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New Discoveries Log
Open Discoveries Log
Closed Discoveries Log
                                                                                                                                          Provider Discovery Log - Open

Prov                                                                                                                                              Sub-    Date
Log#     ID              Title              Type                                        Description                                  Sev.       system Reported        ETA                         Workaround                      Provider Impact       Update
   37           Prior Auth NPI field    Enhancement     The system and paper form for a Prior Authorization (PA) request asks                  Prior Auth 6/2/2010 TBD              On a prior authorization form (excludes      Providers who submit
                label for payment                       for the "Servicing" NPI. This label "Servicing" may cause confusion and                                                     pharmacy), in the field requesting           PA requests. (non-
                (non-pharmacy)                          cause PA requests to be returned because you can only be paid on a PA if                                                    "Servicing" NPI, use the NPI for the         pharmacy)
                                                        you are listed as a servicing provider with a "pay to" NPI. A request is                                                    individual or group who will bill DSHS for
                                                        being submitted to change this label to "Billing" NPI.                                                                      payment.

              835 Defaut Values -                                                                                                   Disabled- PROD:
              Single Digit Modifier                     Working to return double digit modifiers on the 835 as a default as it is   Work      HIPAA
   85 1010926 Issue                     Enhancement     causing issues with banks/clearinghouses.                                   Around 835              7/26/2011 TBA

              835 - Patient                                                                                                         Disabled- PROD:
              Responsibility                                                                                                        No Work HIPAA
   86 1011027 Amount Defect             Defect          Claim failed to balance againt Patient Responsibility Amount.               Around 835               8/3/2011 TBA

                                                        The dispensing fee (S9430) is only billable by Family Planning providers
                                                        and the units must equal the number of paid units of qualifying drugs
                                                        (S4993, J7303, J7304 & J3490-FP) on the same claim. During a routine
                                                        review of claims by HCA audit staff we found that there were claims
                                                        billed inappropriately and we have started the recoupment process.
                                                        Please note, most of these claims cannot be corrected unless there is a
                                                        change to be made that will cause more qualifying drug units to be paid                                       TBD: Claims
                Family Planning                         and therefore more dispensing fee units will be paid. However, if your                                        are still                                                  Dispensing fees
                Dispensing Fees                         claim was denied with AdjRsn/Rmk 125/M16 or 96/N129, you may be                                               being                                                      incorrectly paid will
   88           (S9430) recouped        Informational   able to correct your claim by adding the FP modifier.                       N/A        Claims       8/12/2011 adjusted                                                   be recouped.
                                                                                                                                                                                                                                 How will your
                                                                                                                                                                                                                                 claims get
                                                                                                                                                                                                                                 corrected? 1. For
                                                                                                                                                                                                                                 claims with CPT
                                                                                                                                                                                                                                 45378 and a date of
                                                                                                                                                                                                                                 service of 7/1/2011
                                                                                                                                                                                                                                 or after that were
                                                                                                                                                                                                                                 paid prior to
                                                                                                                                                                                                                                 9/21/2011, HCA
                                                                                                                                                                                                                                 has already
                                                                                                                                                                                                                                 reprocessed and
                                                                                                                                                                                                                                 corrected the
                                                                                                                                                                                                                                 payment amount
                                                                                                                                                                                                                                 2. For endoscopy
                                                                                                                                                                                                                                 claims where CPT
                                                                                                                                                                                                                                 45378 is the
                                                                                                                                                                                                                                 endoscopy base and
                                                                                                                                                                                                                                 a date of service of
                                                                                                                                                                                                                                 7/1/2011 or after
                                                                                                                                                                                                                                 that were paid prior
                                                                                                                                                                                                                                 to 9/21/2011, your
                                                                                                                                                                                                                                 claim may have
                Professional Rate                                                                                                                                                                                                been underpaid.
                issue on CPT 45378                      The facility rate for CPT 45378 was incorrectly loaded effective                                                                                                         HCA is currently
                for July 1 - Sept 21,                   7/1/2011. The rate was loaded at $235.52 instead of the correct                                                                                                          working on
   91           2011                                    rate of $129.64. This was subsequently corrected on 9/21/2011.              3-Low      Claims       9/20/2011     9/21/2011 N/A                                          identifying these

Click below for specific log you wish to view:
New Discoveries Log
Open Discoveries Log
Closed Discoveries Log
Prov                                                                                                                                                                  Date
Log#     ID                 Title                  Type                                     Description                                        Sev.   Sub- system   Reported           ETA          Workaround                       Provider Impact

                                                               the 2011 rate for TribalEncounters ($294.00) is being applied to claims
                                                               that previously paid at the old rate ($289.00). we should be able to have
              Annual Tribal Encounter Mass                     most claims adjusted and RA generated by about 12/03/2011. TCN range                                                              None needed. Refer   Tribal Health Billers who bill the
   92 1011967 Adjustment                     Service Request   of the claims is 4x113052xxxxxxx and 4x113062xxxxxx.                      N/A          Claims        10/25/2011 Exact Dates TBD   to Memo 11-44.       TribalEncounter.

