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