Article by Department of Social and Health Services. Published on Tuesday, March 16, 2010 EST.

OLYMPIA, March 15 – The Department of Social and Health Services announced today that it plans to switch its medical assistance and nursing home bill-paying functions over to a new computer system called ProviderOne on May 9, 2010.

The new system, which will be responsible ultimately for distributing more than $17 million a day in medical and nursing home reimbursements, will bring a number of improvements to the Department’s medical programs and its 14,000 medical providers across the state. Primary contractor on the new system is CNSI, a Maryland company that has been working with the Department on the project since 2005.

ProviderOne will mean faster and more accurate claims processing, it will feature edits that will catch billing mistakes and overpayments before they are processed, and it will collect and sort a wealth of new data that can be used by the Medicaid program for better decision making and analysis of trends and costs.

“The ProviderOne system has gone through rigorous testing and will be fully ready by the go-live date,” said Department Secretary Susan N. Dreyfus. “The system is ready, our staff is ready, and providers have had an unprecedented opportunity in recent months to sign up for the new system and to start testing to make sure their claims will be accepted and paid.”

Another major change that will be involved in ProviderOne is a new plastic Services Card that will replace a mailed paper “coupon” currently used as a medical assistance identification document. The Services Card, which will save the state money on postage, will function like the ID cards used by private insurance plans – providing a special ID number but without any personal health information.

On its timetable of readiness, the Services Card will be mailed to clients by geographic regions beginning in early April in the Spokane area and continuing through that month through the rest of Eastern Washington, Northwest Washington, Seattle and Tacoma, and finishing up with the Olympic Peninsula and Southwest Washington.

Assistant Secretary Doug Porter said the provider readiness efforts have concentrated on providers with the largest claims volume. He estimated that at current rates, the Department expects to have providers who represent more than 90 percent of its claims volume ready and tested with the new system by the go-live deadline.

But he noted there is time for all providers to get on board even if they still need to test their own billing system with ProviderOne. Those providers who miss the deadline will still be able to come on board after go-live.

“What we can’t do is guarantee timely payments for providers who continue to ignore the need to register, upgrade their information and actually test their billings in a simulated ProviderOne environment,” he said.

The Department is making personal phone and mail contact with all of its providers. “We are urging providers who have not completed the process to contact us and get re-engaged,” Porter said.

The Department received federal funding in January to establish a new provider-testing Help desk, with operators who can answer questions as well as literally walk providers through the security, registration and testing stages. Providers and their billing shops can reach the HELP desk by calling 1-800-562-3022 selecting option 2, then 4; or by e-mailing providerone@dshs.wa.gov. 

The new computer payer system’s budgeted cost to date is $161 million, with most of the project supported by a 90-10 percent federal match. The federal government invests heavily in the Medicaid Management Information Systems used by state Medicaid programs because of the long-range efficiencies the upgraded computers can bring to the state-federal partnership.

DSHS does not discriminate and provides equal access to its programs and services for all persons without regard to race, color, gender, religion, creed, marital status, national origin, sexual orientation, age, veteran’s status or the presence of any physical, sensory or mental disability.

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