Click below for specific log you wish to view:
New Discoveries Log
Open Discoveries Log
Closed Discoveries Log
17               Pharmacy claim warrants          Informational   Paid pharmacy claims received from 4/28 to 5/9 will be on         Med        Pharmacy         5/12/2010    N/A                Wait for 5/24 warrant
                                                                  the 5/17 warrant (5/10 and 5/11 paid pharmacy claims will
                                                                  not be on 5/17 warrant, they will be included on the 5/24)
18               Benefit Inquiry Missing May      Informational   ProviderOne has no historical RSN history, which means            Low                         5/11/2010           6/1/2010    Use the legacy process until 6/1/2010.
                 RSN Managed Care History                         there is no RSN information to return on the eligibility
                                                                  inquiry or use to identify non-citizen children.

19               High denial rate of dental       Configuration   ADA dental claims are denying for missing information in          N/A                         5/11/2010    TBD                Complete fields 20, 21, and 22 -- even if
                 claims                           Change          fields 20, 21, and 22. These field are NOT required per the                                                                   "self" is selected in box 18 until the
                                                                  2009-2010 ADA Dental rules IF you selected" self" in box                                                                      configuration change is complete.
                                                                  18. However, if these fields are not complete, the claim will
                                                                  currently deny even if "self" is selected in box 18.

20   TBD         Retreiving Claims Images         Defect          Converted images from the old system have not been                Medium     Claims           5/13/2010          TBD          Go to the Claim Retreival page and type the
                                                                  attached to claim records yet - paper clip not working                                                                        TCN to retreive the image until the paper
                                                                                                                                                                                                clip is working
21   TBD         Provider Claims Inquiry issue    Defect          System hangs or doesn't find claim when searching by              High       Claims           5/13/2010          5/17/2010    Log out and log back and try again, OR
                 when searching by client ID                      client ID and date of service                                                                                                 search by TCN instead
                 and date of service

22   TBD         Faxed Pharmacy PA Requests       Defect          Faxed pharmacy prior authorization requests are being             High       Correspond       5/10/2010    TBD                Staff are entering req'd fields until a fix is
                                                                  received, but due to data issues on the original fax (missing                ence                                             in place to automatically enter default
                                                                  required fields) they are hanging up in the work queues.                                                                      values. Faxes are being received and can be
                                                                                                                                                                                                viewed by client.

23               Direct Entry Claim               Informational   Providers who are directly entering claims in ProviderOne         N/A        N/A              5/17/2010    N/A                Providers should complete submission by
                 Submission                                       are not completing the claim submission by clicking "OK".                                                                     clicking the "OK" button. A tip sheet is
                                                                  If the button is not clicked, the transaction is voided and                                                                   available at http://hrsa.dshs.wa.
                                                                  the provider will have to re-enter.                                                                                           gov/providerone/

24               Resuming Self-Enrollment of      Defect          When an existing billing provider adds a new servicing            Low        Provider         5/18/2010           6/7/2010    Providers who are adding new servicing
                 Servicing Providers                              provider and does not finish the enrollment, they cannot                                                                      providers should complete all steps of the
                                                                  get back to the record to complete it. Also, the "tracking"                                                                   enrollment wizard and submit for approval
                                                                  feature is not available until the defect is fixed.                                                                           until the defect is correctted. After the
                                                                                                                                                                                                defect is corrected, billing providers will
                                                                                                                                                                                                have access to any servicing provider
                                                                                                                                                                                                enrollments they started but did not

25               Pharmacy Claim Warrants          Informational   Paid pharmacy claims for 5/18 will not be on the 5/24             Medium     Pharmacy         5/18/2010    N/A                Wait for 5/31 warrant
                                                                  warrant. These claims will be on the 5/31 warrant.
26               Known Issue with reports         Informational   There is a known compatibility issue with some of the             TBD        N/A              5/18/2010    TBD                DSHS IT staff are working with various
                 and xls format                                   reporting tools and the ability to export to Excel.                                                                           vendors to find a solution. When possible
                                                                                                                                                                                                export to an alternate format.

27   N/A         Blue Forms will be returned      Informational   The Department will return any adjustments submitted on                      Imaging          5/18/2010    N/A                N/A
                 to providers (except                             the Bluepaper form - with the exception of pharmacies.
                 pharmacies)                                      Refer to the ProviderOne Billing and Resource Guide for the
                                                                  appropriate forms.

