Announcements:
Thanksgiving Holiday will impact ProviderOne claims submission deadline and payment date
DSHS Social Services Provider payments for the week of November 25, 2024 will be made on Wednesday, November 27, 2024, including the delivery of Remittance Advices (RAs).
The deadline for submission of claims to ProviderOne for payment during the week of Thanksgiving will be Sunday, November 24, 2024 by 5 p.m. (PST).
Read more
Duplicate claims edit will restart January 1, 2025
Federal and state Medicaid rules do not allow payment for duplicate services. This means more than one payment for the same client, same service code, same date of service, to the same provider is not allowed. To prevent payment for duplicate services, most states implement edits within their Medicaid billing system to automatically review and deny duplicate claims. ProviderOne has an edit which denies exact duplicate claims and possible duplicate claims, but the edit was temporarily turned off in 2021 in order to implement Electronic Visit Verification (EVV) requirements. With these system changes now in place effective January 1 2025, ProviderOne will once again automatically deny claims that are identified as possible duplicates.
More information will be provided about this in our December newsletter. If you have any questions or concerns you would like to share in the meantime, please email p1_escalation@dshs.wa.gov.
Reminder:
Providers won't receive payment for services if authorization is in 'error' status
Providers should not provide services or submit claims in ProviderOne if a client's authorization is in "error" status for current dates of service. If a claim is submitted while the authorization is in error, ProviderOne will deny the claim and you will not receive payment. Adjustment Reason Code/NCPDP Rejection Code: 16: Claim/service lacks information or has submission/billing error(s) and Remark Code: N54: Claim information is inconsistent with pre-certified/authorized services will be listed on your Remittance Advice as the reason for the denial.
If you have an authorization in error, you must reach out to your client's authorizing case worker to have them resolve all errors before providing services.
To prevent payment delays, we recommend reviewing all authorizations monthly to verify authorizations are in good standing (i.e., covering current dates of service and in "no error" status).
|
