 997 file, etc.) 4 for HIPAA testing questions or hipaa-help@dshs.wa.gov 5 for providers participating in the test pilot, or provideronepilot@dshs.wa.gov Stay on the line for general questions or providerone@dshs.wa.gov 22 August 13, 2009

    23. How can providers get info? 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: providerone@dshs.wa.gov Call toll-free telephone line (1-800-562-3022) Select 2, then option 4 (see previous slide for prompt options) 23 August 13, 2009

    24. For more ProviderOne information, including Provider Training Opportunities, visit our Web site at: August 13, 2009 24

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