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ProviderOne Discovery Log

Discovery Log: Open

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

6/14/2022

ETA

7/1/2022

Provider Impact

All Providers

Workaround

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

Date Closed

7/2/2022

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

5/31/2022

ETA

7/22/2022

Provider Impact

Phase 1

Workaround

No workaround

Date Closed

N/A

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

4/30/2021

ETA

12/31/2999

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.

Date Closed

N/A

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

5/5/2017

ETA

12/31/2999

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

12/31/2999

Discovery Log: Closed

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

4/18/2022

ETA

5/27/2022

Provider Impact

Phase 1

Workaround

Date Closed

5/28/2022

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

4/8/2022

ETA

4/17/2022

Provider Impact

All Providers

Workaround

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

Date Closed

4/18/2022

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

3/4/2022

ETA

3/13/2022

Provider Impact

All Providers

Workaround

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

Date Closed

N/A

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

2/23/2022

ETA

4/1/2022

Provider Impact

Phase 2

Workaround

Date Closed

N/A

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

2/18/2022

ETA

3/11/2022

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.

Date Closed

N/A

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

2/4/2022

ETA

2/14/2022

Provider Impact

All Providers

Workaround

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

Date Closed

N/A

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

1/7/2022

ETA

1/16/2022

Provider Impact

All Providers

Workaround

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

Date Closed

1/10/2022

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

12/14/2021

ETA

4/22/2022

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

Date Closed

N/A

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

10/26/2021

ETA

11/30/2021

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

12/1/2021

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

8/5/2021

ETA

9/30/2021

Provider Impact

Phase 1

Workaround

Date Closed

N/A

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

5/6/2021

ETA

8/30/2021

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

8/31/2021

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

5/4/2021

ETA

9/30/2021

Provider Impact

All Providers

Workaround

N/A

Date Closed

10/1/2021

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

4/5/2021

ETA

6/25/2021

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

6/26/2021

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

2/8/2021

ETA

4/21/2021

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

4/22/2021

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

11/18/2020

ETA

1/31/2021

Provider Impact

Phase 1

Workaround

No workaround needed/necessary

Date Closed

N/A

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

11/12/2020

ETA

12/3/2020

Provider Impact

Phase 1

Workaround

There is no workaround. The issue is now fixed and claims will be adjusted by state staff

Date Closed

N/A

Discovery Log Number

00336

Discovery Description

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

Date Reported

7/29/2020

ETA

8/1/2020

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

8/1/2020

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

4/6/2020

ETA

7/24/2020

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.

Date Closed

N/A

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

2/3/2020

ETA

4/3/2020

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.

Date Closed

N/A

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

9/9/2019

ETA

12/13/2019

Provider Impact

All Providers

Workaround

System will allow the Provider to upload an incorrect formatted spreadsheet, but then it will have to be rejected.

Date Closed

N/A

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

8/14/2019

ETA

8/23/2019

Provider Impact

Phase 1

Workaround

Date Closed

N/A

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

8/12/2019

ETA

8/23/2019

Provider Impact

Workaround

Once the issue has been corrected, claims will be identified, and a mass adjustment will be done to update the affected claims.

Date Closed

N/A

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

7/24/2019

ETA

1/23/2020

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.

Date Closed

N/A

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

7/16/2019

ETA

10/21/2019

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.

Date Closed

N/A

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