A. Managing all provider tasks associated with WA Cares Fund including Contracting creating pre-authorizations, processing claims, and remitting payment for services rendered. i. FMS contractor will contract and pay provider(s) for the following service, but WCF may add additional services if needed to achieve provider network adequacy goals. i. Medical provider types registered with WA Cares that do not accept Medicaid and do not wish to enroll as a Medicaid provider, which would include but not limited to: 1) Dementia and behavioral supports, 2) Home safety evaluations, 3) Education and consultation (as a medical providertype), and 4) Professional nursing services.(Skilled nursing services only) ii. The Contractor must have a system that can process claims that: 1) Maintains a record of every payment made to every transaction per beneficiary. 2) Utilizes the conventional rounding method to the nearest penny (e.g., two decimal points); and 3) Automatically detect duplicate claims. ii. If the Contractor causes an error resulting in inaccurate, delayed, or erroneously issued, or erroneously omitted payments, they are responsible for resolving the error as soon as possible, but no more than five business days after a payment error is identified. iii. The Contractor shall adhere to the WA Cares Billing Guide and other resources when billing for services and utilizing the ProviderOne system. B. Purchasing goods and services on behalf of the Beneficiary in accordance with WCF policy. i. These purchases shall be made from online stores for only the following covered services: 1) Adaptive Equipment and Technology a. Durable medical equipment b. Non-medical equipment and supplies c.Assistive technology 2) Environmental modifications items, for self-installation only, and 3) Transportation ii. The FMS may not purchase goods from consumer-to-consumer (C2C) online classified marketplaces such as but not limited to: 1) Offerup, 2) Cragislist, 3) Facebook Marketplace, 4) Ebay classifieds, and 5) Etsy.