28               Accessing the ProviderOne        Informational   Providers are having difficulty obtaining the new                 Medium     IVR/Client       5/19/2010    TBD                The ProviderOne client ID is printed on the
                 Client ID Number                                 ProviderOne client ID when clients don't have a Services                                                                      Services Card and available in a crosswalk
                                                                  Card. We are adding the new ID to the automated                                                                               tool for clients that you have been paid for
                                                                  telephone system response. We are developing a one-for-                                                                       in the past two years and have the
                                                                  one look up tool for clients who were eligible in the old                                                                     Personal Identfication Code (PIC) for from
                                                                  system in the past two years (you will need to know the                                                                       the old system. You can also do an
                                                                  Personal Identification Code (PIC) from the old system. We                                                                    eligibility inquiry in ProviderOne with other
                                                                  are enhancing the search parameters in ProviderOne.                                                                           information like name, social security
                                                                                                                                                                                                number, and date of birth.

29               Client limit inquiry function    Informational   The client limit inquiry function in ProviderOne is disabled                 Client           5/19/2010           6/1/2011    Use same proceses used with the old
                 during direct entry in                           as planned. It requires at least one year of claims to                                                                        payment system.
                 ProviderOne                                      process in ProviderOne before it can be a viable tool. Once
                                                                  enabled, providers will be able inquire if a clients use of a
                                                                  service or procedure exceeds limitations.

30               Navigating 1-800-562-3022        Informational   Providers are reporting that the 1-800-562-3022 is                           IVR              5/19/2010    N/A                A fact sheet is published to assist
                                                                  difficult to navigate and the voice recognition is challenging.                                                               providers with navigation and to show the
                                                                                                                                                                                                telephone key pads that can be used
                                                                                                                                                                                                rather than voice prompts
31               Nursing Home Adjustments         Defect          ProviderOne has discovered a defect that prevents provider                                    5/19/2010           6/7/2010    Hold adjustments until after 6/7/2010.
                                                                  initiated adjustments from processing correctly.

32               Fax Lines Busy                                   Providers getting a fast busy on FAX lines                                                    5/19/2010    5/19/2010          N/A
                                                                                                                                                                             11:00 a.m. (FAX
                                                                                                                                                                             servers reset
                                                                                                                                                                             corrected this
33               Warrant Information              Informational   Providers are reporting they cannot access warrant                                            5/19/2010    N/A                N/A
                                                                  information. While some providers may receive checks as
                                                                  early as Friday following the Wednesday payment cycle,
                                                                  Warrant information/Remittance Advice will be available no
                                                                  later than the Monday following a payment cycle.

34               WINASAP file                     Defect          ProviderOne was informed by ACS (WINASAP vendor) that                                         5/19/2010                        If your claim file has an upload date of
                                                                  no WINASAP files were accepted/processed on 5/18.                                                                             5/19 and you submitted earlier, your
                                                                                                                                                                                                claims did not make this weeks payment
35    103373     837 Dental Batch Files           Defect          Dental providers are submitting Appliance Placement Date          High       Claims           5/25/2010          6/28/2010    Until the batch process is fixed providers
                 containing Appliance                             on the 837 dental batch claims, however, the information is                                                                   can enter claims that carry appliance
                 Placement Date                                   not mapped in ProviderOne so claims are incorrectly                                                                           placement date through direct entry in the
                                                                  denying                                                                                                                       ProviderOne web portal or on paper.

36    103384     Point of Sale (POS) 835 data     Change          In the old payment system, the ACS 835 transaction                High       POS              5/25/2010    TBD - change       The information is available on the
                                                  Request         returned prescription number for POS claims in data                                                        request is in      ProviderOne PDF Remittance Advice
                                                                  element CLP01. ProviderOne does not return the                                                             process of
                                                                  information on the 835.                                                                                    being
                                                                                                                                                                             developed. The
                                                                                                                                                                             change request
                                                                                                                                                                             includes a
                                                                                                                                                                             request to have
                                                                                                                                                                             CNSI recycle all
                                                                                                                                                                             835's to return
                                                                                                                                                                             number in data
                                                                                                                                                                             element CLP01

38    103258     Providers Resubmitting           TBD             The Department is analyzing an issue reported by providers                   Claims             6/4/2010         8/16/2010    If you are resubmitting a claim and receive
                 claims via Direct Data Entry                     that occurs when providers are trying to resubmit claims via                                                                  a SQL error, you can submit a new claim.
                                                                  direct data entry. When providers change data they
                                                                  sometimes receive a SQL error message. We are researching
                                                                  which data element is causing the error.

40    103758     HIPAA 835 data elements          Defect          The BPR11 and TRN04 data elements within the 835                             EDI                6/4/2010         8/16/2010
                 BPR11 and TRN04                                  transaction must match. The ProviderOne Companion
                                                                  Guides reference the same data elements (WA DSHS).
                                                                  However, the 835 is returning different data elements.
                                                                  BPR11 is returning "WA DSHS" (3 spaces between WA and
                                                                  DSHS) and TRN04 is returning "WA DSHS" (1 space
                                                                  between WA and DSHS).

