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  • 1. Introduction to Medical Assistance and ProviderOne Welcome! The Webinar will begin shortly. While you are waiting, please check your audio settings. You can use computer speakers or headphones Your Dial-In Number Access Code and Audio PIN are located in the Webinar control panel. You can dial in using a telephone. Long distance charges may apply.
  • 2. Before we get started – Sound Check
    • If you are not hearing us through your PC, then:
      • Your computer does not have a sound card
      • Your speakers/headphones are turned off
      • Your speakers/headphones are not plugged in
      • Your PC is muted
      • Your PC sound settings are incorrectly set
      • Your GoToWebinar sounds settings are incorrectly set
    • Check www.GoToWebinar.com for support info
    • We are broadcasting audio now!
    • If you cannot hear anything and want to dial in use the phone # after the word “Dial:” in your control panel.
    • Remember: Toll charges may apply
  • 3. Welcome
    • Submitting Professional Fee For Service Claims Through ProviderOne
  • 4. Disclaimer
    • A contract, known as the Core Provider Agreement, governs the relationship between DSHS and Medical Assistance providers. The Core Provider Agreement’s terms and conditions incorporate federal laws, rules and regulations, state law, DSHS rules and regulations, and DSHS program policies, numbered memoranda, and billing instructions, including the materials located in this presentation. Providers must submit a claim in accordance with the DSHS rules, policies, numbered memoranda, and billing instructions in effect at the time they provided the service.
    • Every effort has been made to ensure the accuracy of this material. However, in the unlikely event of an actual or apparent conflict between this material and a department rule, the department rule controls.
  • 5. Webinar Tips
    • Attendee Control Panel
    • Asking Questions
    • Follow-up Email
  • 6. Attendee Control Panel
    • Hiding the Control Panel
      • Toggle Auto-Hide On/Off
    • Use this panel to:
      • Set your sound preferences
      • Ask Questions and view answers
    • Your microphone should always be muted
    • Do not use the hand raising icon
      • we are not monitoring this feature
  • 7. Asking Questions
    • You may ask questions anytime during the Webinar
      • Click the Questions option in the Webinar toolbar
      • Type in question
      • Click Send
    • Selected questions will be answered during the Webinar – time permitting
    • Questions will be reviewed for inclusion in future communications from DSHS
  • 8. Follow-up Email
    • Follow-up Email sent one-hour after completion of the Webinar
    • Follow-up Email contents:
      • URLs listed in this Webinar
      • Email address where you can send additional questions
      • Additional sources of information
      • Additional training available
  • 9. Course Description
    • Follow along as a fictitious health care provider performs the following tasks in ProviderOne:
      • Submit a professional claim
      • View the status of a professional claim
      • View/Download the Remittance Advice for a professional claim
      • Void and Adjust a professional claim
      • Resubmit a denied or voided professional claim
  • 10. Recommended Audience
    • DSHS Providers who will be performing any Professional claims related activities using ProviderOne
    • Prerequisites
      • ProviderOne Essentials
  • 11. Course Objectives
    • Identify the ProviderOne security profiles needed to perform claims related tasks in ProviderOne
    • Use ProviderOne to:
      • Log into ProviderOne with the correct profile for a given claims related task
      • Submit a professional claim using the direct data entry method
      • Submit a professional claim using the batch upload method
      • View the status of a submitted claim
      • View/Download a Remittance Advice
      • Void a claim
      • Adjust a claim
      • Resubmit a denied or voided claim
  • 12. Webinar Agenda
    • Overview of ProviderOne Claims and Related Profiles
    • ProviderOne Claims Related Tasks:
      • Launch/Log Into ProviderOne
