Discovery log: Open
- 00381: Anesthesia Pricing at Zero
Discovery log number00381Discovery description
Anesthesia claims are currently pricing at zero. This issue started after our last release, claims with paid dates after 01/11/23-01/13/23, and is scheduled to be corrected in special release on 02/10/2023.Date reportedETAProvider impactPhase 1WorkaroundOnce the issue has been corrected, claims will be identified, and a mass adjustment will be done to update the affected claims.Date closed
- 00349: 3M Inpatient Grouper Issue
Discovery log number00349Discovery description
Due to a system issue involving the inpatient grouping software that is still being tracked, some inpatient claims received by HCA may either improperly fail to group to a DRG, causing a denial, or in a smaller number of cases, group to an incorrect DRG, which may cause some denials or pricing changes. The issue will be resolved as quickly as possible.
In most cases involving this issue, providers will see inpatient claims deny for failure to group to a DRG. In a minority of cases, there may be some claims which group to an incorrect DRG.Date reportedETAProvider impactPhase 1WorkaroundFollow established processes for checking into claims denials through customer service phone or email. Alternatively, the user may attempt to adjust claims themselves as most claims group correctly on the second attempt.
- 00270: PDF issues with some browsers
Discovery log number00270Discovery description
This issue is not specific to ProviderOne. Please refer to the Adobe website for assistance. ProviderOne related issue: When creating barcode coversheets using come internet browsers, the barcode is not generating/displaying.Date reportedETAProvider impactAll ProvidersWorkaroundUsing your preferred internet browser, enter the TCN or prior authorization number on the appropriate barcode coversheet and submit. HCA is aware that the barcode will not be on your barcode coversheet and will process your backup accordingly.Date closed
Discovery log: Closed
- 00380: D9999 late rate update
Discovery log number00380Discovery description
The ABC Dental rate was not updated on 1/1/2023. We caught the issue and updated the rate on 1/18/2023.
Providers were underpaid $11.03 per claim line. This will be corrected with a mass adjustment.Date reportedETAProvider impactPhase 1WorkaroundThere is no workaround or anything anyone needs to do.Date closed
- 00379: Inpatient Claims Failure to Price
Discovery log number00379Discovery description
Inpatient claims using DRG pricing, and which processed from late morning 1/10 to afternoon 1/11 may have denied in error for failure to price due to a now corrected grouper error. Affected claims are being identified and will be mass adjusted.
Staff may receive contacts for these claims. Providers may see denials on claims.Date reportedETAProvider impactPhase 1WorkaroundClaims will be mass adjusted and currently processing claims should price correctly.Date closed
- 00378: ProviderOne outage planned for Saturday, December 10, 2022, through Sunday, December 11, 2022
Discovery log number00378Discovery description
ProviderOne outage planned for Saturday, December 10, 2022, through Sunday, December 11, 2022
The ProviderOne system will be unavailable from 3 a.m. Saturday, December 10 until 10 a.m. Sunday, December 11 (31 hours) due to scheduled maintenance.Date reportedETAProvider impactAll ProvidersWorkaroundThis outage does not affect the Pharmacy POS
Pharmacies will still be able to submit claims for processing and faxes can be sent during the outage. Faxes will be processed after the outage is complete.
Please report any issues to: email@example.com.
- 00377: Thanksgiving holiday ProviderOne payment date change
Discovery log number00377Discovery description
In observance of Thanksgiving, state offices will be closed Thursday, November 24, 2022 and Friday, November 25, 2022. As a result, provider payments for the week of November 21, 2022 will be made on Wednesday, November 23, 2022, including the delivery of Remittance Advices (RAs) and HIPAA 835 remittance files.
Claim submission deadlines have been moved up to ensure that providers are able to receive payment and RA documents on November 23, 2022.
The deadline for submission of claims to ProviderOne for payment during the week of Thanksgiving will be Sunday, November 20, 2022 by 5 p.m.