41               Billing Inpatient Psych Claims   Informational   Providers billing for inpatient psych claims that have an old     N/A        Claims             6/4/2010   N/A                Do not bill inpatient psych claims that
                 with old 88xxxxxx                                88xxxxxx authorization number from the old system are                                                                         have the old 88xxxxxx authorization
                 authorization number                             having difficulty getting these claims paid.                                                                                  number on paper! Submit these claims via
                                                                                                                                                                                                direct data entry in the ProviderOne portal
                                                                                                                                                                                                and put the 88 number in the Remarks
                                                                                                                                                                                                Field and attach the ICA form
                                                                                                                                                                                                electronically. The claim will be processed
                                                                                                                                                                                                for payment if the claim data matches the
                                                                                                                                                                                                ICA form.

42    103267     TPL information on                               Remittance Advice (RA) is showing Third Party Liability (TPL)                                   6/2/2010   TBD                Several enhancements are in progress to
                 Remittance Advice                                information that is not current, appropriate or necessary.                                                                    correct these issues. Until then, you may
                                                                  We are seeing sometimes the client TPL information                                                                            see extra TPL information on your RA. For
                                                                  printing on the RA regardless if the insurance coverage has                                                                   example, you may have seen the client's
                                                                  ended prior to the dates of service.                                                                                          Part D information whether or not they
                                                                                                                                                                                                denied for TPL. Some information that
                                                                                                                                                                                                may be helpful: First, look at the reasons
                                                                                                                                                                                                the claim was denied, the last column on
                                                                                                                                                                                                the line. Claims denied for TPL reasons
                                                                                                                                                                                                most often have an adjustment/denial
                                                                                                                                                                                                reason code of 22. If it was denied for TPL
                                                                                                                                                                                                reasons, then you can look at the TPL
                                                                                                                                                                                                information on the RA. Second, we do not
                                                                                                                                                                                                deny claims for Part D coverage only. If
                                                                                                                                                                                                your claim was denied for TPL reasons and
                                                                                                                                                                                                TPL listed is Part D, there was another plan
                                                                                                                                                                                                that caused the denial and you can call the
                                                                                                                                                                                                Coordinations of Benefits line to find the
                                                                                                                                                                                                plan information you need to bill the
                                                                                                                                                                                                primary insurance. If you have questions
                                                                                                                                                                                                regarding the deinal of your claim or the
                                                                                                                                                                                                plan that we have on file for the client, call
                                                                                                                                                                                                customer service at 1-800-562-3022.

43    103718     Daily Transportation Broker      Defect          Ongoing issues with daily Transportation Broker eligibility       TBD        Data               6/7/2010   TBD                Refer to the weekly eligibility file.
                 File                                             files. Only weekly file will be sent until problem resolved.                 conversion

44   N/A         ProviderOne Benefit Inquiry      Informational   ProviderOne's Benefit inquiry screens show enhanced                          Client             6/8/2010                      For clarification, you can read the fact
                 Screen                           /Enhancemen     managed care information -- more than what was shared in                                                                      sheet "Choosing the Appropriate Provider
                                                  t               the past. Some of it is not applicable to clients only                                                                        from the Managed Care Information
                                                                  accessing medical services. This has caused some                                                                              Screen" at
                                                                  confusion for providers trying to coordinate Managed Care                                                           
                                                                  Services. Text will be added to the ProviderOne screens to                                                                    mentation/RSNs-ManagedCare.pdf
                                                                  make the Regional Support Network (RSN) information
                                                                  more understandable and the chronic care will be removed.
                                                                  2/23/11 The department had hoped to have this
                                                                  information either updated or removed from the screens by
                                                                  now. However, due to competing priorities we are unable to
                                                                  make those changes. We apologize for any inconvenience
                                                                  this has caused.”

45    103384     ProviderOne 835 does not         Change          The ProviderOne 835 remittance advice does not capture            High       EDI              6/14/2010    TBD - change       Until the change to the system can be
                 return prescription numbers      Request         the prescription number and return it to providers in data                                                 request is in      made, pharmacy providers can try to use
                                                                  element CLP01. The department has requested the system                                                     process of         the PDF RA because it does contain the
                                                                  vendor to change the system to return the prescription                                                     being              prescription number. The Department
                                                                  number in data element CLP01 (as it was in the old                                                         developed. The     recognizes that is a labor intensive
                                                                  payment system). The change request also asks that all all                                                 change request     workaround and not a long-term solution.
                                                                  previous 835's prior to the change are reprocessed so that                                                 includes a
                                                                  they will show the prescription number.                                                                    request to have
                                                                                                                                                                             CNSI recycle all
                                                                                                                                                                             835's to return
                                                                                                                                                                             number in data
                                                                                                                                                                             element CLP01