      • Access and Tour the Professional Claim Form
      • Submit a Professional Claim Using Direct Data Entry
      • Submit a Professional Claim Using HIPAA Batch Upload
      • View Claim Status
      • View Remittance Advice
      • Void a Claim
      • Adjust a Claim
      • Resubmit a Denied or Voided Claim
  • 13. Overview of the Claims Process
    • Confirm Client Eligibility
    • Check Prior Authorization Status
    • Perform the Service
    • Submit the Claim – DDE or Batch Upload
      • If the claim is submitted using Direct Data Entry ProviderOne verifies the claim data prior to adjudication
      • If the claim is submitted using Batch Upload, ProviderOne verifies only format and structure of claim data prior to adjudication
    • Claim is Assigned a TCN
    • Claim is Adjudicated
    • Check the Status of a Claim
    • View/Download the RA
    • Void or Adjust a Claim
    • Resubmit a Denied Claim
  • 14. ProviderOne Claims Tasks
    • Submit a Claim Using Direct Data Entry Method
    • Submit a Claim Using Batch Upload Method
    • Check the Status of a Claim
    • View and/or Download a Remittance Advice
    • Resubmit a Denied Claim
    • Void a Previously Submitted Claim
    • Adjust a Previously Submitted Claim
  • 15. ProviderOne Claims Related Profiles
    • EXT Provider Claims Submitter
      • On-line Claims Submission
      • Batch Claims Submission
      • Adjust/Void and Resubmit a Claim (DDE or Batch)
      • Check RA
    • EXT Provider Claims/Payment Status Checker
      • View Claims Status (Claim Inquiry)
      • Check RA
    • EXT Provider Eligibility Checker-Claims Submitter
      • On-line Claims Submission
      • Batch Claims Submission
      • Adjust/Void and Resubmit a Claim (DDE or Batch)
      • Check RA
    • EXT Provider Super User
      • Allows full access to ProviderOne including all claims related activities
      • Does not include maintaining user accounts
  • 16. What You Will and Will Not Learn During This Presentation
    • You will learn how to use ProviderOne to submit a claim
    • This presentation does not teach medical billing
  • 17. Task: Launch/Log Into ProviderOne Launch and Log Into ProviderOne
  • 18. About This Task
    • Launch ProviderOne
    • Log Into ProviderOne
    • Select a Claims Related Profile
  • 19. Launch ProviderOne
  • 20. Home
  • 21. Select Profile
  • 22. Provider Portal
  • 23. Task Review: Launch/Log Into ProviderOne
    • Launch ProviderOne
    • Log Into ProviderOne
    • Select a Claims Related Profile
  • 24. Task: Locate and Launch the Professional Claims Submission Form Locate and Launch the Professional Claims Submission Form
  • 25. About This Task
    • Provider Portal
    • Online Services – Claims Area
    • Select On-line Claims Entry
    • Select Submit Dental
  • 26. Provider Portal
  • 27. Claims Submission
  • 28. Submit Professional Claim Form
  • 29. Task Review: Locate and Launch the Professional Claims Submission Form
    • Provider Portal
    • Online Services – Claims Area
    • Select On-line Claims Entry
    • Select Submit Professional
  • 30. Task: Tour the Professional Claim Form Tour the Professional Claim Form
  • 31. About This Task
    • The Submit Professional Claim Form
    • Action Buttons
    • Basic Claim Info – Other Claim Info
    • Four Sections of the Form
    • Required Fields
    • Billing Instructions
    • Submitter ID
    • Entering Claim Data
  • 32. Submit Professional Claim Form
  • 33. Action Buttons
  • 34. Basic Claim Info and Other Claim Info Sections
  • 35. The Four Sections of the Claim Form
  • 36. Required Fields Reminder
  • 37. Billing Instructions
  • 38. Submitter ID
  • 39. More About Entering Claim Information
  • 40. Task Review: Tour the Professional Claim Form
    • The Submit Professional Claim Form
    • Action Buttons
    • Basic Claim Info – Other Claim Info
    • Four Sections of the Form
    • Required Fields
    • Billing Instructions
    • Submitter ID
    • Entering Claim Data
  • 41. Important Note About Saving
    • ProviderOne does not allow a partially completed claim form to be saved and completed later.
    • You must complete the form and submit the claim without leaving the online claim form or your data will be lost.
