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

Easiest way to access is through AQS Provides information on

EligibilityAuthorizationsPayments

Can access via https://owcp.dol.acs-inc.com

Accessing the ACS Web Portal via AQS

Bring up desired case in AQS

Click on Bill Inquiry

Accessing the ACS Web Portal via AQS

There are 3 types of inquiry options

1. Eligibility Inquiry

2. Bill Status Inquiry

3. Medical Authorization Status Inquiry

Click on desired inquiry

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

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

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 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 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

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

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

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

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

Click on Medical Authorization Inquiry

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 Authorizations

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 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 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 Status

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

How Employing Agencies Can Help Providers

Encourage providers to register/enroll Encourage providers to use ACS web portal

http://owcp.dol.acs-inc.com for 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

Encourage Injured Workers to use ACS web portal http://owcp.dol.acs-inc.com for 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