The deadline for submission of pharmacy claims to the Point of Sale (POS) during the week of Thanksgiving will be Saturday, November 19, 2022 by 5 p.m.Date reportedETAProvider impactAll ProvidersWorkaroundPlease report any issues to: firstname.lastname@example.orgDate closed
- 00375: Recoupment of Inpatient Claims
Discovery log number00375Discovery description
Due to mass adjustment error, more than 1,200 paid inpatient claims were recouped, paying at $0. A new adjustment will be done which should correct this issue.Date reportedETAProvider impactPhase 1WorkaroundMass adjustment will be done.Date closed
- 00374: ProviderOne ADA Compliance – Navigation
Discovery log number00374Discovery description
As part of the ProviderOne production release occurring on Friday, September 16, 2022 changes will be implemented to align with ADA compliance standards. These changes are being implemented to support access for individuals who rely on a keyboard to navigate within ProviderOne. For those users who are accustomed to navigating using the ‘tab’ button, ProviderOne will no longer only tab through data fields. In addition to data fields, tab functionality will now move through additional information on the page such as field labels, grid columns and navigational control arrows.
Please report any issues to: email@example.com.Date reportedETAProvider impactAll Providers
- 00373: ProviderOne user account expiration date
Discovery log number0373Discovery description
ProviderOne user accounts that have an expiration date less than the system date; the system is allowing the expiration date to be changed.
Example: user account expiration date 06/01/2022, system date 08/18/2022. It is not to allow the expiration date of 06/01/2022 to be changed since it is less than the system date of 08/18/2022.Date reportedETAProvider impactAll ProvidersWorkaroundIf a ProviderOne user account is to be reactivated, the process is to add the user. When adding the user, system will check first name, last name, DOB and EID data for the new user; if data matches a message "User Account exist and not active for the given period. Do you want to activate the User Account for the period?" is displayed, click OK button. There is now another user account for the person and the new user account has the status "In Review" with new date segments. Approve the in review user account, add and approve appropriate associated profiles for your organization.Date closed
- 00372: 2022 State Fiscal Year End – ProviderOne Payment Schedule Change
Discovery log number00372Discovery description
Due to the timing of the State Fiscal Year End, payments to providers for the week of June 27, 2022, will be made on Wednesday, June 29, 2022. Remittance Advices (RAs) and HIPAA 835 payment files will also be made available on Wednesday, June 29, 2022. Normally payments and remittance advices would be available for providers on Friday, July 1, 2022.
Claim submission deadlines have been updated as reflected below to ensure that providers are able to receive payment and Remittance Advice documents on June 29, 2022.
The deadline for submission of claims to ProviderOne in order to receive payment on June 29, 2022 will be 5 p.m. on Sunday, June 26, 2022.
The deadline for submission of pharmacy claims to the Point of Sale (POS) in order to receive payment on June 29, 2022 will be 6 p.m. on Saturday, June 25, 2022.Date reportedETAProvider impactAll ProvidersWorkaroundPlease report any issues to: firstname.lastname@example.orgDate closed
- 00371: CAS "119" incorrectly calculating for FQHC T1015 payment in UP1
Discovery log number00371Discovery description
There are two allowed amount in FQHC pricing where ‘Actual allowed amount’ is the one which is not updated during pricing
and ‘Allowed amount’ is the other one which gets updated in pricing. The defect is causing a balancing issue with the 835s and will need to be fixed in UP1.
Impacted TCNs and RAs cannot be patched; a Mass Adjustments will need to be completed after R4-2022 implementation to show correct amounts.Date reportedETAProvider impactPhase 1WorkaroundNo workaround
- 00370: Claims incorrectly denying with CARC 204
Discovery log number00370Discovery description
Claims that are submitted with a facility type at header are incorrectly denying with CARC 204 (This service/equipment/drug is not covered under the patient's current benefit plan.). The code fix will be corrected in a future ProviderOne code release. After the code is fixed, HCA will adjust the claims that denied for this reason.Date reportedETAProvider impactPhase 1Date closed
- 00369: ProviderOne outage planned for Saturday, April 16, 2022, through Sunday, April 17, 2022
Discovery log number00369Discovery description
The ProviderOne system will be unavailable from 3 a.m. Saturday, April 16 until 9:00 a.m. Sunday, April 17 (30 hours) due to scheduled maintenance.
