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ProviderOne | DSHS

  • what is the providerone interface?
  • how often does the providerone interface take place?
  • online processing

    • what information is sent from aces to providerone?
    • what information is received from providerone to aces?
    • what information is displayed in the providerone web service?
    • mainframe processing

      • what information is sent from aces to providerone?
      • what information is received from providerone to aces?
      • what information is displayed in the providerone web service?
      • see ace screens and online pages for an example of the pages or screens used in this chapter.

        See also: Get Multi-Trip Travel Insurance! (And Other Lifesaving Travel Planning Tips) | Allianz Global Assistance

        what is the providerone interface?

        The ProviderOne interface is an information exchange between Aces and the Healthcare Authority (HCA) ProviderOne system. providerone uses this information to authorize payment of medical bills from medical providers, generate reports, and obtain federal funds.

        Reading: What is provider one insurance

        aces uses data received from providerone to automatically update the appropriate screens with new or updated medical information data, third party liability (tpl) data, provider data, and rate information.

        how often does the providerone interface take place?

        The providerone interface occurs daily, weekly, and monthly, depending on the client or provider information that is exchanged.

        online processing

        what information is sent from aces to providerone?

        See also: Buyer or Seller: Who Pays for Closing Costs and Title Insurance?

        See also: Best dive insurance (2022 update) | OutsiderView

        The eligibility interface file contains customer demographic, medical eligibility, expense, and tpl information. aces sends this file to providerone in the nightly batch. The real-time version of this interface is sent throughout the day at approximately 15-minute intervals to clients who need medical services on the same day their medical request is approved.

        what information is received from providerone to aces?

        the following files are received from providerone and sent to aces:

        • The daily facility update file provides demographic and rate information for the various attending medical and long-term care providers. When new providers are added or changes are made to existing provider information, Aces updates the provider details with the new information daily. You can access the provider details popup from the facilities section on the institutional care/expenses page, by clicking details link for the selected provider.
          • a weekly batch process recalculates the client’s benefits and sends a letter if there is a change in the client’s benefits or participation due to information received in the facility’s daily update file.
            • If aces cannot update the aces vendor database or find all customers actively associated with the vendor with the change, barcode tokens are created for manual review.
            • The client insurance tpl file identifies clients who have medical coverage through a third-party provider. The file provides information about the insurance organization and other pertinent information related to the client’s coverage. aces updates the client’s third party liability page with the current tpl information being submitted. Included in this tpl file is the medicare data for part a and part b, which is used to ensure customers are added or removed from the state’s medicare buy-in program.
            • medicare purchase data received from providerone automatically update medicare part a and part b premium payment data changes on the third party liability page in the field paid by. ases also uses the transaction data to update customers’ medicare (title xviii) data and this interface file is received weekly.
            • The insurance organization file identifies all insurance organizations and all their pertinent information. ases updates the tpl organization search page with the names, addresses and carrier codes of all known tpl carriers in the state and this file is received monthly.
            • what information is displayed in the providerone web service?

              providerone’s web service provides real-time information and the file fills the medical information page on aces.online.

              The data items displayed on this page are:

              • client medical information:
                • provider identification number
                • medication
                • tpl safe
                • kinship care placement indicator
                • hospice indicator
                • restriction flag
                • dda client indicator
                • managed care information:
                  • health plan
                  • program
                  • start and end dates
                  • for more information consult the medical information.

                    mainframe processing

                    what information is sent from aces to providerone?

                    See also: Buyer or Seller: Who Pays for Closing Costs and Title Insurance?

                    See also: Best dive insurance (2022 update) | OutsiderView

                    The eligibility interface file contains customer demographic, medical eligibility, expense, and tpl information. aces sends this file to providerone in the nightly batch. The real-time version of this interface is sent throughout the day at approximately 15-minute intervals to clients who need medical services on the same day their medical request is approved.

                    what information is received from providerone to aces?

                    the following files are received from providerone and sent to aces:

                    • The daily facility update file provides demographic and rate information for the various attending medical and long-term care providers. When new providers are added or information changes to existing providers, Aces updates the prov screen with the new information daily.
                    • The client insurance tpl file identifies clients who have medical coverage through a third-party provider. The file provides information about the insurance organization and other pertinent information related to the client’s coverage. ases updates the client’s tpl1 screen with the current tpl information being sent. Included in this tpl file is the medicare data for part a and part b, which is used to ensure customers are added or removed from the state’s medicare buy-in program.
                    • medicare purchase data received from providerone automatically update medicare part a and b premium payment data changes on screen tpl1 in field paid for. ases also uses the transaction data to update customers’ medicare (title xviii) data and this interface file is received weekly.
                    • The insurance organization file identifies all insurance organizations and all their pertinent information. ases updates the tplc screen with the names, addresses and carrier codes of all known tpl carriers in the state and this file is received monthly.
                    • what information is displayed in the providerone web service?

                      this feature does not currently exist in mainframe aces, see inline processing: what information is displayed in the providerone web service?

                      see ace screens and online pages for an example of the pages or screens used in this chapter.

                      See also: Get Multi-Trip Travel Insurance! (And Other Lifesaving Travel Planning Tips) | Allianz Global Assistance

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