ProviderOne Billing and Resource Guide

Current Guide

Use for claims billed on and after August 14, 2014.

The effective date and Change Log related to the current guide now appear in a table on page 2 of the manual titled "What has Changed?

Note:  Please do not print this document. The Health Care Authority may make occasional changes to reflect current policy, program updates, and ProviderOne system enhancements.

If you print the document and use the paper copy instead of the webpage, your version may become outdated. For best results, bookmark this page instead so that you are always using the most up-to-date version of the Guide.

Individual Sections

  • Appendix A - Use Interactive Voice Response (IVR) to Verify Eligibility
  • Appendix B - Verifying Eligibility Using a Magnetic Card Reader or MEV Service
  • Appendix C - Managed Care Orginaztions (MCOs)
  • Appendix D - Casualty Claims and Health Insurance Claims
  • Appendix E - Benefit Services Packages
  • Appendix F - Instructions to Fill Out the General Information for Authorization Request Form
  • Appendix G - How to Check Status of an Authorization
  • Appendix H - Cover Sheets for Backup Documentation
  • Appendix I - Completing the CMS-1500 Claim Form
  • Appendix J - Completing the UB-04 Claim Form
  • Appendix K - Completing the 2006 ADA Dental Claim Form
  • Appendix L - Taxonomy and ProviderOne
  • Appendix M - Medicare Crossover Claim Payment Methodology
  • Appendix N - Use the IVR to Check Claim Status
  • Appendix O - Use the IVR to Check Warrants

Glossary

Guide to Requesting Prior Authorization (from previous ProviderOne Billing & Resource Guide)

View and download the following HCA forms which are discussed in this Guide:

  • Authorization Agreement for Electronic Funds Transfer, form HCA 12-002
  • Electronic Funds Transfer (EFT) Authorization Change, form HCA 12-003

Third Party Insurance Carrier Codes

Document Submission Cover Sheets