ProviderOne Discovery Log

The ProviderOne system will be unavailable from 3 a.m. Saturday, November 18 until 10 a.m. Sunday, November 19 (31 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.

In observance of Thanksgiving, state offices will be closed Thursday, November 23, 2023 and Friday, November 24, 2023. As a result, provider payments for the week of November 20, 2023 will be made on Wednesday, November 22, 2023, 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 22, 2023.

The deadline for submission of claims to ProviderOne for payment during the week of Thanksgiving will be Sunday, November 19, 2023 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 18, 2023 by 5 p.m..

Due to the observance of Veterans Day (November 10), ProviderOne claims submission deadlines have been moved up to ensure that providers are able to receive payment and Remittance Advices (RA’s and HIPAA 835 files) on Thursday November 9, 2023.

The deadline for submission of claims to ProviderOne for payment during the week of Veterans Day will be 5 p.m., Monday November 6, 2023.

The deadline for submission of pharmacy claims to the Point of Sale (POS) for payment during the week of Veterans Day will be 5 p.m., Sunday November 5, 2023.

The ProviderOne system will be unavailable from 6 p.m. Friday, October 20 until 3 p.m. Saturday, October 21 (21 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.

The ProviderOne system will be unavailable from 4 a.m. to 10 a.m. Saturday, October 14, 2023 (6 hours) due to scheduled maintenance.  This outage duration replaces the previously schedule outage for the evening of Friday, October 13, 2023.  The ProviderOne system will remain fully operational on Friday October 13, 2023.

The ProviderOne system will be unavailable from 6 p.m. to 9 p.m. Friday, September 1, 2023 (3 hours) due to scheduled maintenance.

Some service lines on professional crossover claims with procedure codes such as E0260, E0265, E0570, E0261 and E1028 are denying for failure to price due to a system issue. The issue should be corrected 10/13/23, at which point a mass adjustment will take place to correct affected claims.

Impact to clients, provider or staff: Denied service lines on professional crossover claims.

We made updates to the rules that derive claim account coding. After the updates were made, we adjusted the claims. Our expectation was that the adjustments would not create any changes to provider payments for the claims that were adjusted. We are working to reprocess incorrectly denied claims; some claims denied appropriately and will need to be corrected by the provider. We did not expect claims to suspend. Our staff is working diligently on the suspended claims so they will finalize soon.

Due to the timing of the State Fiscal Year End, payments to providers for the week of June 26, 2023, will be made on Thursday, June 29, 2023. Remittance Advices (RAs) and HIPAA 835 payment files will also be made available on Thursday, June 29, 2023.  Normally payments and remittance advices would be available for providers on Friday, June 30, 2023.

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, 2023.

The deadline for submission of claims to ProviderOne in order to receive payment on June 29, 2023 will be 5 p.m. on Monday, June 26, 2023.

The deadline for submission of pharmacy claims to the Point of Sale (POS) in order to receive payment on June 29, 2023 will be 6 p.m. on Sunday, June 25, 2023.

Providers are unable to submit modifications from Provider Portal with common data changes (for both HCA and LNI)(example: Changes to Location step)

Receiving error : Current bpw Transaction SID :'' is not allow to modify LNI Information

Providers unable to submit a common data modification.

Providers are unable to submit modifications from Provider Portal with common data changes (for both HCA and LNI) (example: Changes to Location step)

Receiving error : Current bpw Transaction SID :'' is not allow to modify LNI Information

Providers unable to submit a modification for shared agency.

Oracle Error Message when billing provider tries to add a servicing provider by click on the name from the BPW Step 14.

Provider is unable to add a servicing provider.

The ProviderOne system will be unavailable from 3 a.m. Saturday, April 15 until 10 a.m. Sunday, April 16 (31 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.

Medical Record Companies (MRC) are currently using Taxonomy 246YR1600X on submission of claims into ProviderOne.  This taxonomy is ending as of March 31st, 2023 (03/31/2023).  The Taxonomy that is replacing and needs to be used/submitted as of April 1st, 2023 (04/01/2023) is 247000000X. 

HCA is providing this update for the MRC providers and changes can be viewed on the HCA website (Medicaid 101 for medical record company providers (wa.gov)) as well as on the DSHS website (Medical Records - Medical Evidence Fee Schedule | DSHS (wa.gov)). 

HCA updates provider billing guides quarterly, as needed. Providers may access the most up-to-date versions at the provider billing guides and fee schedules webpage. 

Impact to clients, provider or staff: Medical Record Companies (MRC) Providers only

HCA and L&I are working on a system issue impacting servicing provider accounts. We anticipate the fix to be implemented by the week of March 20th. We recommend avoiding any changes to your ProviderOne accounts until the system issue is resolved. Applications for providers who are new to ProviderOne are not affected by this issue.

The ProviderOne system will be unavailable from 3 a.m. Saturday, March 11 until 10 a.m. Sunday, March 12 (31 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.

Please report any issues to:  mmishelp@hca.wa.gov. 

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. 

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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. 

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.

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

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

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

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).

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

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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.