ProviderOne Discovery Log

This week's (October 10, 2024) ProviderOne payment is delayed for some Social Services Providers. The Health Care Authority (HCA) has informed the Department of Social & Health Services (DSHS) that there is a delay for this week's ProviderOne payment cycle, affecting some Social Services Providers. There are approximately 465 total providers who submitted claims by 10/8/2024 who are affected.
The expectation is that electronic funds transfer (EFT) payments and paper checks will be sent on Monday, 10/14/2024. The payments sent out on 10/14/2024 will be on the Remittance Advice (RA) dated 10/18/2024. If you have questions about this or do not receive payment when expected, please contact HCA's Medical Assistance Customer Service Center (MACSC) via phone at 800-562-3022 (choose "provider services") or via webform. We apologize for any inconvenience.

ProviderOne has identified a small set of providers affected by a remittance advice issue that occurred on September 5-6, 2024. A Mass Adjustment of the impacted claims will be completed to ensure all financial aspects used in reconciling accounts are connected back to the original Transaction Control Numbers (TCNs) on the unbalanced remittance advice. A message will be placed on the identified providers' remittance advices to inform them that the Mass Adjustment is complete. If you do NOT see a message on your Remittance Advice, you are not one of the providers impacted by this issue. For those providers impacted by this issue, if you have additional questions, please submit a ProviderOne help request to mmishelp@hca.wa.gov.

The ProviderOne system will be undergoing maintenance from 4 p.m. to 7 p.m. Saturday, September 28, 2024 (3 hours).  Although we do not expect the maintenance activity to result in a full outage, there is the potential for an intermittent outage or degraded performance during the maintenance period.

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 5 a.m. Saturday, September 21 until 9 a.m. Sunday, September 22 (28 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 undergoing maintenance from 6 a.m. to 10 a.m. Sunday, September 15, 2024 (4 hours).  Although we do not expect the maintenance activity to result in a full outage, there is the potential for intermittent outages or degraded performance during the maintenance period.

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 undergoing maintenance from 3 p.m. to 8 p.m. Saturday, August 24, 2024 (5 hours).  Although we do not expect the maintenance activity to result in a full outage, there is the potential for an intermittent outage or degraded performance during the maintenance period.

This maintenance 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.

When submitting claims via DDE, the system will throw an undescriptive SQL exception (error) when trying to submit single digit dates for some fields.  Instead, the System should display a screen error reflecting an appropriate message, so that the claim can be corrected.

Dental claims: "Applicance Placement Date"

Institutional Claims: Statement To/From Date, Medicare Adjudication Date, Occurrence Code Date, Occurrence span code date, procedure date, Medicare paid date.

Professional: Medicare Adjudication date, Medicare paid date

Update for remittance advice issue that occurred on July 5-6, 2024

As stated in previous communications, this was a remittance issue, not a payment issue.

• The mass adjustment claims were not on the 08/02 Remittance Advice but are expected to make this week’s payment cycle completing on Friday 08/09.
• The impacted claims have been patched and the correct payment amounts are now showing in ProviderOne.
• A Mass Adjustment of these provider's impacted claims has been completed to ensure all financial aspects used in reconciling accounts are connected back to the original Transaction Control Numbers (TCNs) on the unbalanced remittance advice.
• A special message was added to impacted provider’s RAs last week and will be added to this week's RAs as well.

Link to Discovery log - ProviderOne Discovery Log | Washington State Health Care Authority

The ProviderOne system will be unavailable from 3 a.m. Saturday, July 13 until 2 p.m. Sunday, July 14 (35 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.

Error is returned when attempting to view or adjust claims when the billing provider has multiple enrollment record types.

Impact to clients, provider and staff as no one can access claims for the following impacted providers (ProviderOne ID):
1043367
1043387
1044667
1044687
1045370
1045521
1045938
1079965
2123915
2127961
2161592
2190188
2227125
2238557
2245886
2273407
2273843
2275959
2278260
2281928
2285209
 

This maintenance activity replaces the activity previously scheduled for Saturday, June 15, 2024.

The ProviderOne system will be undergoing maintenance from 10 a.m. to 3 p.m. Saturday, June 15, 2024 (5 hours).  Although we do not expect the maintenance activity to result in a full outage, there is the potential for an outage or degraded performance during the maintenance period.

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.
 

If provider receives the denial “147 – Provider contractual/negotiated rate expired or not on file” posted on a line of an Outpatient claim that has been denied for other reasons.