This outage does not affect the Pharmacy POS
Pharmacies will still be able to submit claims for processing and faxes can be sent during the outage. Faxes will be processed after the outage is complete.Date reportedETAProvider impactAll ProvidersWorkaroundPlease report any issues to: email@example.com.Date closed
- 00368: ProviderOne outage planned for Saturday, March 12, 2022
Discovery log number00368Discovery description
The ProviderOne system will be unavailable Saturday, March 12, 2022 from 6 a.m. until 5 p.m. (11 hours) due to scheduled maintenance.
This outage does not affect the Pharmacy POS
Pharmacies will still be able to submit claims for processing and faxes can be sent during the outage. Faxes will be processed after the outage is complete.Date reportedETAProvider impactAll ProvidersWorkaroundPlease report any issues to: firstname.lastname@example.org
- 00367: Incorrect client responsibility amounts listed on RA
Discovery log number00367Discovery description
Client responsibility amounts being displayed on the RA and claims screens are greater than what is being actually applied to claims. Paid claim amounts and applied client responsibility is still correct, but the display of the applied client responsibility amounts are incorrect.
Confusion around client responsibility amounts listed on RA.Date reportedETAProvider impactPhase 2
- 00366: NH claim client responsibility deducting incorrectly
Discovery log number00366Discovery description
After the ProviderOne code release on 2/5/22, we discovered an issue with the system not recognizing previously deducted client responsibility which is resulting in duplicate client responsibility deductions in the same month. We have identified the fix for this issue, but it is not scheduled to be corrected until the next ProviderOne code release on 4/1/22. Providers might see multiple claims with the same client responsibility deducted. After the code is released, we will adjust the affected claims.Date reportedETAProvider impactPhase 1WorkaroundWe have identified a work around. NH providers can submit 1 claim for the full month. If you have already submitted multiple claims that have had CR deducted incorrectly, please void all but 1 of the paid claim(s) for each client. Then adjust the remaining paid claim and update the dates and dollar amounts so it has the dates and dollar amounts for the full month. This will create take backs for the voided claims and pay the full amount on the adjusted claim.
- 00365: ProviderOne outage planned for Saturday, February 12, 2022, through Sunday, February 13, 2022
Discovery log number00365Discovery description
The ProviderOne system will be unavailable from 3 a.m. Saturday, February 12 until 8:30 a.m. Sunday, February 13 (29.5 hours) due to scheduled maintenance.
This outage does not affect the Pharmacy POS
Pharmacies will still be able to submit claims for processing and faxes can be sent during the outage. Faxes will be processed after the outage is complete.Date reportedETAProvider impactAll ProvidersWorkaroundPlease report any issues to: email@example.com.
- 00362: ProviderOne outage planned for Saturday, January 15, 2022
Discovery log number00362Discovery description
The ProviderOne system will be unavailable Saturday, January 15, 2022 from 3 a.m. until 9 p.m. (18 hours) due to scheduled maintenance.
This outage does not affect the Pharmacy POSDate reportedETAProvider impactAll ProvidersWorkaroundPlease report any issues to: firstname.lastname@example.org.Date closed
- 00361: An organizations ProviderOne system administrator is unable to reactivate ProviderOne OHP user account.
Discovery log number00361Discovery description
ProviderOne user accounts were inactivated/expired due to inactivity. Users that access ProviderOne from OneHealthPort (OHP) will have their ProviderOne user account username the same as their OHP username but starting with ‘OHP’. If a user is accessing ProviderOne from OHP and their ProviderOne OHP user account is inactive/expired, they receive message “Error: The current ProviderOne user account has been locked and/or expired. Please contact your organizations ProviderOne system Administrator.” If the organizations ProviderOne system administrators want the ProviderOne OHP user account reactivated, they are unable to update the expiration date of the user account.Date reportedETAProvider impactAll ProvidersWorkaroundThe organizations ProviderOne system administrator submits a ticket to ProviderOne Security requesting a ProviderOne OHP user account to be reactivated, supplying the Domain ID and Username for the user account that is to be reactivated. The organizations ProviderOne system administrator please include your contact information in the request. ProviderOne Security email is email@example.com
- 00358: Edit Code 11120 posting on claims in error
Discovery log number00358Discovery description
Claims processed after 10/15/2021 may be posting the Prior Authorization edit in error. This is causing some services to deny for Prior Authorization in error.
