Discovery log: Open

00373: ProviderOne user account expiration date
Discovery log number
0373
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
If 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
00349: 3M Inpatient Grouper Issue
Discovery log number
00349
Discovery 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 reported
ETA
Provider impact
Phase 1
Workaround
Follow 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 number
00270
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
Using 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

00374: ProviderOne ADA Compliance – Navigation
Discovery log number
00374
Discovery 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:  mmishelp@hca.wa.gov.

Date reported
ETA
Provider impact
All Providers
00372: 2022 State Fiscal Year End – ProviderOne Payment Schedule Change
Discovery log number
00372
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
Please report any issues to: mmishelp@hca.wa.gov
Date closed
00371: CAS "119" incorrectly calculating for FQHC T1015 payment in UP1
Discovery log number
00371
Discovery 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 reported
ETA
Provider impact
Phase 1
Workaround
No workaround
00370: Claims incorrectly denying with CARC 204
Discovery log number
00370
Discovery 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 reported
ETA
Provider impact
Phase 1
Date closed
00369: ProviderOne outage planned for Saturday, April 16, 2022, through Sunday, April 17, 2022
Discovery log number
00369
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
Please report any issues to: mmishelp@hca.wa.gov.
Date closed
00368: ProviderOne outage planned for Saturday, March 12, 2022
Discovery log number
00368
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
Please report any issues to: mmishelp@hca.wa.gov
00367: Incorrect client responsibility amounts listed on RA
Discovery log number
00367
Discovery 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 responsbility is still correct, but the display of the applied client responsibility amounts are incorrect.

Confusion around client responsibility amounts listed on RA.

Date reported
ETA
Provider impact
Phase 2
00366: NH claim client responsibility deducting incorrectly
Discovery log number
00366
Discovery 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 reported
ETA
Provider impact
Phase 1
Workaround
We 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 number
00365
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
Please report any issues to: mmishelp@hca.wa.gov.
00362: ProviderOne outage planned for Saturday, January 15, 2022
Discovery log number
00362
Discovery 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 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 reported
ETA
Provider impact
All Providers
Workaround
Please report any issues to: mmishelp@hca.wa.gov.
Date closed
00361: An organizations ProviderOne system administrator is unable to reactivate ProviderOne OHP user account.
Discovery log number
00361
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
The 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 provideronesecurity@hca.wa.gov
00358: Edit Code 11120 posting on claims in error
Discovery log number
00358
Discovery 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 reported
ETA
Provider impact
Phase 1
Workaround
There 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 number
00354
Discovery description

Providers have billed the MCO’s and HCA for same services.

Claim payments made by HCA for MCO covered services being recouped.

Date reported
ETA
Provider impact
Phase 1
00351: OPPS Processing Errors
Discovery log number
00351
Discovery 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 correctly

Date reported
ETA
Provider impact
Phase 1
Workaround
These errors have been fixed. For adjustments, the providers can submit the claim numbers on an excel spreadsheet to claimerror@hca.wa.gov
Date closed
00350: Adding Servicing Providers by Location, by Agency and Taxonomy
Discovery log number
00350
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
N/A
Date closed
00348: When adding a new user account to ProviderOne, the EID field is only allowing numeric characters.
Discovery log number
00348
Discovery description

When adding a new user account to ProviderOne, the EID field is only allowing numeric characters and should be allowing alphanumeric characters.

Date reported
ETA
Provider impact
All Providers
Workaround
After 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 number
00345
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
Providers can call Provider Enrollment or email them at providerenrollment@hca.wa.gov if it is an emergent situation.
Date closed
00342: Nursing Home mass adjustments
Discovery log number
00342
Discovery 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 reported
ETA
Provider impact
Phase 1
Workaround
No workaround needed/necessary
00341: Issue with EPA 870001347/D2930
Discovery log number
00341
Discovery 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 adjustment

Date reported
ETA
Provider impact
Phase 1
Workaround
There 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 number
00336
Discovery description

Institutional status in client file incorrectly suspending some Nursing Home claims slowing down processing time.

Date reported
ETA
Provider impact
Phase 1
Workaround
There 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 number
00332
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
Currently 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 number
00329
Discovery 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 reported
ETA
Provider impact
Phase 1
Workaround
Provider 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 number
00324
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
System 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 number
00323
Discovery 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 reported
ETA
Provider impact
Phase 1
00322: DMEPOS Pricing Issue, Charge Modes 271-273
Discovery log number
00322
Discovery 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 reported
ETA
Workaround
Once 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 number
00321
Discovery 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 reported
ETA
Provider impact
Phase 1
Workaround
Providers 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 number
00320
Discovery 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 reported
ETA
Provider impact
All Providers
Workaround
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.