Washington Medicaid is an E-Claims Direct Carrier.

In Clearinghouses, click Add.

• Washington Medicaid web portal: ProviderOne
• Washington Medicaid website: https://www.hca.wa.gov/billers-providers-partners.

Other Resources:

• Dental Provider Guide: https://www.hca.wa.gov/billers-providers-partners/programs-and-services/dental-services
• HIPAA/EDI web page: https://www.hca.wa.gov/billers-providers-partners/prior-authorization-claims-and-billing/hipaa-electronic-data-interchange-edi

Setup

The Colorado Medicaid clearinghouse must be manually added to Open Dental. Set up the clearinghouse as follows:

• Description: Enter WA State HCA.
• Authorization Information: Enter 00.
• Sender ID Qualifier: Enter ZZ.
• Tax ID Number: 9 digits. Find the Tax ID Number in the ProviderOne portal (a 7 digit number), then add two trailing zeros at the end.
• Name: Enter the practice name.
• Telephone Number: Enter the practice phone number.
• Receiver ID Qualifier: Enter ZZ.
• Clearinghouse ID: Enter 77045.
• GS03: Enter 77045.
• Test or Production: Enter P.
• Claim Export Path: Typically C:\Washington Medicaid\.
• Format: Select x837D_5010_dental.
• Payors: Enter 77045.

In the Carriers list, create a carrier for WA State HCA.

Ensure all Washington Medicaid insurance plans use the WA State HCA carrier, and the insurance filing code Medicaid (Insurance Plan).

Claims

To send claims:

1. In the Send Claims window, select the claims for Washington Medicaid. Click the Send E-Claims dropdown and select Washington Medicaid from the list.
2. In the Windows file explorer, go to C:\Washington Medicaid\. Change the extensions on the newest files from TXT to DAT.
3. Log into the ProviderOne portal.
   • Find the Batch Claims Submission (837) link.
   • Upload each new DAT file created.
4. 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. One line displays for each file uploaded.
   • For each file, click the Custom Report Response File link to view any errors in the claim format.
5. The next day, use the Claim Inquiry link to look up each claim and verify that it will be paid.