This is causing claims or claim lines to deny in error.Date reportedETAProvider impactPhase 1WorkaroundThere is no work around, all effected claims will be reprocess as soon as the issue is corrected.Date closed
- 00354: Duplicate Covid Vaccine payments
Discovery log number00354Discovery description
Providers have billed the MCO’s and HCA for same services.
Claim payments made by HCA for MCO covered services being recouped.Date reportedETAProvider impactPhase 1
- 00351: OPPS Processing Errors
Discovery log number00351Discovery description
For OPPS claims with a payment date of 07/01/2020, in addition to incorrectly paying the claims at 0.00, several erroneous EAPG errors were returned
Impact to clients, provider or staff: Claims were not paid correctlyDate reportedETAProvider impactPhase 1WorkaroundThese errors have been fixed. For adjustments, the providers can submit the claim numbers on an excel spreadsheet to firstname.lastname@example.orgDate closed
- 00350: Adding Servicing Providers by Location, by Agency and Taxonomy
Discovery log number00350Discovery description
When adding a new servicing provider (step 14), additional information will need to be indicated: Agency, Taxonomy and Location.
Billing providers will be able to associate their servicing providers to a specific servicing location.
Billing providers will be able to associate taxonomies to a specific servicing location.
A resource document for making changes to the provider file will be available soon.
The location information will improve the accuracy of online tools to assist clients in finding available medical providers.
The Provider Roster spreadsheet has been modified to include these 3 new elements: Location, Agency and Taxonomy.
These changes meet March 2021 CMS rule and provision to make provider directory information publicly available via a standards-based Application Programming Interface (API).Date reportedETAProvider impactAll ProvidersWorkaroundN/ADate closed
- 00348: When adding a new user account to ProviderOne, the EID field is only allowing numeric characters.
Discovery log number00348Discovery description
When adding a new user account to ProviderOne, the EID field is only allowing numeric characters and should be allowing alphanumeric characters.Date reportedETAProvider impactAll ProvidersWorkaroundAfter the new user is created, access the users ‘User Details’ screen, update the EID field with the alphanumeric characters and save.Date closed
- 00345: Providers who have their Business Status Closed and can't access Portal
Discovery log number00345Discovery description
Providers are signing into the Portal and can't access their closed domains as they are not listed as one of the Provider IDs.
Currently Providers will not be able to access their closed domains on the Portal until after this defect goes into production.Date reportedETAProvider impactAll ProvidersWorkaroundProviders can call Provider Enrollment or email them at email@example.com if it is an emergent situation.Date closed
- 00342: Nursing Home mass adjustments
Discovery log number00342Discovery description
UPDATE 12/4/20: Due to system constraints, ProviderOne cannot offset the payments on the remittance advice due to a switch in payment from agencies. This will look like the provider has been paid twice for the services, but it is creating a receivable in OFR for the overpayment. OFR will reach out to providers to collect the overpayment. PROVIDER IMPACT: Over 40K Nursing Home claims were paid out of the incorrect account code program. Claims affected have payment dates between Sept 18 and November 13. The adjustments will correct the account coding. ORIGINAL ISSUE 11/18/20: Over 40K Nursing Home claims were paid out of the incorrect account code program. Claims affected have payment dates between Sept 18 and November 13. The adjustments will correct the account coding.
No impact to staff or clients. Providers will see a claim increase in the Adjustment area of their Remittance Advice. The adjustments should not affect the payment amount.Date reportedETAProvider impactPhase 1WorkaroundNo workaround needed/necessary
- 00341: Issue with EPA 870001347/D2930
Discovery log number00341Discovery description
There was an issue with units on EPA causing claims to deny for units billed being greater than the authorized units available. Claims were denied erroneously and will be reprocessed with a mass adjustmentDate reportedETAProvider impactPhase 1WorkaroundThere is no workaround. The issue is now fixed and claims will be adjusted by state staff
- 00336: Client status is not Nursing Facility
Discovery log number00336Discovery description
Institutional status in client file incorrectly suspending some Nursing Home claims slowing down processing time.Date reportedETAProvider impactPhase 1WorkaroundThere is no work around. Claims Processing will review the suspended claims and force through for payment as needed.Date closed
- 00332: Provider Roster upload errors 5082 and 5083
Discovery log number00332Discovery description
Currently when Provider rosters are being uploaded and DEA and License dates are outside of the business status start dates the system is throwing errors 5082 and 5083. This defect will be removing these errors and excepting dates outside of the enrollment dates.Date reportedETAProvider impactAll ProvidersWorkaroundCurrently staff and providers will need to keep the DEA and license dates in the same start date of the enrollment of the provider on the Roster.
