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Washington Medicaid E-Claims  

Washington Medicaid is an E-Claims Direct Carrier. ProviderOne is the name of the web portal for Washington Medicaid.  Visit the Washington Medicaid website at http://hrsa.dshs.wa.gov/hipaa/index.htm.

Other Resources:
Dental Provider Guide:  http://hrsa.dshs.wa.gov/billing/dental-related_services.html
HIPAA/EDI web page:  http://hrsa.dshs.wa.gov/hipaa/index.htm

Manually Upload Claims in X12 5010 format
1.  In the Main Menu, click Setup, Family/Insurance, Clearinghouses, then click Add.  Set up the clearinghouse as follows:

The Tax ID Number should be 9 digits.  To find the Tax ID Number, log in to the ProviderOne web portal and locate the 7-digit ProviderOne ID at the top of the page, then tack two trailing zeros at the end to make it 9-digits.

2.  Click Lists, Insurance Carriers and add a new carrier using the information below.

3.  Make sure ALL Washington Medicaid Insurance Plans use the WA State HCA carrier, and the insurance filing code "Medicaid".

4.  In the Manage module, click Send Claims.  Select the claims for Washington Medicaid only, then click the Send E-Claims dropdown and select Washington Medicaid from the list.

5.  In a file browser, go to C:\Washington Medicaid\. Change the extensions on the newest files from .txt to .dat. Older files should already have a .dat extension, so it should be easy to tell which files are new. You can also look at the file date and time information to determine which files are new.

6. Go to https://www.waproviderone.org/edi and log in using the provider credentials.

7.  On the left, click the On-line Batch Claims Submission (837) link.

8.  For each new .dat file created, click the browse button, and locate the file, then click Upload.

9.  After 15 minutes, the files should register in ProviderOne.
- Go to the Retrieve HIPAA Batch Responses link, select 837D from the Transaction Type dropdown menu.
- Change the first filter to Upload/Sent Date and type today's date in the box to the right.
- Click Go. You will see one line for each file uploaded.
- For each file, click the Custom Report Response File link to view any errors in the claim format.

If there are errors at this point, email derek@opendental. If no errors are indicated, then the file format is correct, but that does not mean that each claim will be paid. The morning after the files are uploaded, use the Claim Inquiry link to look up each claim and verify that it will be paid.

 

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