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Washington state launches Medicaid system

Billing program will pay out about $17 million a day

State officials are hoping their switch to a new, $161 million computerized billing and payment system for Medicaid goes smoothly, avoiding glitches that can accompany major computer projects.

The ProviderOne system, which launched Sunday, is about two years late in arriving. It is expected to handle about $17 million a day in payments for medical and nursing home care to about 14,000 health care providers statewide. The system’s first phase replaces a Medicaid payment system constructed more than a quarter-century ago and is supposed to cut down on errors, overpayments and fraud.

Providers representing about 90 percent of clients in the program have undergone training and testing of the system.

Doug Porter, manager of Medicaid and other programs for the Department of Social and Health Services, said last week that overall, he is confident the system will work. He said counterparts with the federal Centers for Medicare and Medicaid Services tell him the state’s system is in far better shape than those in other states, which frequently had hundreds of defects when launched.

“We’re down to something like eight defects (on computer code). We were in the hundreds when we started testing,” he said.

The new system requires providers to put in new codes for billings, and the screen options are different. For clients, a new plastic “services card” is replacing a mailed paper coupon previously used to identify a client for medical assistance.

ProviderOne goes into effect in two phases. The first replaces Washington’s Medicaid Management Information System, which is 30 years old but has had upgrades. ProviderOne’s second phase is scheduled for start-up in 2012, replacing a Social Service Payment System for DSHS’ home-care and nonmedical services.

Among the expected benefits are fewer payment errors, reduced costs, and better verification of a provider’s licenses and credentials before a payment is made. The federal government is picking up about 90 percent of the costs, and it will assume up to 75 percent of its operational costs.

ProviderOne also is supposed to help DSHS become the payer of last resort for medical care, reduce fraudulent billings or payments for deceased clients, improve audit trails, reduce time needed to pay providers and reduce time that clients and providers are put on hold on the phone as they wait for information.

Tags: medicaid