Changes to ProviderOne effective January 2020

Washington State Health Care Authority sent this bulletin at 12/31/2019 04:14 PM PST

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Changes to ProviderOne effective January 2020

You are receiving this message because you may be affected by ProviderOne (P1) changes that are effective January 1, 2020.

Does this affect me?

These changes affect community hospitals and free-standing psychiatric hospitals who admit for inpatient behavioral health care - including Single Bed Certifications.

What are the changes?

Health Care Authority (HCA) will stop processing and paying inpatient claims for a non-Apple Health (Medicaid) eligible person through ProviderOne effective January 1, 2020

Please do not submit any inpatient claims with an admit date on or after January 1, 2020 to ProviderOne (P1) for payment.

This benefit will be administered by a Behavioral Health Administrative Services Organization (BH-ASO) admitted for behavioral health care on behalf of HCA. The BH-ASO will be responsible for contracting for these services as well as processing and paying these claims. The BH-ASOs will be following the HCA inpatient fee schedule for their reimbursement rates.

HCA will be completing transition to statewide integrated managed care by adding Thurston/Mason, Salish and Great Rivers regions.

For Apple Health enrolled clients, any inpatient psychiatric admissions at your facility not discharged before midnight December 31, 2019 must be billed to P1 for payment of the entire stay regardless of the discharge date.

Do not split bill these admissions (billing HCA up through December 31, 2019 and then billing managed care organizations (MCOs) for the dates of service after January 1, 2020. The MCOs are instructed not to pay inpatient behavioral health claims submitted with an admit date on or before December 31, 2019 at community hospitals or free standing behavioral health hospitals.

If you have any difficulties in receiving payment for these admissions, please email the HCA MC inbox.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.