  • 42. Required Data Elements for Professional Claims
    • PROVIDER INFORMATION
      • Billing Provider NPI and Taxonomy
    • SUBSCRIBER/CLIENT INFORMATION
      • Client ID
      • Last Name, Date-of-Birth, Gender
    • CLAIM INFORMATION
      • Diagnosis Code
    • BASIC LINE ITEM INFORMATION (at least one is required)
      • Service From and To Date
      • Place of Service
      • Procedure Code
      • Diagnosis Pointer
      • Submitted Charges
      • Units
  • 43. Questions That Require Answers
    • PROVIDER INFORMATION
      • Is the Billing Provider also the Pay-To-Provider?
      • Is the Billing Provider or Pay-To-Provider also the Rendering Provider?
      • Is this service the result of a referral?
    • SUBSCRIBER/CLIENT INFORMATION
      • Is this claim for a Baby on Mom’s Client ID?
      • Does the subscriber have insurance other than Medicaid?
    • CLAIM INFORMATION
      • Is this claim accident related?
      • Is this a Medicare Crossover Claim?
  • 44. Task: Complete the PROVIDER INFORMATION Section Complete the PROVIDER INFORMATION Section
  • 45. About This Task
    • Complete the Provider Information Section
      • Enter the Required Billing Provider Information
      • Identify the Pay-To- Provider
      • Identify the Rendering Provider
      • Identify the Referring Provider (if applicable)
  • 46. Understanding the Taxonomy Code
    • What is a Taxonomy Code?
      • 10-digit Number
        • Provider Type
        • Specialty/Subspecialty
        • Reserved Digit
    • How is it used?
      • Taxonomy code entered in the claim must match the service provided
      • The Service Date of the claim must fall within the Start/End date period of the Taxonomy Code entered in the claim
  • 47. About The Provider Information Section
  • 48. Enter the Required Billing Provider Information
  • 49. Question: Is the Billing Provider also the Pay-To-Provider?
  • 50. Question: Is the Billing Provider or Pay-To Provider also the Rendering Provider?
  • 51. Question: Is this service the result of a referral?
  • 52. Task Review: Complete the PROVIDER INFORMATION Section
    • Complete the Provider Information Section
      • Enter the Required Billing Provider Information
      • Identify the Pay-To- Provider
      • Identify the Rendering Provider
      • Identify the Referring Provider (if applicable)
  • 53. Task: Complete the SUBSCRIBER/CLIENT INFORMATION Section Complete the SUBSCRIBER/CLIENT INFORMATION Section
  • 54. About This Task
    • Complete the SUBSCRIBER/CLIENT INFORMATION Section
      • Enter Client ID
      • Complete Additional Subscriber/Client Information
      • Identify if this claim is for a baby on the Mom’s Client ID
      • Identify any insurance other than Medicaid
      • Complete optional data entry segments
  • 55. Terminology
    • Subscriber
    • Client
    • Patient
    • All three terms refer to the recipient of the services being provided in the claim.
  • 56. About The Subscriber/Client Information Section
  • 57. Client ID
  • 58. Additional Subscriber/Client Information
  • 59. Important Note About This Data Segment
  • 60. Question: Is this claim for a Baby on the Mom's Client ID?
  • 61. Question: Does the subscriber have insurance other than Medicaid?
  • 62. OTHER INSURANCE INFORMATION
  • 63. Other Subscriber Information
  • 64. Additional Other Subscriber Information
  • 65. Other Payer Information
  • 66. Additional Other Payer Information
  • 67. COB Monetary Amounts
  • 68. Additional COB Information
  • 69. Important Information About Other Insurance
  • 70. Answer the Other Insurance Question
  • 71. All Done
  • 72. Task Review: Complete the SUBSCRIBER/CLIENT INFORMATION Section
    • During this task Betty:
      • Entered the Client ID
      • Entered the Client’s last name and date of birth
      • Indicated that the claim was not for a baby covered under the mother’s Client ID
      • Indicated that the client was not covered by other insurance
      • Explored additional data entry segments
  • 73. Task: Complete the CLAIM INFORMATION Section Complete the CLAIM INFORMATION Section
  • 74. About This Task
    • Complete the CLAIM INFORMATION Section
      • PRIOR AUTHORIZATION
      • CLAIM NOTE
      • EPSDT INFORMATION
      • Is this claim accident related?