46    103880     Seattle Children's 270/271       Defect          Seattle Children's reported that they used clients Full Name                 EDI                7/2/2010         8/16/2010    If this situation occurs, use the 270/271
                 batch issue                                      and Date of Birth as the search criteria on the 270 batch                                                                     direct entry screens in ProviderOne until
                                                                  transaction but the 271 response did not return client                                                                        the defect is corrected.
                                                                  eligibility information for some of the clients. However, the
                                                                  client eligibility information would be returned when the
                                                                  same Full Name and Date of Birth was used in the
                                                                  ProviderOne 270/271 direct data entry screens

47    104019     Bilateral Pricing Error          Defect          The system is inappropriately applying bilateral pricing to                                     7/7/2010   TBD
                                                                  Professional Claims causing claims to deny and/or price in

48               Denial EOB 181 for               Issue           Professional claims processed on July 2nd were incorrectly        Medium     Claims             7/7/2010   In process         No workaround needed. Claims processed
                 professional claims                              denied with EOB 181, indicating that the procedure code                                                                       after July 4th are processing correctly. The
                 processed on July 2, 2010                        was not valid.                                                                                                                Department is correcting the claims that
                                                                                                                                                                                                denied in error. No action is required

49    104815     Screen level error during        Defect          When a provider enters a claim through DDE that requires                     Claims           7/20/2010          8/16/2010    Until the fix is in place, providers will need
                 Direct Data Entry(DDE) of                        TPL information, after all data is entered correctly, the claim                                                               to go back to the ProviderOne Portal page
                 multiple claims requiring                        will be loaded into ProviderOne correctly. When the screen                                                                    to start the next claim to avoid the screen
                 Third Party Information (TPL)                    is refreshed, and the provider tries to enter subsequent                                                                      level error. After the fix is in place,
                                                                  claims with TPL information, a screen level error message                                                                     providers should be able to refresh the
                                                                  will be received.                                                                                                             claim page and submit the next claim
                                                                                                                                                                                                without going back out to the main page.

50   105217-     Direct Data Entry Third Party    Defect          This defect prevents providers from adding electronic TPL                                       8/3/2010         9/12/2010    Providers should hold off on adding TPL
     Ready       Liability (TPL) Adjustment                       HIPAA adjustment reason codes to a direct entry claim.                                                                        HIPAA adjustment reason codes to DDE
     Promote -   Reason Codes                                                                                                                                                                   claims until after the defect is corrected.
     PROD                                                                                                                                                                                       Once the defect is corrected, you will be
                                                                                                                                                                                                able to add the TPL HIPAA adjustment
                                                                                                                                                                                                reason code after you add the service line
                                                                                                                                                                                                item. You will click on the Other Service
                                                                                                                                                                                                Info hyperlink at the end of your line. Fill
                                                                                                                                                                                                out the Service Line Adjudication
                                                                                                                                                                                                information under the Other Line Item
                                                                                                                                                                                                Information section. Make sure to include
                                                                                                                                                                                                a comment "Electronic TPL".

51    105212     Baby On Mom's ID billing         System Defect   Providers are following the guidelines for billing Baby on        Medium     HIPAA/Clai         8/2/2010         9/27/2010
                 issue                                            Mom's ID set forth in memo 10-18, but the system did not                     ms
                                                                  correctly capture the baby's information. The system then
                                                                  processed the claim incorrectly.

52    106030     Claims Pricing at zero           Defect          Various procedure codes are pricing at zero in error; and, is     High       Claims           9/20/2010    Will be
                 problem                                          known to be impacting “Maternity Support Services/Infant                                                   promoted to
                                                                  Case Management”, "Child Birth Education" and                                                              production on
                                                                  “Outpatient Chemical Dependency” programs.                                                                 9/25/2010

55               Part B crossovers for            Defect          Part B crossovers for Pharmacy providers (taxonomy                Med        Claims           9/22/2010       10/18/2010      none, claims will be reprocessed
                 Pharmacy providers are                           begins with 3336) are not having the Medicare paid                                                                            (recouped) after system correction.
                 overpaying                                       amount deducted from the allowed amount
56    106569     some claims for family           defect          Family planning/takecharge clients have limited scope of          High       Claims        approximately         11/8/2010    none. – We will work to identify and
                 planning/takecharge clients                      care. We have noticed that some claims are denying in error                                7/1/2010                           correct any claims paid incorrectly once
                 are paying in error and/or                       and some claims are paying in error                                                                                           the fix is implemented
                 denying in error
57    106408     DME providers only/tax rate                      There was a problem where taxable procedure codes on                         Claims                        cleanly
                 adjustment                                       claims with a prior authorization were not paying sales tax.                                               adjusted claims
                                                                  It was discovered the system was limiting payments based                                                   should show
                                                                  on what was authorized. If the allowed amount was the                                                      on your RA
                                                                  same as the authorized amount or if the allowed amount                                                     dated on or
                                                                  plus sales tax was more than the authorized amount, the                                                    about
                                                                  system only paid up to the authorized amount in the prior                                                  11/13/10
                                                                  authorization. It should have paid the authorized amount
                                                                  plus sales tax. ProviderOne is now paying these claims
                                                                  correctly and we are initiating a mass adjustment to correct
                                                                  your payments

