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ProviderOne Social Services Newsletter |
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Reminders
All providers:
Reviewing authorizations
It is important for Social Services Providers to verify a client's authorization details before providing services and before submitting claims for payment. Providers can view authorization lists for clients in ProviderOne.
When reviewing the authorization lists, providers must ensure the auth is in "no error" status and that the rates, dates, units, and services are correct. For example, if you are submitting a claim for a client who was recently in the hospital and they have since returned to your facility, you should review your authorization list and verify that there is a bed hold (if applicable) and that the authorized dates for the bed hold match your records.
If any information on the authorization is incorrect, or if the authorization is in "error" status, providers must contact the client's authorizing case worker before providing services.
Updates
All providers:
Check out new features on the ProviderOne for Social Services webpage:
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Newsletters section. This section provides links to past ProviderOne Social Services Newsletters.
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Contact section. This section provides detailed HCA & DSHS contact information for Social Services Providers.
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Related links section. This section has been updated with important links related to ProviderOne.
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ProviderOne FAQs
How do I know when to adjust, void, resubmit, or submit a new claim?
Adjust a claim when you have already been paid for the service (i.e.,
the claim is in 'paid' status) but you need to make a change to the claim (i.e., units, rate, dates of service). P1 does not allow adjustments to denied or void claims.
Void a claim when you never should have been paid for the service (i.e., you submitted a claim for the wrong code, client was not eligible for services, wrong date of service, wrong rate). Voiding a claim will result in an overpayment.
Resubmit a claim when a claim is in denied or void status. Denied claims can be resubmitted using the resubmit feature and
correcting the error that caused the claim to deny.
Submit a new claim for services you have never been paid for (i.e., you have provided the service but you have not yet submitted the claim in P1). Do not submit new claims for services and dates that are already in paid status.
Directions on how to adjust, void, resubmit & submit new claims can be found on the ProviderOne for Social Services webpage.
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Resource spotlight
Viewing authorizations
Submitting and adjusting social service claims
Submitting and adjusting social service medical claims
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Authorization & Contract 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.
If you have questions about your DSHS/Social Service contract, please contact your contracts manager at DSHS.
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Health Care Authority: Medical Assistance Customer Service Center (MACSC)
- Assistance w/ submitting claims in ProviderOne
- Claim inquiry/claim errors
- Payment issues
- Technical issues w/ ProviderOne
Phone: 1-800-562-3022 (choose "provider services")
Phones are open: Monday-Friday, 8 am-noon and 1:30 pm-3:30 pm
Email: Social service provider online form
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Health Care Authority: Provider Enrollment
Updating info in ProviderOne such as:
- Signing up for Electronic Funds Transfer (EFT)
- Updating locations/addresses
- Updating contact preferences, email addresses, etc.
Phone: 1-800-562-3022 ext. 16137 Phones are open: Tuesdays and Thursdays, 7:30 am-noon and 1:00 pm- 4:30 pm
Email: ProviderEnrollment@hca.wa.gov
(email response time is approximately 4-6 weeks)
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