Due to several State activities and the observance of two holidays, there will be four ProviderOne Payment Schedule changes occurring during the months of June and July of 2024.  The following table indicates the timing of changes and the impact to; Provider Payments, Remittance Advice (RAs)/835 availability and claim submission deadlines for both ProviderOne and the Pharmacy POS systems. 

The ProviderOne system will be unavailable from 3:30 p.m. to 9:30 p.m. Saturday, June 8, 2024 (6 hours) in support of the cutover to the new Pharmacy Point of Sale system. 

When updating security secret questions and answers, if a special character is used in an answer the user will receive message “Error while authenticating User. Please contact Administrator”.

Due to several State activities and the observance of two holidays, there will be four ProviderOne Payment Schedule changes occurring during the months of June and July of 2024.  The attached document is a table that indicates the timing of changes and the impact to; Provider Payments, Remittance Advice (RAs)/835 availability and claim submission deadlines for both ProviderOne and the Pharmacy POS systems.  

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

Thank you.

Provider users that access ProviderOne from OHP, but changed their ProviderOne password will receive message “"Please contact System Administrator 1-800-973-4797. The user association failed." when attempting to access ProviderOne from OHP. 

The ProviderOne system will be undergoing maintenance from 1 p.m. to 5 p.m. Saturday, May 11, 2024 (4 hours).  Although we do not expect the maintenance activity to result in a full outage, there is the potential for an outage or degraded performance during the maintenance period.

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.

When OHP subscriber is accessing ProviderOne from OHP, OHP sends to ProviderOne the OHP role the OHP subscriber has associated.  When the ProviderOne security domain does not have ProviderOne profiles associated for ProviderOne profiles to OHP role, the incorrect message is displayed "No User Profiles assigned to the User. Please contact HCA ProviderOne Security”. 

The correct message is "Error: Please contact System Administrator. There are no ProviderOne profiles associated with your roles".

When creating claim batch templates in UP1 Provider, the Template Name field is not allowing the use of special characters, like commas. 

When an OHP subscriber has LOTS of Tax IDs associated to the OHP subscriber account and accessing ProviderOne from OHP, they are receiving ProviderOne message "No User Profiles assigned to the User. Please contact HCA ProviderOne Security".

The fix is being fast tracked for production promotion evening of 04/19/2024.

When changing profile using ability in blue menu bar is receiving message "BOSOL query name is not found"

Providers logging in to DDE and using the Claim Inquiry search function are not getting results when they use lower case letters in the client ID field. This pertains to both Medical Claim Inquiry and SS Claim Inquiry screens.

Claim inquiry may not return results.

In upgraded ProviderOne when selecting the Print icon in the blue bar, the font in the print output changed.

Due to a large increase in Social Service claims, HCA was not able to make the Wednesday cut off time with one Social Service claim file with OFM.  Fortunately, OFM will process these claims by tonight.  As a result, the Social Service providers impacted will experience the following:

•          Social Service providers will not receive payment for these claims by Friday 4/5/2024.

•          These claims will not be available on the Friday 4/5/2024 Remittance Advice.

•          Social Service providers will receive payment for these claims by Monday 4/8/2024.

•          These claims will be available on the Friday 4/12/2024 Remittance Advice.

The reason for this issue is that DSHS implemented a rate change that resulted in approximately 30 times more than average claims volume. 

After a system update to the ProviderOne portal, the ability to update the NPI in the Service Facility field in the Other Claim Info tab was made inaccessible.

If provider receives the denial “147 – Provider contractual/negotiated rate expired or not on file” posted on a line of an Outpatient claim that has been denied for other reasons.

The ProviderOne system will be unavailable from 3 a.m. Saturday, February 17 until 10 a.m. Sunday, February 18 (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.

The ProviderOne system will be unavailable from 4 a.m. to 11 a.m. Saturday, December 9, 2023 (7 hours) due to scheduled maintenance.  This outage duration replaces the previously schedule outage for the evening of Friday, December 8, 2023.  The ProviderOne system will remain fully operational on Friday December 8, 2023.

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 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..

When a Pharmacy signs up in ProviderOne and has other taxonomies than the Pharmacy taxonomy of 3336 they are being sent to POS as a prescriber.  Pharmacies should not be using the Pharmacy domain as a Prescriber.  The Pharmacist should also be signed up in ProviderOne as a Prescriber.

Pharmacy domains will no longer be able to be used as a Prescriber in POS.