58    106398     some professional claims are     service         place of service 32,33,54,55 were incorrectly identified as       low        Claims           6/15/2010       11/13/2010      no workaround needed. Mass adjustment
                 paying facility rate rather      request         facility places of service and were paying at the (lower)                                                                     to reprocess the affected (effected?)
                 than nonfacility rate                            facility rate in error                                                                                                        claims is in process.

59    108114     TribalEncounter annual mass      Service         during the annual TribalEncounter mass adjustment some            Med        Claims             1/5/2011   TBD                N/A
                 adjustment issues                Request         medicare crossovers became non-crossovers during the
                                                                  adjustment process and were denied (EOB 22 + MA04).

53               Crossover Claims for Nursing     Enhancement     Nursing home crossover claims are being received from             High       Claims             7/1/2010
                 Homes                                            CMS and processing incorrectly through the system

54               Adjustments for Nursing          Defect          When adjusting nursing home claims, the system is                 High       Claims           9/15/2010
                 Home claims                                      applying patient participation twice

60               Nursing Home mass                informational   Attention Nursing Home Providers:                                 low        claims           3/18/2011          3/25/2011
                 adjustment                                       Over the weekend of 03/19/11 we are processing a mass
                                                                  adjustment for Nursing Home claims. This adjustment will
                                                                  affect most NH claims paid after July 1, 2010 where a rate
                                                                  update was made retroactively. You should expect to see
                                                                  these claims on your remittance advice dated 03/25/2011.

61    109327     Posting NDC edit                 Defect          ProviderOne is not currently posting the edit for an NDC                 2   Claims -         3/25/2011          4/25/2011    N/A
                                                                  not valid for the DOS on a claim. Once this defect is fixed,                 Adjudicatio
                                                                  the edit will post appropriately.                                            n

39   105358      Remittance Advice                Enhancement     Providers have been giving feedback about the new                                               6/2/2010   First Release -  N/A
     Claims-                                                      ProviderOne Remittance Advice (RA). Themes include that                                                    4/8 RA
     0569                                                         the RA does not contain a few key data elements currently                                                  Second Release -
                                                                  needed by different provider types; and the RA prints 1-3                                                  4/29 RA
                                                                  claims per page which creates a large number of pages. A
                                                                  Workgroup will explore options suggested by providers to
                                                                  see if they are feasible and within budget constraints.
  67     108865   Auto-batch functionality for     Enhancement     There is new functionality being added to ProviderOne that        N/A          DDE                4/1/2011         4/25/2011   Submit the templates as the system will
                  Claims templates                                 will make it easier for SNF providers to submit their batches                                                                  allow today.
                                                                   of templates. The new functionality will more closely mirror
                                                                   the current WINASAP 2003 system.

  39   105358     Remittance Advice                Enhancement     Providers have been giving feedback about the new                                                 6/2/2010   First Release -  N/A
       Claims-                                                     ProviderOne Remittance Advice (RA). Themes include that                                                      4/8 RA
       0569                                                        the RA does not contain a few key data elements currently                                                    Second Release -
                                                                   needed by different provider types; and the RA prints 1-3                                                    4/29 RA
                                                                   claims per page which creates a large number of pages. A
                                                                   Workgroup will explore options suggested by providers to
                                                                   see if they are feasible and within budget constraints.

  63     109186   Age calclulation error causing   Defect          For some EPSDT services, where the age limit is 6 years, the               2   Claims -          3/17/2011         4/25/2011   N/A
                  edit to post incorrectly on                      age is not being calculated correctly causing the claim to                     Adjudicatio
                  some EPSDT claims.                               post edit 12255 erroneously.                                                   n

  65     109181   Allowed amount for some          Defect          For Medicare X-overs, specifically ASC claims billed with                  2   Claims -          3/17/2011         4/25/2011   N/A
                  Medicare Crossover ASC                           diagnosis V2785, should have an allowed amount of                              Adjudicatio
                  claims is not being calculated                   $2500.00, but the system shows an allowed amount of                            n
                  correctly.                                       $0.00.

