Greetings WV Medicaid Providers Submitting Prior Authorization Requests!
APS Healthcare would like to first take the opportunity to thank you for your patience and feedback regarding the APS CareConnection® (C3) system for WV Medicaid Prior Authorizations. We hope you are becoming more familiar with navigating the system. With that being said, we would like to provide some additional important information about the C3 system, which will help reduce your number of administrative closures and resubmissions. This will improve the efficiency in receiving your determinations.
We would like to reiterate the importance of your computers’ compatibility with the APS CareConnection® system. It has come to our attention that if every user is not working on a computer that has IE8, (Internet Explorer 8), this can produce some problems with submitting your requests. Instructions on how to make your computers compatible with our system are available by clicking here. (Please note, following these instructions does not impair your computer system, and does not bother your other programs that are on the computer). Please make sure that all users of our system have access to these instructions. This will help prevent requests from being what we call “stuck in cyberspace”. This is when a request has been submitted, but stays in Pending status, and never goes to queue to be reviewed.
Another important thing to remember is that you have to have patience when submitting a request. Please remember to wait until everything is populated on the Summary and Submit page, BEFORE clicking the Submit button. Clicking Submit before being able to see the information on the page could be another contributing factor to “stuck” requests. Also, waiting for the entered information will allow you the opportunity to review the request, to make sure dates and all information are correct, and to make sure you didn’t leave anything off that might be pertinent to the review.
Next, we would like to inform you about timelines for sending in additional clinical information, whether it be faxed, or mailed additional information, for any case, to WVMI. In order for your requests to be processed in a timely, efficient manner, WVMI needs to receive information in a timely manner. If you enter requests via the CareConnection® system, and want to fax the clinical information to WVMI, the faxed information needs to be received by WVMI within 2 business days from the submission of the request. If you enter a reconsideration request into the system, and mail the additional clinical information, WVMI needs to receive this information within 5 business days. If the information is not received within the allotted timeframe, your request will be closed administratively, and you will have to re-submit your request, which could cause you to miss the 72 business hour timeline, for a timely submission. Leniency will NOT be given in these cases!
APS would like to stress that it is the provider’s responsibility, and is IMPERATIVE that the provider check each member’s eligibility. Although, both APS and WVMI, check for sufficient coverage, we are only responsible for determining whether or not a procedure meets medical necessity. This is especially important for PT, OT, Speech, and Audiology because your authorizations run to the end of the calendar year; however, this DOES NOT mean that each member’s eligibility runs through to the end of the year. That is the provider’s responsibility to check.
It is also the provider’s responsibility to check for determinations of their requests, via the CareConnection® system. WVMI and APS will not give authorizations over the phone. APS will, however, continue to assist you by teaching you how to find your determination. The instructions for this are available by clicking here.
Finally, please make sure you are entering the correct dates on requests. We want to clarify that when submitting Acute Inpatient or Inpatient Rehab <21 requests, please make sure the Authorization Start Date and the Admission Date are the SAME date! When submitting therapy requests, (PT, OT, Speech, Audiology), if you have more than one procedure to get authorized, the Authorization Start Date should be the Start Date for the earliest service. You do not need to enter the date the request was entered because that date will automatically populate once the request is submitted. APS has to submit an IT request ticket to our Corporate Data Management team in order to have the dates changed, and this delays your ability to seek reimbursement for services rendered. So, in order to help us help you more efficiently, let’s please be sure to enter the correct dates on the requests.
If anyone is still in need of assistance and/or training with the APS CareConnection® system, please let us know. We can set up times to do trainings via webinars for your facility, or when time permits, we can work with you by phone and help you enter a request step by step, if you would prefer.
Thank you for time attention to the above matters. As always, we are here to help you in any way possible, so please feel free to contact us with any questions, comments, or concerns you may have by calling: 1-800-346-8272, or by emailing: firstname.lastname@example.org.