Washington State Health Care Authority

The Washington State Health Care Authority processes more than $8 billion dollars annually in provider payments. Provider payments had been processed analog with paper forms and telephonic data transfer for 3 decades, causing overpayment and duplicate payments. Acentra Health upgraded Washington’s ProviderOne system to a contemporary system that processes claims and payments for both providers and payers.

Challenge

The Medicaid system ProviderOne was implemented in 2010 and processes more than $8 billion annually in provider payments with about $2 billion of which are for social service. Payments are processed through a 30-year-old phone and paper billing system and are prone to provider over-payments and duplicate payments. The Washington Healthcare Authority (WHA) had a vision of an integrated system, which would integrate social service and medical claims payments. To accomplish this, the phone and paper billing systems needed to be updated.

Solution

Acentra Health updated the ProviderOne system to include a modern payroll-like system that meets federal requirements and supports increased management efficiencies through better utilization and expenditure data across Medicaid. Medicaid services will no longer be claimed by phone or paper and social service providers who provide care to Medicaid clients can now submit claims online using the ProviderOne system. Providers can also manage claims reporting and payment schedules more easily.

Results

Utilizing Acentra Health’s ProviderOne system technology, the state of Washington successfully transitioned more than 4,300 social service providers to the online payment and claims management system. Within the first couple of weeks post launch of the integrated system, more than 2,600 warrants were issued to social service providers, totaling more than $4 million.

Success

This platform is the first in the country to integrate social service provider payments to serve the businesses and organizations that support clients in home and community-based settings in Washington. The enhanced functions of ProviderOne will reduce provider overpayments and duplicate payments, improve care coordination and provide more data about cost utilization while realizing HCA’s mission to improve quality of life for individuals and families in need.