  66     109065   Claims are not completing        Defect          A new edit needs to be added to allow adjudicaiton to                      2   Claims -          3/10/2011         4/25/2011   Always submit the "To" date of service on
                  the adjudication process                         complete for claims that make it into the system without a                     Adjudicatio                                     claims.
                  because of missing "To"                          "To" date of service. This is affecting primarily paper claims.                n
                  Date of Service.

  71   DENIALS    K0108 procedure code issue       Defect          An update on March 7, 2011, to the K0108 procedure                Claims         4/6/2011     Fix is         None needed       The line with the K0108 procedure code
       OF K0108                                                    code caused the system to automatically end date the                                          completed                        denied in error
       PROCEDU                                                     Manual Price Indicator. This indicator is required for the
       RE CODE                                                     K0108 procedure code to process correctly. This caused an
                                                                   error to post that is an autodeny on electronically filed
                                                                   claims. The problem has been fixed and claims will now
                                                                   process correctly
  62     109225   Place of Service not returning   Defect          ProviderOne is currently not returning the Place of Service                2   DDE               3/18/2011         5/16/2011   Re-enter the Place of Service on the DDE
                  on DDE for Reubmit                               on the DDE screens when attempting to re-submit a denied                                                                       screen.
                  Denied/Voided claims.                            or voided claim.

  64     109183   Physician claim type             Defect          The system allowed an adjustment done to a current                         2   Claims -          3/17/2011         5/16/2011   N/A
                  adjustment incorrectly re-                       Physician claim to re-coup monies from a previously                            Adjudicatio
                  couped a historical claim                        processed and paid DME claim. The logic for the edit                           n
                  that was type DME.                               should only apply to Physician claim types.

  68     105894   Destination based sales tax      Enhancement     The system is going to be changed to now calculate the tax        N/A          Claims -           9/2/2010          6/5/2011   N/A
                  system enhancement                               location by the 9-digit zip code of the client recieving                       Adjudicatio
                                                                   services.                                                                      n

  70     109441   Edit for Invalid Place of        Defect          Place of Service 12 is being submitted correctly on the                    2   Claims -           4/4/2011         5/16/2011   N/A
                  Service for Procedure                            encounters, but the edit is still posting.                                     Adjudicatio
                  posting erroneously on                                                                                                          n
                  Managed Care encounters
                  submitted for mid-wife
  72     109542   Error Code 00750                 Defect          Error code posting incorrectly for Institutional providers -               2   Claims            4/11/2011         5/16/2011
                                                                   Hospitals, Kidney Centers, Rural Health Clinics.                               Adjudicatio
  74     109543   Endoscopy pricing PE1_1_22       Defect           Some multiple endoscopy procedures are paying at zero                     2   Claims            4/11/2011         5/16/2011
                  not working                                      instead of the reduced rate. Instead of reducing the scopy                     Adjudicatio
                                                                   by the base rate, system is reducing by scopy rate, paying                     n
                                                                   the line at zero.
  69     109445   DDE name not being               Defect          The last name of a client that had a space in it was not                   2   DDE                4/4/2011   TBD               N/A
                  retained.                                        retained on the Claim Header Detail page when it was
                                                                   entered in the appropriate fields on a DDE claim, specifically
                                                                   the last name. As a result, the name is not shown on the
                                                                   screen and also this will cause no name to be printed on
                                                                   the RA.
  75     109987   Error Code 16293                 Issue           New CMS edit “Revenue Code Requires Reason for Visit                       2   Claims                40658   TBD/Mass          We are currently in the process of
                                                                   Diagnosis Code effective for 4/1/11 dates of service was                       Adjudicatio                   Adjustment:       identifying and mass adjusting any claims
                                                                   inaccurately denying claims in error for submit dates                          n                             June 24, 2011     that were denied inaccurately. Until such
                                                                   between 04/14/2011 – 05/03/2011. ProviderOne is                                                                                time, the edit has been turned off,
                                                                   working as designed however an enhancement will be made                                                                        however providers should still follow
                                                                   to the system to update a mapping error in the logic.                                                                          policy as claims may be subject to post-
                                                                                                                                                                                                  pay review.

  76     109722   835 Tertiary Claim Issue         Defect          HIPAA 835 Remittance Advice is returning a Tertiary claim                  2   HIPAA             4/20/2011         6/27/2011
                                                                   status for Medicare crossover claims when they should be
  73     109549   Interfaces loaded missing        Defect          When validating an address in Provider file we are missing                 2   Common            4/11/2011         6/27/2011
                  city names when associated                       City names when associated to a zip. Example, when putting                     Component
                  to zip                                           in Zip code 98431 and hitting the “validate address”
                                                                   button it only shows Tacoma when it should also include
                                                                   “Lewis McChord” in the dropdown that the provider would
                                                                   choose their City by.

