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ProviderOne Social Services Newsletter |
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All Providers:
Reviewing the remittance advice
The Remittance Advice (RA) provides detail about paid, denied, adjusted and in process claims. Providers should review each RA when it becomes available in ProviderOne. When reviewing the RA, you should reconcile the details against your claims submission. Make sure you understand which claims paid, if any denied, and whether there were any adjustments completed.
For more information, refer to pages 9-19 of the Claim Status Inquiry and View RA billing guide.
Social Services Medical Providers:
ProviderOne setup
DSHS Social Services Medical Providers must take additional steps in establishing and maintaining their enrollment in ProviderOne. To submit social services medical claims for payment, SS Medical Providers must:
- Complete an application with the Health Care Authority (HCA)
- Your DSHS Contract Specialist will provide you with the necessary paperwork
- It may take up to eight (8) months for HCA to process and approve the application
- If client services are impacted, providers may contact their DSHS Contract Specialist to request the HCA application be expedited
Note: SS Medical Providers should not accept new Medicaid referrals or provide medical services until HCA approves the application. HCA notifies providers via U.S. Mail when the application is approved.
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ProviderOne FAQs
How do I sign up to receive electronic payments?
Sign up for Electronic Funds Transfer (EFT) so payments go directly to your bank account. Directions to sign up for EFT can be found on pages 19-25 of the Managing Provider Data billing guide.
How often will I receive payments?
You can enter claims in ProviderOne at any time. Claims submitted by 5 p.m. (PST) on Tuesday should pay the following Friday (holidays may impact payment schedule):
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Authorization Issues
Contact the client's DSHS/AAA authorizing case worker for changes to the authorized:
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Service code
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Dates
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Units
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Rate
You should also contact the authorizing worker if there is an error on the authorization service line.
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Health Care Authority: Medical Assistance Customer Service Center (MACSC)
- Assistance w/ submitting claims in ProviderOne
- Claim inquiry
- Claim errors
- Service limitations
- Payment issues
- Technical issues w/ ProviderOne
Phone: 1-800-562-3022 (choose "provider services")
Email: Social service provider online form
Website: ProviderOne for Social Services
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Health Care Authority: Provider Enrollment
- Updating info in ProviderOne (P1)
- Setting up electronic funds transfer (EFT)
- Enrolling providers in P1
- Medicaid revalidation
Phone: 1-800-562-3022 ext. 16137
Phones are open: Tuesdays and Thursdays from 7:30 a.m. to 4:30 p.m. (Closed from noon to 1 p.m.)
Phones are closed: Mondays, Wednesdays, and Fridays
Email: ProviderEnrollment@hca.wa.gov
(email response time is approximately 4-6 weeks)
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