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Update on Central Bill Pay and Medical Authorization

Update on Central Bill Pay and Medical Authorization. Topics. Accessing ACS Web Portal via AQS Prior Authorization Process Walk-Thru ACS Web Portal How Employing Agencies Can Help Providers How Employing Agencies Can Help Injured Workers. ACS Web Portal – Employing Agency Access.

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Update on Central Bill Pay and Medical Authorization

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  1. Update on Central Bill Pay and Medical Authorization

  2. Topics • Accessing ACS Web Portal via AQS • Prior Authorization Process • Walk-Thru ACS Web Portal • How Employing Agencies Can Help Providers • How Employing Agencies Can Help Injured Workers

  3. ACS Web Portal – Employing Agency Access • Easiest way to access is through AQS • Provides information on • Eligibility • Authorizations • Payments • Can access via https://owcp.dol.acs-inc.com

  4. Accessing the ACS Web Portal via AQS • Bring up desired case in AQS • Click on Bill Inquiry

  5. Accessing the ACS Web Portal via AQS There are 3 types of inquiry options • Eligibility Inquiry • Bill Status Inquiry • Medical Authorization Status Inquiry Click on desired inquiry

  6. Prior Medical Authorization Process • Using the ACS Web Portal to Check Eligibility • Services Requiring Authorization • Using The ACS Web Portal To Check Authorization Status • Timeframes For Completion

  7. Services Requiring Authorization • Eligibility status available via AQS access to the ACS web portal http://owcp.dol.acs-inc.com • Level 1 - procedures do not require authorization (for example, Office Visits, MRIs, Routine Diagnostic Tests) • Level 2 - procedures can be authorized by ACS – often over the phone with ACS • Level 3 and 4 - procedures require authorization by a Claims Examiner but initiated via fax from provider to ACS

  8. Using the ACS Web Portal to Check Eligibility Check service eligibility without calling ACS by entering • valid case number • valid procedure (CPT) or revenue code • approximate date of service

  9. Using the ACS Web Portal to Check Eligibility • If the procedure entered is related to the accepted condition, the user will see a message indicating the approval level of the procedure and other case-specific information:

  10. Using the ACS Web Portal to Check Eligibility • If the procedure entered into the Eligibility Inquiry doesn’t match the accepted condition, the user will see the following message:

  11. When Accepted Condition and Procedure Don’t Match • Advise that provider needs to complete the Authorization Request Process • Claims Examiner will determine if claim can be expanded for new condition based on information in file and information submitted with request • Claims examiner will determine if additional development is needed to determine if claim can be expanded to include new condition

  12. Timelines for Prior Medical Authorizations • Level 2 procedures that ACS can authorize take an average of 3.5 days • All spinal surgery and many other surgery authorizations require District Medical Advisor (DMA) approval and take about 30 days • In some instances, additional development of the claim by the Claims Examiner is needed to approve or deny an authorization request. Case complexity, claimant responsiveness, employing agency responsiveness, and other factors impact the timeline for authorization.

  13. Notifications Regarding Authorization Request • Within 2 business days, the authorization request is logged into the system, forwarded to the Claims Examiner if necessary, or returned to provider if incomplete • If a request for authorization is approved, the requesting provider is notified via mail • If a request cannot be approved because additional information is needed, requesting provider is notified via mail • If a request is denied, the Claims Examiner issues an official denial letter to claimant • Authorization status available via AQS or direct access to ACS web portal http://owcp.dol.acs-inc.com or via the ACS IVR at 866-335-8319

  14. Authorization Letter • Requesting Provider receives authorization via U. S. Mail • But…No need to wait for the mail. Check authorizations via AQS or direct access to ACS web portal http://owcp.dol.acs-inc.com

  15. Using the ACS Web Portal to Check Authorizations • Click on Medical Authorization Inquiry

  16. Using the ACS Web Portal to Check Authorizations • Enables users to check authorization status without calling ACS • Limit the number of authorizations returned by entering dates of service range

  17. Using the ACS Web Portal to Check Authorizations

  18. Using the ACS Web Portal to Check Bill Status • Choose to see Resolved or In Process bills • Dates of Service is optional • Can search for a particular provider number • Can search for a particular TCN

  19. Using the ACS Web Portal to Check Bill Status • Displays information on bills submitted bills • Returns a maximum of 200 bills – message tells if there are more than 200 bills matching search criteria • To view description of billed diagnosis (ICD9), click on hyperlink • To view line items for a specific bill, click on the hyperlinked TCN

  20. Using the ACS Web Portal to Check Bill Status • All line items for the selected bill appear • To view descriptions for Procedure (CPT), Revenue, or EOB codes, click on hyperlink

  21. Using the ACS Web Portal to Check Bill Status • It is possible for some line items to pay on a bill and others not

  22. How Employing Agencies Can Help Providers • Encourage providers to register/enroll • Encourage providers to use ACS web portal http://owcp.dol.acs-inc.comfor • Eligibility status • Authorization status • Bill payment status • Link to FAQs • Encourage providers to bill electronically • Give Providers accepted condition information – ICD9s and descriptions – when they request it • Don’t submit bills for providers • Don’t complete med auths for providers

  23. How Employing Agencies Can Help Injured Workers • Encourage Injured Workers to use ACS web portal http://owcp.dol.acs-inc.comfor • Eligibility status • Authorization status • Bill payment status • Link to FAQs • Forms • Give Injured Workers their accepted condition information – ICD9s and descriptions – a screen shot from AQS works for this • Advise/Encourage Injured Workers to give their accepted condition information to their treating physicians • Educate Injured Workers about the authorization and bill pay processes

  24. We appreciate your willingness to work with us to create a system that works for all of our customers – Injured Workers, Providers, and Employing Agencies

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