  77     109882   Batch Claims From Templates      Defect          ProviderOne Batch Template process creates batch claims                    2   Claims             5/3/2011         6/27/2011
                  - Claim ID and DOS Issue                         for providers. However, some claims within the batch are
                                                                   missing claims numbers and/or From and To Dates. Defect
                                                                   has been logged and CNSI is working on resolving the issue.
                                                                   This issue appears to be intermittent in that providers who
                                                                   attempt this again find no problems. However, the fact that
                                                                   it is happening has us concerned and it needs to resolved

  78     109922   DDE Inst. Batch Claims - TOB     Defect          Very similar to 109822 above. The only difference with this                2   Claims             5/5/2011         6/27/2011
                  and DOS Missing                                  one is that the Type of Bill doesn’t appear in ProviderOne
                                                                   for the DDE claim submission. Again, this is intermittent
                                                                   but because we have evidence that it occurred, it needs to
                                                                   be researched and resolved immediately.

  80   1010028    Change RA font size to 8         Enhancement     Request submitted to make the RA font size larger.                         1   Claims - RA       5/12/2011         6/27/2011

                                                                   Some ProviderOne batches may get stuck with the "In
                                                                   Process" status. Batches need to move from "In Process"                        2-Disabled -
                  Batch Claims Stuck "In                           to "Passed Validation" status in order for providers to                        No Work
  81   1010140    Process" Status                  Defect          submit the claims within the batch.                                            Around            5/23/2011         6/27/2011   None
  79   1010239    Other payer detail               Defect          Adjustments on some paper claims done through DDE are                      2   Claims-                             7/17/2011   No work around at this time.
                  duplicating                                      causing the other payer detail to duplicate or triplicate,                     Adjudicatio
                                                                   causing the TPL amount to double or triple the actual TPL                      n
                                                                   paid amount.

                                                                   In mid-June, HCA released a mass claims adjustment
                                                                   affecting around 17K claims. A number of these
                                                                   adjustments were denied in error and subsequently, an
                                                                   accounts receivable was sent to the Office of Financial
                                                                   Recovery (OFR). This would have shown up on your RA on
                                                                   or after 6/27/11 as "NOC Referred to CARS" showing that                                                                        A provider can adjust any of these claims,
                                                                   you owe and the invoiced amount. HCA is in the process of                      Claims                                          if appropriate, for correct payment and the
                                                                   manually reviewing and reprocessing these claims in order                      Adjudicatio                                     receivable amount will change based on
  83   1010661    NOC Referred to CARS             Defect          to reverse the incorrect receivable.                              1 High       n                 7/21/2011         8/12/2011   the new payment amount

                                                                   When a ProviderOne submitted DDE batch file doesn’t pass
                                                                   validation, and a provider goes in to make the necessary                       PROD:
                  Batch - Revalidation Button                      changes, the revalidation button isn’t available to have the      2            Claims
  82   1010516    Issue                            Defect          system reprocess the file.                                        Medium       Screens           6/23/2011          9/5/2011

                  Medical providers having
                  access to claims records for                     Change request will allow providers to access claims                           PROD:                         Late Aug/Early
  84   1010021    children in foster care.         Enhancement     records for children in foster care.                              1 High       Client            5/11/2011   Sept
                                                                   HCA became aware of an issue regarding DDE claim visibility
                                                                   on the morning of 8/16/11. DDE claims that were keyed
                                                                   into the system starting around noon Friday, 8/12/11, until
                                                                   the morning of 8/16/11 were accepted in the system but
                                                                   not visible to providers.
                                                                   All claims should be available for providers to view by COB
                                                                   8/16/11 and are expected to process in time for the
  87              DDE Claims                                       payment cutoff.                                                   Low                            8/16/2011   COB 8/16/11

                                                                   Code update made on the Family Planning preventive codes
                                                                   (99384-99396) on 8/10/2011 caused claims to deny
                                                                   inappropriately for AdjRsn/Rmk 96/N428. System has been
                                                                   corrected and claims are being reprocessed. If you have a
                  Family Planning Preventive                       claim that denied in error and has not been reprocessed                                                                        None needed, system correction has been
                  Visits Denied for EOB 96 +       Configuration   before 10/15/2011 you can adjust/replace/rebill and the                                                                        made on 9/19/2011, claims processed
  89              N428                             Error           claim should autopay correctly in this regard.                    Low          Claims            9/19/2011     10/15/2011      after 09/19/2011 will process correctly

                                                                   Starting 10/3/11, a small number of providers were not able
                                                                   to enter claims into the ProviderOne DDE screens due to an
                                                                   error message of Invalid NPI entered. The issue was
                                                                   identified and fixed on 10/6/11. Providers that were
  90   1011740    DDE Invalid NPI Error            Defect          receiving this error should be able to enter claims now.          1-High       Claims            10/3/2011         10/6/2011

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