Providers

Client Data Collection and Reporting

Children's Long Term Support (CLTS)

Authorization Process

  1. Dane County sends a weekly authorization to its CLTS providers by every Monday via email spreadsheet. Please review the authorization file to make sure it lists the children and their services for which your agency expects to be paid.
  2. Authorized services on this file are pulled from each CLTS participant's Individual Service Plan (ISP). The ISP is developed in conjunction with the child, their family/guardian, and the Dane County or Family Support & Resource Center (FSRC) case manager.
  3. The authorization file is created every Thursday (usually late in the afternoon) so any ISP service updates entered into the County database prior to Thursday will be reflected on the next authorization file.
  4. The weekly authorization file sent to WPS by Dane County includes all new and revised services that will start in the next month or any time in the current year and those from the previous year until the 150th day of the ensuing year is surpassed.
  5. Once the authorization file is created it is sent electronically to WPS. The WPS system will accept all authorizations that are valid and will reject any authorizations the system deems invalid; usually this process takes 12 hours. Any invalid authorizations usually reflect data translation errors. These require a fix on the County end.

Submitting claims to WPS

  1. All the information needed to submit a claim to WPS can be found on your authorization file, e.g., dates of service, HCPCS code, units allowed, MCI number, etc.
  2. Claims can be submitted to WPS using EDI (electronic data interchange) or emailing claims using their Excel spreadsheet format.
  3. It is possible for CLTS providers to be paid via direct deposit for claims. The County strongly suggests this as paper checks are mailed from a separate facility, located outside of Wisconsin.
  4. Do not submit a claim for any service that you do not see on the authorization file. These claims will be rejected.
  5. A claim must be submitted within 90 days from the date of service. If it is submitted after 90 days, it will be denied and will need a special request to WI DHS in order for it to be paid.
    1. Please note in the Dane County Children's service system, Family Support and Resource Center (FSRC) acts as a fiscal agent. If your or your agency sends invoices to FSRC for payment, be aware they in turn need to submit a claim for reimbursement to WPS that has be within that 90-day time-frame. FSRC's policy is invoices arrive as close to 30 days as possible from date of service. Also note that it is important to get the invoice to FSRC within that first 30 days because there might not be an authorization in place, which means further delay in getting the service listed on the ISP.
    2. If you or your agency first need to bill primary insurance (parent's insurance, or Medicare/Medicaid) for a children's service, i.e., autism services, the 90-day clock starts from the primary payor's processed date compared to WPS claim receipt date.

Resolving errors and/or denied claims

  1. After a provider submits a claim to WPS, the status of what has been paid or not been paid will be made known in the Provider Remittance Advice (PRA). The PRA arrives in the mail and will be a report of all the claims recently submitted and whether or not they were paid or given an error code.
  2. WPS encourages providers to start with their call center (877-298-1258) to begin the process of resolving errors.
  3. Most, if not all rejected claims will require intervention either by the child's case manager and/or County administrative staff. Here are some tips on how to start resolving rejected claims based on common error messages:
    Code AH: “dollar amount exhausted…”
    Contact the child's case manager because the dollar amount for this authorized service has been exhausted and the authorization amount will need to be increased. Additionally, please note the following: unless there has been previous communication between the case manager and the family about use of their child's funds for the service in question, case managers will not automatically increase an ISP. Providers and case managers should be having conversations about the needed number of units of support at the time of plan development.
    • The process/time-frame from the point of an ISP being updated to reflect needed units to seeing it on your agency's authorization file you receive from the county can take up to two weeks. Please be patient when expecting to see a revised authorization for the service in question. If you do not see it after two weeks, please contact the county for follow-up on the status of the revised authorization.
    Code BL: “no authorization on file”
    1. Review your authorization file from Dane County to see if the claim submitted matches the data on the authorization file.
    2. If there is no authorization for this service on the authorization file, either wait until next week's authorization file is sent to you or contact the County to see if the service is listed on the child's ISP.
    3. If there is an authorization for this service, first call WPS call center to inquire why WPS denied the claim with that error code. Depending on what is said by WPS, you may then need to contact the County for assistance.
    Code 29: “the time limit for filing has expired”
    Contact the county so we can make a special request to DHS to waive the timely filing requirement in order for payment. DHS requires a reasonable explanation as to why the claim was filed beyond 90 days. It most cases with code 29 errors, the claim was originally filed within 90 days, however, it was denied with an error and by the time the corresponding authorization or correction to the claim is made, 90 days has come and gone.
  4. Anytime a claim needs to be resubmitted because it was paid partially upon submission, it will need to be submitted on paper and mailed. This process is referred to as submitting a corrected claim. Please contact the WPS call center if you need a corrected claim form sent to you.

Miscellaneous Information

  1. If a child has a legal name change, this will need to be changed on the LTC-FS. DHS will then update its enrollment file to reflect the name change. In order for an authorization to be accepted by WPS, the county will need to change the child's name in InfoSys.
04/30/2014