DSHS brings live Medicaid pharmacy billings on line with new computer payer system called ProviderOne

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The Department of Social and Health Services took an historic step in late October, quietly bringing the state's $8 million-a-week Medicaid pharmacy claims and payments online in a new computer system called ProviderOne. The transition, which occurred on Oct. 20 without major incident, involved the pharmacy payment system – called "Point of Sale" or POS. "This is the first real test of the new system, and it is performing just as it should, " said Robin Arnold-Williams, DSHS secretary. "This reflects a tremendous effort and superb coordination by staff from all across DSHS. I thank them all for the hard work they put into the development and management of this system."Arnold-Williams called the project "the most complex and significant undertaking in state government for the next decade. We are moving away from the old bolt-to-the-floor mainframes and into an era of modular design that will give us greater flexibility for updates, as well as increased cost controls and efficiencies."Doug Porter, assistant secretary for the Health and Recovery Services Administration, which has been developing the ProviderOne Project, thanked the project team, headed by Project Manager John E. Anderson. "Our philosophy throughout the development of ProviderOne has been to proceed carefully and make sure that we implement the system only when the technology, our staff and our provider partners are all prepared to handle the changes, " Porter said."We had extra help standing by, watching ProviderOne and troubleshooting problems, and the call center staff was prepared to respond to the increased inquiries and minor problems we anticipated, " Porter said. "We also recognize the good support we received from individual pharmacies – from the mom and pops up to the chain stories, and the Washington State Pharmacy Association."The POS system handles about 1 million pharmacy claims a month. It services about 500, 000 fee-for-service clients – about half of the total medical assistance caseload. (The other half receives medication through managed-care health plans.)ProviderOne's next step forward will come in 2009, when the system begins accepting bills and paying claims for the primary medical assistance programs, including nursing homes. With that change, ProviderOne will be paying more than $75 million a week to pharmacies, doctors, hospitals and nursing homes across the state. The final phase of ProviderOne development will follow in stages beginning in 2010 and over a two-year period when ProviderOne becomes the main payer system for DSHS, handling most of the agency's non-medical billings as well as health care.For now, Project Manager Anderson said the project team will continue to monitor ProviderOne and the "Point of Sale" system. The change did result in an anticipated increase in provider calls to the Medical Assistance Customer Service Center. "So far there hasn't been anything surprising, " Anderson said. "If we do turn up some unanticipated problems, we are poised to handle them, " he said.Editor's Note: Main contractor on the ProviderOne project is CNSI, a data management and computer design firm located in Rockville, Md.