ProviderOne Social Services Newsletter – July 2025
ProviderOne billing guide webinar recording available
Last month, DSHS hosted two webinars for Social Services Providers where we shared information about the updated ProviderOne for Social Services billing guides and reviewed some ProviderOne basics. For those who couldn’t attend, a recording of the webinar and the slide deck are now available:
- Billing Guides and ProviderOne Basics: View the webinar | Presentation slides
Note about Q&As: We received a lot of great questions during the webinars! We are still compiling answers to all of your questions and will post a Q&A document to our webpage within the next few weeks. If you have questions in the meantime, please see the Social Services Provider contact list.
Billing guides updated July 2025
As a reminder, the ProviderOne for Social Services billing guides are available on the ProviderOne for Social Services webpage. After publishing the guides in June 2025, DSHS identified a few corrections that were needed. These changes have been made, and the revised guides have been reposted. Changes include:
- Adding hyperlinks within the Table of Contents and throughout the guides for ease of navigation.
- Reordering pages within the claim template batch sections.
- Removing the following embedded attachments and adding them as separate documents on our webpage:
Reporting medical leave
Per Medicaid rules, DSHS cannot pay for residential care services (RCS), residential add-ons, or in-home personal care services (PCS) when a client is on medical leave for more than 24 hours (i.e., admitted to a hospital or a skilled nursing facility-SNF). Residential providers and in-home care agencies must notify the client’s case manager/social worker per the requirements outlined in their DSHS contract when a client is on medical leave.
It is very important to notify the case manager timely so that the authorization can be modified appropriately and so that the case manager can notify other providers as needed. In addition, providers should not bill for services when a client is not in their eligible setting. DSHS will deny claims or assess an overpayment if claims are submitted for RCS, add-ons, or PCS while the client is on medical leave.
Questions? Refer to your DSHS Medicaid contract. Contact the client’s authorizing case manager for questions on how/when to report medical leave.
Monthly FAQ: How do I bill for a bed hold?
When billing for a bed hold (SA685 or SA686), there are a few things to keep in mind:
- Verify that you do not have claims in paid status for ineligible days while the resident was on medical leave. Directions on how to adjust or void a claim can be found in the ProviderOne for Social Services Billing Guides.
- Verify the authorized dates for the bed hold are not in error status and consistent with what you expect to be authorized for based on when your resident was on medical leave.
- If a bed hold spans multiple months, you must submit separate claim lines for each month. For example, your client is authorized for 12 units of SA686 (Bed Hold 8-20 days) for 5/31/24-6/11/24. You must submit one claim line with 1 unit for 5/31/24 and one claim line with 11 units for 6/1/24-6/11/24. See example.
- If you are a Social Services Medical Provider, you will use the ‘Social Services Authorization and Billing’ section within ProviderOne to submit a bed hold claim. Bed hold codes are ‘non-medical’ and cannot be submitted under the ‘Claims’ section in ProviderOne. Directions on how to submit a non-medical Social Services claim can be found in the Submitting and Adjusting Social Services Claims Guide.
Questions? If you still need assistance with submitting or adjusting claims after reviewing the ProviderOne for Social Services Billing Guides, contact HCA’s Medical Assistance Customer Service Center (MACSC). If the bed hold authorization is in error status, contact the client’s authorizing case manager.
Reminders
Rate changes went into effect July 1, 2025. For more information:
Upcoming webinars
August 5, 2025, 11 a.m.-12 p.m., WA Cares Basics Webinar: What Providers Need to Know. Register here. (More information about WA Cares Fund)
September 17, 2025, 1 p.m.-2:30 p.m., AFH Administrator Training. Register here.
Resource spotlight
ProviderOne for Social Services webpage
Free resources and workshops for small businesses
New provider corner
FAQ: ProviderOne Setup and Payment Information for New Providers
Getting Started and Billing Essentials Guide (ProviderOne)
