Payment Glitches Trigger ProviderOne Quality Improvement Efforts

On November 6, WHCA representatives, including Carma Matti-Jackson, Lauri St. Ours, and Bill Ulrich, President of Consolidate Billing Services and WHCA board member, met with executive staff from the ProviderOne system to determine whether the delays were anomalous and to discuss strategies for reducing the risk of future payment interruptions. HCA representatives noted that each of the three incidents was unrelated, and that HCA is currently engaged in quality improvement efforts with DSHS to eliminate such unfortunate events based on WHCA’s prompting.  Quality and systems improvements are being pursued in a joint operating procedure work group with DSHS. These improvements include building in earlier communications efforts related to systems interruptions. HCA staff has also committed to driving communications through WHCA to leverage our communications capacity with members.

We will continue to monitor this issue. In the meantime, we encourage Medicaid contracted providers to sign up to receive ProviderOne alerts here. Select Apple Health (Medicaid) providers and sign up using the Provider Alerts submenu that allows you to select alerts by sector (ARC/EARC/AL and Nursing Homes.)

You can expect information about claims cutoffs or payment changes with two weeks’ advanced notice; system outages are generally announced one week in advance.

Please let us know if you have additional questions.