ProviderOne Social Services Newsletter – November 2025

ProviderOne has released their November 2025 Social Services Newsletter. This issue features information on how Thanksgiving will affect claims submissions, several updates for Home Care Agencies, and more.

Thanksgiving Holiday will impact ProviderOne claims submission deadline and payment date

In observance of Thanksgiving, state offices will be closed Thursday, November 27, 2025 and Friday, November 28, 2025. As a result, provider payments for the week of November 24, 2025 will be made on Wednesday, November 26, 2025, including the delivery of Remittance Advices (RAs).

Claim submission deadlines have been moved up to ensure that providers are able to receive payment and RA documents on November 26, 2025.

The deadline for submission of claims to ProviderOne for payment during the week of Thanksgiving will be Sunday, November 23, 2025 by 5 p.m..

Please report any issues to: [email protected].

Attention: Adult Family Homes

Claiming for mileage

This is a reminder that when claiming for mileage (S0215 U3 and S0215 U4), Adult Family Home (AFH) providers can only claim for actual miles driven. This means that if a client is authorized for 100 miles per month but the AFH only transports the client for a total of 30 miles for the month, the AFH can only claim 30 miles. In addition, claims for mileage must be entered in ProviderOne as separate service lines and each service line must include the number of miles driven for each date (1 mile = 1 unit of service).

For more information, please refer to your DSHS Client Service Contract for AFHs. A sample DSHS AFH Contract is also available online. Mileage reimbursement is referenced on Page 14 & Page 25.

Questions? Contact your DSHS Contract Specialist.

Attention: Home Care Agencies

***Information in this section applies only to Home Care Agencies***

EVV updates and reminders

Manual Claims Indicator

This is a reminder that a Manual Claims Indicator must be included on a claim for personal care services or respite care services when:

• A claim is submitted via direct data entry (DDE).
  • If entering a claim via DDE, a Manual Claims Indicator is always required.
  • If a claim is submitted via DDE and EVV data was captured electronically via the agency’s contracted EVV system, use Manual Claims Indicator BPEV01 (this is a new indicator that was added to ProviderOne last month).
  • If a claim is submitted via DDE and EVV data was not captured electronically via the agency’s contracted EVV system, choose one of the following indicators to indicate why EVV data was not captured electronically: SPST01, SPET01, SPEV01, or EVSF01.
• A claim is submitted via .dat file upload and the caregiver/servicing provider was unable to use the EVV system to capture EVV data.
  • A Manual Claims Indicator is only required on a .dat file claim if the caretaker/servicing provider was not able to capture EVV data electronically. In this situation, one of the following indicators must be entered on the .dat file claim line(s) to indicate why EVV data was not captured electronically: SPST01, SPET01, SPEV01, or EVSF01.

Note: When submitting claims for personal care services or respite care, all required EVV data must be included on the claim. The Manual Claims Indicator is not a substitute for the required EVV data.

Description of Manual Claims Indicators:

• BPEV01-Billing provider claims data received electronically
• SPST01-Servicing provider unable/prevented from logging correct start time
• SPET01-Servicing provider unable/prevented from logging correct end time
• SPEV01-Servicing provider unable/prevented from using EVV system
• EVSF01-EVV system failure

See the Submitting and Adjusting Social Services Claims Guide for more information on the Manual Claims Indicator and directions on how to submit DDE claims and .dat file upload claims.

EVV claim elements required on claims

This is a reminder that effective January 2026, ProviderOne claims for personal care services and respite care services missing specific Electronic Visit Verification (EVV) elements will deny. To support a smooth transition, DSHS will implement these changes in phases between January and July 2026. See the October 2025 newsletter for more information.

Questions? Contact Jennifer Smith, EVV Program Manager.

Monthly FAQ: What should I do if my resident won’t pay their client participation/responsibility?

Residential providers are responsible for the collection of the client’s participation amount (if any) from the client in the month in which services are provided. Client participation/responsibility is the amount determined by DSHS that the client is required to contribute toward the cost of 1) room and board and/or 2) their care. As a practice, DSHS staff are not involved in the collection process.

There are instances when a client has not paid their participation for a variety of reasons, and this may put their services at risk. The Non-Payment Frequently Asked Questions flyer was created as a guide for residential providers to help resolve non-payment issues.