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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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Presentation Transcript
Update on central bill pay and medical authorization

Update on Central Bill Pay and Medical Authorization


Topics
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
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


Accessing the acs web portal via aqs
Accessing the ACS Web Portal via AQS

  • Bring up desired case in AQS

  • Click on Bill Inquiry


Accessing the acs web portal via aqs1
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


Prior medical authorization process
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


Services requiring authorization
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


Using the acs web portal to check eligibility
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


Using the acs web portal to check eligibility1
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:


Using the acs web portal to check eligibility2
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:


When accepted condition and procedure don t match
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


Timelines for prior medical authorizations
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.


Notifications regarding authorization request
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


Authorization letter
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


Using the acs web portal to check authorizations
Using the ACS Web Portal to Check Authorizations

  • Click on Medical Authorization Inquiry


Using the acs web portal to check authorizations1
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



Using the acs web portal to check bill status
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


Using the acs web portal to check bill status1
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


Using the acs web portal to check bill status2
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


Using the acs web portal to check bill status3
Using the ACS Web Portal to Check Bill Status

  • It is possible for some line items to pay on a bill and others not


How employing agencies can help providers
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


How employing agencies can help injured workers
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


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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