      • CLAIM DATA
      • Additional Claim Data
      • Is this a Medicare Crossover Claim?
  • 75. About the CLAIM INFORMATION Section
  • 76. PRIOR AUTHORIZATION
  • 77. CLAIM NOTE
  • 78. EPSDT INFORMATION
  • 79. Question: Is this claim accident related?
  • 80. CLAIM DATA
  • 81. Additional Claim Data
  • 82. Question: Is this claim a Medicare Crossover Claim?
  • 83. All Done
  • 84. Task Review: Complete the CLAIM INFORMATION Section
    • Complete the CLAIM INFORMATION Section
      • PRIOR AUTHORIZATION
      • CLAIM NOTE
      • EPSDT INFORMATION
      • Is this claim accident related?
      • CLAIM DATA
      • Additional Claim Data
      • Is this a Medicare Crossover Claim?
  • 85. Task: Complete the BASIC LINE ITEM INFORMATION Section Complete the BASIC LINE ITEM INFORMATION Section
  • 86. About This Task
    • Complete the BASIC LINE ITEM INFORMATION Section
      • BASIC SERVICE LINE ITEMS
      • Medicare Crossover Items
      • Drug Identification
      • Prior Authorization
      • Additional Service Line Item Information
      • Action buttons
      • Previously Entered Line Item Information
  • 87. About the BASIC LINE ITEM INFORMATION Section
  • 88. BASIC SERVICE LINE ITEMS
  • 89. Medicare Crossover Items
  • 90. National Drug Code and Drug Identification
  • 91. Prior Authorization
  • 92. Additional Service Line Information
  • 93. Add and Update Service Line Item Buttons
  • 94. Previously Entered Line Item Information
  • 95. All Done
  • 96. Task Review: Complete the BASIC LINE ITEM INFORMATION Section
    • Complete the BASIC LINE ITEM INFORMATION Section
      • BASIC SERVICE LINE ITEMS
      • Medicare Crossover Items
      • Drug Identification
      • Prior Authorization
      • Additional Service Line Item Information
      • Action buttons
      • Previously Entered Line Item Information
  • 97. Task: Add and Update a Service Line Item Add and Update a Service Line Item
  • 98. About This Task
    • Add and Update a Service Line Item
      • Click the Add Service Line Item Button
      • Examine the Previously Entered Line Item Information
      • Select the Line Item to Update
      • Make Changes to Service Line Item
  • 99. Click the Add Service Line Item Button
  • 100. ProviderOne Confirms Required Fields Are Complete
  • 101. Previously Entered Line Item Information
  • 102. Updating a Service Line Item
  • 103. Task Review: Add the Service Line Item
    • Add and Update a Service Line Item
      • Click the Add Service Line Item Button
      • Examine the Previously Entered Line Item Information
      • Select the Line Item to Update
      • Make Changes to Service Line Item
  • 104. Task: Add Additional Service Line Items Add Additional Line Items
  • 105. About This Task
    • Add Additional Service Line Items
      • Method 1 – Add a New Line Item
        • Examine the Previously Entered Line Item Information
      • Method 2 – Using a Previous Line Item
        • Select a Line Item
        • Modify Data
        • Click Submit Line Item Button
      • Delete a Line Item
  • 106. Method 1 - Add a New Line Item
  • 107. Previously Entered Line Item
  • 108. Deleting a Line Item
  • 109. Method 2 – Using a Previous Line Item
  • 110. View the Line New Line Item
  • 111. Task Review: Add Additional Service Line Items
    • Add Additional Service Line Items
      • Method 1 – Add a New Line Item
        • Examine the Previously Entered Line Item Information
      • Method 2 – Using a Previous Line Item
        • Select a Line Item
        • Modify Data
        • Click Submit Line Item Button
      • Delete a Line Item
  • 112. About This Task
    • Submitting the Claim
      • Confirm the Data
      • ProviderOne Checks for Missing Data
