Procurement Library

Quick Links:

◊Projected implementation dates

◊Communications
   -Newsletters
   -Presentations
   -Events
   -Glossary

◊Request for Proposal (RFP)

◊Overview

DSHS Main Page
Search DSHS
Contact Us
Privacy Disclaimer

» File Readers
If you are having trouble opening certain files you may need to download a free file reader.

DSHS Organization
State Medicaid Manual
Medicaid Management Information System (MMIS)
Medicaid Statistics

MMIS Systems Documentation
Sample MMIS Reports
Edits/Audit Business Rules

Social Service Payment System (SSPS) Information
Project Deliverables for vendor RFP
HIPAA Privacy
RFP Documentation
Business Process Documentation
Data Warehouse Documentation
Enterprise Architecture Program Documentation
Interface Documentation
Contact Information

DSHS Organization

DSHS Organization
HRSA (MAA) Organization

Medicaid Management Information System (MMIS) Documentation

Washington State Medicaid Statistics

Eligibility Data
Call Center Stats
Call Center ACD Report
2004 Healthy Options (HMO) Paper Enrollments

MMIS Systems Documentation

Data Element Dictionary*

*Data Element Dictionary will be provided on request.

Record Element Directory

Sample ProviderOne/Claims Processing Reports

Current Operational Report Output
WSR Log
WSR Index
WSR CSR List
POS CSR Index
POS CSR List
POS CSR Log
CSR Stats
CSR Log
CSR Index
Daily Exception Summary
POS Adjudication Summary
Operational Performance Summary
Active Batch Summary
Claims Processing Daily Summary
Claims Processing Thru put Analysis
Monthly Claims Count
POS Adjudication Summary
Monthly Exception Summary
Suspend File Analysis by Claim Type
Claims Statistics by Submitter

Edits/Audit Business Rules

Exception Code Notes
Exception Code Cross Reference
Audits
Current Washington Medicaid Provider Manuals

Social Service Payment System (SSPS)

Social Service Payment System (SSPS) Information

Overview

Authorization Form
Authorization Turnaround
Electronic Funds Transfer
FICA Tax Report
Invoice
Report List
Reporting Unit Table
SCAR Word Form
Service Code Table
Social Service Payments
Social Service Notice
Warrants
Social Service Payment System Web Site (SSPS)

SSPS IVR Documentation

IVR System
IVR Main flow & block diagrams
IVR Caller Transfer flow & block diagrams
IVR Unlock Invoice flow & block diagrams
SSPS IVR Script

SSPS Reference Manual

Section

Section Title

01 Basic Instructions

05
DSHS 14-154(X) Social Services Authorization

10
Processing Authorization Documents

15
DSHS 14-159, Change of Service Authorization

20
Payments

25 Provider File

30 Edit Error Codes

Sample Social Services Program Detail

Project Deliverables for vendor RFP

ACES Interface Assessment Report
MMIS Needs and Issues Report
Stakeholder Management Plan
Business Process Review Report
Existing Technical and Organizational Environment Report

HIPAA Privacy

HIPAA Privacy

Data Warehouse Documentation:

These files show the major databases, their tables, fields, and other statistics for the current data warehouse. 42MoPaidClaims shows the claim volume for 42 months; 6MoDeniedClaims shows the data volume for 6 months of denied claims. Data volume is relatively consistent and averaging the volume is an accurate indicator. You may want to figure in average growth over the 42 months for volume projections. Claims are updated each month. Client, Provider, and NDC databases are dropped and completely recreated each month with fresh data, so the data volume is indicative of what is always there.

Denied Claims
Paid Claims
Client
NDC
Provider
Statistical Sampling Methodology

Enterprise Architecture Program Documentation

Enterprise Architecture Overview

Interface Documentation:

Batch Interface Documentation
Interface Inventory-Overview

Business Process Documentation:

Health Insurance Premium Payments
Garnishment Process/Requirements

For questions, please contact:

Travis Sugarman
RFP Coordinator
360 664-6075
SugarTS@DSHS.wa.gov

This file last updated: Friday, July 23, 2004. Contact the ProviderOne Office for more information. For more ways to get in touch with the Department of Social and Health Services go to the DSHS Contact Information Web page. Technical Site Comments: DSHS Webmaster. Site Information.