00442: ProviderOne Payment Schedule Changes: 2025 State Biennium End and Independence Day
Discovery log number
00442
Discovery description

Due to the timing of the State Biennium End and the observance of Independence Day, payments to providers for the week of June 30, 2025, will be delayed and made the following week on Tuesday, July 8, 2025. Remittance Advices (RAs) and HIPAA 835 files will also be made available on Tuesday, July 8, 2025.  Normally payments and remittance advice documents would be available for providers on Friday, July 4, 2025, but must be moved due to the Biennium end and the holiday.

Claim submission deadlines have been updated as reflected below to ensure that providers are able to receive payment and Remittance Advice documents on July 8, 2025.

The deadline for submission of claims to ProviderOne in order to receive payment on July 8, 2025, will be extended to 5 p.m. on Wednesday, July 02, 2025.

The deadline for submission of pharmacy claims to the Point of Sale (POS) in order to receive payment on July 8, 2025 will be extended to 5 p.m. on Tuesday, July 1, 2025.

Payment and claims submission deadlines for the week of July 7, 2025 will not be impacted.  Two payments will be made during this week.

Date reported
ETA
Provider impact
All Providers
Workaround
N/A
Description
The agency is amending these rules to remove reference to “other medical necessary services” to align with SHB 2051.

Agency contacts

Rulemaking contact

Valerie Freudenstein

Program contact

Abby Cole

Rulemaking status history

Preproposal (CR101)

Christine Winn

Description
To create a new chapter which establishes the Medicaid agency’s: (1) requirements for enabling a tribal clinic to receive the agency’s all-inclusive rate (AIR); (2) reimbursement methodology for receiving the AIR; and (3) process to appeal decisions related to the AIR.

Agency contacts

Rulemaking contact

Jason Crabbe

Program contact

Christine Winn

Rulemaking status history

Preproposal (CR101)

Kendra Cullimore

Description
The agency is developing rules for a statewide Certified Community Behavioral Health Clinic (CCBHC) model as directed by ESSB 5167 Sec 214 (43), 69th Legislature, 2025 Regular Session, and cost-based rates and standards for CCBHC certification. CCBHCs are outpatient, community-based clinics that provide a comprehensive range of mental health and substance use disorder services to people
seeking care.

Agency contacts

Rulemaking contact

Melinda Froud

Program contact

Kendra Cullimore

Rulemaking status history

Preproposal (CR101)

00441: ProviderOne outage planned for Saturday, June 14, 2025, through Sunday, June 15, 2025 - CANCELLED
Discovery log number
00441
Discovery description

The ProviderOne system outage planned for 5:30 a.m. Saturday, June 14 until 8 a.m. Sunday, June 15 (25.5 hours), has been cancelled and will be rescheduled for a future date.  The ProviderOne system will be available and fully operational on Saturday, June 14, 2025 and Sunday, June 15, 2025.

Date reported
ETA
Provider impact
All Providers
Workaround
N/A
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