- 00329: Tribal Health Enrollment Type can't add servicing providers to their domain
Discovery log number00329Discovery description
When a HCA provider is enrolled under Tribal Health and they go into Step 15 to add servicing providers the Add button is greyed out.Date reportedETAProvider impactPhase 1WorkaroundProvider Enrollment staff can go into the servicing provider domain and add these to their Billing Provider step which then will associate to the Tribal Health domain.
- 00324: Provider Roster upload not receiving an error when uploading incorrect formatted spreadsheet
Discovery log number00324Discovery description
There is one Provider Roster spreadsheet that was determined by the agency to be used. If a provider uploads an incorrect formatted spreadsheet it could seem to have been accepted by the system, but staff will have to reject it. Please make sure and use the Agency specific Provider Roster spreadsheet.Date reportedETAProvider impactAll ProvidersWorkaroundSystem will allow the Provider to upload an incorrect formatted spreadsheet, but then it will have to be rejected.
- 00323: Dental Claims Issue: Crowns required PA in error
Discovery log number00323Discovery description
Codes D2390, D2932, D2933, and D2934 were erroneously updated to require Prior Authorization. This has been corrected in the system. A mass adjustment has been submitted to correct the claims.
Claims for these codes have denied for 'No Prior Authorization'. These claims will be adjusted and paid to providers.Date reportedETAProvider impactPhase 1
- 00322: DMEPOS Pricing Issue, Charge Modes 271-273
Discovery log number00322Discovery description
Claims that should be paying at PAC DMEPOS are paying at MAXNONFAC-Maximum Non-Facility Amount instead. This issue started after our last release, claims with paid dates after 07/05/19, and is scheduled to be corrected in our next release on 08/23/19.Date reportedETAWorkaroundOnce the issue has been corrected, claims will be identified, and a mass adjustment will be done to update the affected claims.
- 00321: Managed care recoupments due to Medicare/Retro Medicare updates in ProviderOne.
Discovery log number00321Discovery description
There are Apple Health (Medicaid) clients, whose claims have been denied because of a Managed Care Plan's recoupment (due to Medicare/Retro Medicare eligibility). There is an impact to Providers. Premiums that have been paid to Managed Care Plans have been recouped, due to Medicare/Retro Medicare eligibility updated within ProviderOne.Date reportedETAProvider impactPhase 1WorkaroundProviders will need to submit claims to Medicare for reimbursement, if applicable, and those claims should crossover to ProviderOne for additional payment. If Medicare does not cover the specific service, then Providers will need to submit those claims directly to ProviderOne for payment. When submitting a claim for payment consideration, please add the following claim note to your claims submission:
MC RECOUP DATED [MM/DD/YYY]
When the claim is submitted/resubmitted, it may be denied for timely filing and you must contact the Health Care Authority (1-800-562-3022) with the claim/TCN numbers to be reprocessed.
Once the claim has been submitted please do not resubmit your request until you receive final determination on your Remittance Advice and/or 835. If you do resubmit before finalization of the claim, the claim will automatically deny as a duplicate.
- 00320: Social Service Servicing Only providers with Roster upload associate to all SSL locations
Discovery log number00320Discovery description
When uploading a provider roster for SSSO providers and the billing provider has multiple locations for SSL system didn't know which location to add these providers to.
When using the Roster for Social Service Servicing Only providers to a billing provider with multiple locations the system will only load to one of the locations.Date reportedETAProvider impactAll ProvidersWorkaroundWhen using the Roster for Social Service Servicing Only providers to a billing provider with multiple locations the system will only load to one of the locations.