Provider One Provider System User Manual

Single Sign-On

The Single Sign-On offers healthcare professionals an easy and secure way to access the provider portals of major local health plans and hospitals as well as other valuable online services.

Health Information Exchange

Washington State’s Health Information Exchange (HIE) provides healthcare organizations a secure, low-cost means to share standardized messages with trading partners on a system-to-system basis.

The ProviderOne interface is an exchange of information between ACES and the Health Care Authority (HCA) ProviderOne system. ProviderOne uses this information to authorize payment for medical bills from medical providers, generate reports, and obtain federal funding. Medicaid EHR Incentive Program Provider User Manual February 2014 Version 3.1. Utah HIT/EHR Provider User Manual i Table of Contents. National Level Registry (NLR) and must match a TIN linked to the individual provider in DMHF’s system.

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Clinical Data Repository

The Clinical Data Repository (CDR) is designed to simplify access to clinical history and provide a longitudinal view of an individual's patient record. The CDR is now open for testing.

Pre-Service Directory

The Pre-Service Directory offers healthcare professionals quick access to an online directory of updated links and instructions for using Payer websites for pre-authorizations and admission notifications.

Credentialing

OneHealthPort operates the Provider Data Service as one element of its administrative simplification work for Washington state. It is a statewide solution for gathering all the information that health plans and hospitals request from providers in the course of credentialing.

AdminSimp

The Administrative Simplification (AdminSimp) program makes it easier for providers and payers to do business together by helping both parties solve problems related to shared workflows and information exchange.

Online Processing

Mainframe Processing

See ACES Screens and Online Pages for an example of pages or screens used in this chapter.

What is the ProviderOne interface?

ACES uses the data received from ProviderOne to automatically update the appropriate screens with the new or updated medical information data, Third Party Liability (TPL) data, provider data, and rate information. User manual for fq777 english download pdf.

How often does the ProviderOne interface take place?

The ProviderOne interface takes place on a daily, weekly, and monthly basis depending on what client or provider information is being exchanged.

Online Processing

What information is sent from ACES to ProviderOne?

The Eligibility Interface file contains client demographic, medical eligibility, spenddown, and TPL information. ACES sends this file to ProviderOne in the overnight batch process. The real-time version of this interface is sent throughout the day at approximately 15 minute intervals for clients who need medical services the same day their medical application is approved.

What information is received from ProviderOne to ACES?

The following files are received from ProviderOne and sent to ACES:

The Daily Facility Update file provides demographic and rate information for the various Long Term Care and Take Charge medical providers. When new providers are added or changes are made to the information of existing providers, ACES updates the Provider Details with the new information on a daily basis. You can access the Provider Details pop up from the Facilities sectionon the Institutional Care/Expenses page, by clicking the Details link for the selected provider.
- A weekly BATCH process recalculates the client’s benefits and sends a letter if there is a change to the client’s benefits or participation due to information received on the Daily Facility Update file.
  - If ACES is unable to update the ACES Provider database or find all the clients actively associated to the provider with the change, Barcode tickles are created for manual review.
The Client TPL Insurance file identifies clients who have medical coverage through a third party provider. The file provides information about the insurance organization and other pertinent information related to the client’s coverage. ACES updates the client’s Third Party Liability page with the current TPL information that is sent. Included in this TPL file is Medicare data for Part A and Part B, which is used to ensure clients are added or deleted from the State’s Medicare Buy-In program.
The Medicare Buy-in data received from ProviderOne automatically updates changes of Medicare Part A and Part B premium payment data on the Third Party Liability pagein the Paid By field. ACES also uses the transaction data to update clients’ Medicare (Title XVIII) data and this interface file is received weekly.
The Insurance Organization file identifies all the Insurance Organizations and all their pertinent information. ACES updates the TPLOrganization Search page with the names, addresses, and carrier codes of all TPL carriers known to the state and this file is received monthly.

Providerone Provider Phone Number

What information displays in the ProviderOne Web Service?

The ProviderOne Web Service provides real-time information and the file populates the Medical Information page in ACES.online.

The data elements displayed on this page are:

Client Medical Information:
- ProviderOne ID number
- Medicare
- TPL Insurance
- Relative Care Placement Indicator
- Hospice Indicator
- Restriction Indicator
- DDA Client Indicator
Managed Care Information:
- Health Plan
- Program
- Start and End Dates

For more information see Medical Information.

Mainframe Processing

What information is sent from ACES to ProviderOne?