      • ProviderOne Checks NPI’s, Client IDs, Procedure Codes for Validity
      • Submit Backup Documentation
      • Print the Cover Sheet
      • View the Submitted Claim Details Page
  • 113. Confirm the Claim Data: PROVIDER INFORMATION
  • 114. Confirm the Claim Data: SUBSCRIBER/CLIENT INFORMATION
  • 115. Confirm the Claim Data: CLAIM INFORMATION
  • 116. Confirm the Claim Data: BASIC LINE ITEM INFORMATION
  • 117. Submit the Claim ProviderOne Checks Required Fields
  • 118. ProviderOne Confirms Validity of Data
  • 119. Windows Message: Do you want to submit any Backup Documentation
  • 120. Submitted Professional Claim Details
  • 121. Attach a By Web Document
  • 122. Submitted Professional Claim Details
  • 123. Attach a By Mail Document
  • 124. Submitted Professional Claim Details
  • 125. Print a Cover Page
  • 126. The Submitted Professional Claim Details Page
  • 127. Professional Claim Form
  • 128. Provider Portal
  • 129. Task Review: Submitting the Claim
    • Submitting the Claim
      • Confirm the Data
      • ProviderOne Checks for Missing Data
      • ProviderOne Checks NPI’s, Client IDs, Procedure Codes for Validity
      • Submit Backup Documentation
      • Print the Cover Sheet
      • View the Submitted Claim Details Page
  • 130. Task: Submit a Professional Claim Using the On-line Batch Claims Submission Method Submit a Professional Claim Using the On-line Batch Claims Submission Method
  • 131. About This Task
    • Submit a Professional Claim – On-line Batch Upload Method
      • Before uploading
      • Batch Attachment Response – Attach the document
      • Batch Attachment Respone – Upload file response
      • HIPAA Response/Acknowledgement
    If you do not use ProviderOne to upload batch claims and wish to step away from the presentation please be aware: Betty will complete this task in 4 ½ minutes.
  • 132. Before Uploading Your Document
    • Profiles that allow DDE claims submission also allow Batch Upload method
    • Complete the Trading Partner Agreement
    • Submit to testing
    • Provider File reflects Batch Upload
    • Refer to the DSHS Web Site for more information
  • 133. Provider Portal
  • 134. Batch Attachment Response
  • 135. Attachment
  • 136. Batch Attachment Response - Upload File Response
  • 137. Provider Portal
  • 138. HIPAA Response/Acknowledgement
  • 139. Provider Portal
  • 140. Task Review: Submit a Professional Claim Using the On-line Batch Claims Submission Method
    • Submit a Professional Claim – On-line Batch Upload Method
      • Before uploading
      • Batch Attachment Response – Attach the document
      • Batch Attachment Response – Upload file response
      • HIPAA Response/Acknowledgement
  • 141. Task: View the Status of a Submitted Claim View the Status of a Submitted Claim
  • 142. About This Task
    • View the Status of a Submitted Claim
      • Change profile
      • Launch Provider Claim Inquiry Search
      • View the Inquire Claims List
      • View Claim Details
      • View Remit Remark Codes
  • 143. Provider Portal
  • 144. My Inbox
  • 145. Select Profile
  • 146. Provider Portal
  • 147. Provider Claim Inquiry Search
  • 148. Inquire Claims List
  • 149. Claim Details
  • 150. Inquire Claims List
  • 151. Provider Portal
  • 152. Task Review: View the Status of a Submitted Claim
    • View the Status of a Submitted Claim
      • Change profile
      • Launch Provider Claim Inquiry Search
      • View the Inquire Claims List
      • View Claim Details
  • 153. Task: View and/or Download the Remittance Advice View and/or Download the Remittance Advice
  • 154. About This Task
    • View and/or Download the Remittance Advice
      • Access the RA Payment List
