|
ProviderOne for DSHS Social Services Providers Newsletter
January 2025
|
|
Updated newsletter design
Welcome to the ProviderOne for DSHS Social Services monthly newsletter! This newsletter is a space for DSHS & HCA to share ProviderOne updates, FAQs, reminders, and resources for DSHS-contracted providers. Based on your feedback, we have made a few changes to the monthly newsletter including a new layout, an updated color scheme to align with DSHS's new branding and logo, and a "new provider corner" with resources for newly contracted providers. We hope you enjoy the new look and find the information in these newsletters helpful.
|
|
Attention: Home Care Agencies
Electronic Visit Verification (EVV) attestation forms due to DSHS by
January 31, 2025
DSHS sent EVV attestation forms to Home Care Agencies in December 2024. Agencies must complete, sign, and return the form to DSHS by January 31, 2025. Thank you for your cooperation with this process and thank you to those who have already responded with your completed attestations.
If you are a Home Care Agency and have questions about the attestation form or EVV requirements, please email EVVQuestions@dshs.wa.gov
|
|
Monthly FAQ: What is the remittance advice and why is it important?
The remittance advice (RA) provides a detailed breakdown of paid, denied, adjusted, and in process claims. To ensure recent claim submissions processed correctly, it is very important for providers/billers to review their RAs as soon as they become available in ProviderOne.
When are new RAs available?
If claims are submitted by the 5 p.m. Tuesday deadline, the RA for these claim submissions will typically be available in ProviderOne on Friday of the same week.
What should I look for on my RA?
When reviewing your RAs, you should:
- First, review the 'Claims Summary' on Page 2.
- Here you can see the total dollar amount of claims billed, total amount paid, total client responsibility deducted, and whether there were any denied claims, adjusted claims, or any claims in process (i.e., claims that have not paid yet).
- Next, review subsequent pages of the RA to view claim details for each client.
- For paid claims, confirm the following are correct:
- Service dates
- Service codes
- Total units billed
- Billed amount & allowed amount
- Client responsibility
- Paid amount
- If any of the paid info is incorrect, correct the claims as needed. On next week's RA, confirm the claims you adjusted paid correctly.
- For adjusted claims:
- If you adjusted any claims, confirm the claims reprocessed the way you expected.
- If DSHS adjusted any claims, review the 'Adjustment Reason Codes' on the RA to see why the claims were adjusted.
- For denied claims:
- Review the 'Remark Codes' and 'Adjustment Reason Codes' to see why the claims denied.
- Correct the claims and resubmit as needed and then check next week's RA to see if the claim paid.
How to view and download the RA:
-
Log in to ProviderOne using your 'EXT Provider Social Services' or 'EXT Provider Social Services Medical' profile.
- Click on 'View Payment' on the left side of the screen.
- A list of your 10 most recent RAs appear. To view more RAs, click the 'Next' button at the bottom of the screen.
-
Note: You can view RAs for the past four years in ProviderOne. You should download and save a copy of your RA to comply with the Maintenance of Records requirement in your DSHS contract.
- To view a specific RA, click on the blue 9-digit 'RA/ETRR Number'.
- A pop-up appears. You can either view the RA or you can save it as a PDF. If you save as a PDF, you have the option to print the RA.
- Click here for step-by-step directions on how to view and download RAs.
Stay tuned for the February 2025 newsletter, which will provide a detailed review of each of these RA sections.
|
|
Resource spotlight
New provider corner
|
|
More information
The ProviderOne for DSHS Social Services Providers Newsletter is published monthly by the Department of Social & Health Services (DSHS) in collaboration with the Health Care Authority (HCA). The intent of the newsletter is to share ProviderOne information, updates, and resources for DSHS-contracted providers who submit authorized claims through the ProviderOne system.
Visit the ProviderOne for Social Services webpage to view past newsletters and to read more about ProviderOne for Social Services.
Sign up to receive the monthly newsletter and other ProviderOne for Social Services notifications.
|
|
|
|