      • View / Download the Remittance Advice
  • 155. Provider Portal
  • 156. RA Payment List
  • 157. Provider Portal
  • 158. Task Review: View and/or Download the Remittance Advice
    • View and/or Download the Remittance Advice
      • Access the RA Payment List
      • View / Download the Remittance Advice
  • 159. Task: Adjust or Void a Previously Submitted Claim Adjust or Void a Previously Submitted Claim
  • 160. About This Task
    • Change to a Profile that enables Void/Adjusting a Claim
    • Access the Provider Claim Adjust/Void Search Page
    • The Provider Claims Adjust Void List
    • Void a Claim
      • Voided Claim Detail Page
    • Adjust a Claim
      • Adjusted Claim Details
  • 161. Provider Portal
  • 162. My Inbox
  • 163. Select Profile
  • 164. Provider Portal
  • 165. Provider Claim Adjust/Void Search
  • 166. Provider Claims Adjust Void List
  • 167. Void Professional Claim
  • 168. Voided Dental Claim Detail
  • 169. Void Dental Claim
  • 170. Provider Portal
  • 171. Provider Claim Adjust Void Search
  • 172. Provider Claims Adjust Void List
  • 173. Adjust Professional Claim
  • 174. BASIC LINE ITEM INFORMATION
  • 175. Adjust Professional Claim
  • 176. Backup Documentation
  • 177. Adjusted Professional Claim Details
  • 178. Adjusted Professional Claim
  • 179. Provider Portal
  • 180. Task Review: Adjust or Void a Previously Submitted Claim
    • Change to a Profile that enables Void/Adjusting a Claim
    • Access the Provider Claim Adjust/Void Search Page
    • The Provider Claims Adjust Void List
    • Void a Claim
      • Voided Claim Detail Page
    • Adjust a Claim
      • Adjusted Claim Details
  • 181. Task: Resubmit a Denied or Voided Claim Resubmit a Denied or Voided Claim
  • 182. About This Task
    • Access the Provider Claim Model Search Page
    • Select the Claim From the Inquire Claims List
    • Examine and Modify the Information on the Claim Form
    • Add Backup Documentation
    • Submit the New Claim
  • 183. Provider Portal
  • 184. Provider Claim Model Search
  • 185. Provider Claims Model List
  • 186. Professional Claim Form
  • 187. Backup Documentation
  • 188. Submitted Professional Claim Details
  • 189. Professional Claim Form
  • 190. Provider Portal
  • 191. Task Review: Resubmit a Denied or Voided Claim
    • Access the Provider Claim Model Search Page
    • Select the Claim From the Inquire Claims List
    • Examine and Modify the Information on the Claim Form
    • Add Backup Documentation
    • Submit the New Claim
  • 192. Summary
  • 193. Additional Resources
    • Online Help
    • ProviderOne Provider Training Web Site http://hrsa.dshs.wa.gov/ProviderOne/Provider%20Training.htm
      • Self-paced E-Learning
      • Self-paced Interactive Tutorials
      • Schedule of Upcoming Webinars
      • ProviderOne Provider System User Manual
      • Links to FAQs
      • Link to the ProviderOne Security Profiles Document
    • The link shown above will be included in the follow-up email sent out approximately one-hour after the conclusion of the webinar.
  • 194. Webinar Conclusion
    • Access the ProviderOne System at: https://waproviderone.org
    • Additional Questions?
      • Email us at ProviderOne@dshs.wa.gov
    • You can find more information on ProviderOne at http://hrsa.dshs.wa.gov/providerone/providers.htm
    • Please Complete the Webinar Evaluation
      • The evaluation form will automatically launch at the close of the webinar
    • Thank you for attending!
  • 195. Ending the Webinar
    • To close the Webinar and complete the Evaluation
      • Click the X button in the control panel
      • The evaluation will launch immediately after the close of the Webinar

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