1	OWCP Interagency Meeting June 30, 2004
2	Agenda Welcome and Introductions SHARE Update Shelby Hallmark Davis Layne ACS Update Pete Krah Bea Way
3	Safety Health and Return to Employment (SHARE) Goals have been announced for all Agencies. (Handout included in Folders) Halfway through the first year of a three year initiative. Training continues to assist Agencies meet their goals.
4	Here is how we are doing so far…
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6	CA-1/CA-2 Timeliness (by major agency)
7	Lost Production Days (per 100 employees)
8	Lost Production Days (by major agency)
9	Exceptional Achievements in Timeliness Greatest Improvement Dept. of Housing and Urban Development 56.5% improvement in FY04 Timeliness up to 53.5%
10	Exceptional Achievements in Timeliness Greatest Sustained Performance Dept. of Veterans Affairs 73.2% timeliness in FY04 Improvement of 7.9%
11	Exceptional Achievements in Lost Production Days Greatest Improvement Department of Defense Agencies 20.5% reduction in FY04 LPD down to 41.0
12	Exceptional Achievements in Lost Production Days Greatest Sustained Performance Dept. of Air Force 33.1 LPD in FY04 Reduction of 20%
13	What is OWCP doing to help?
14	Web-based Resources www.dol-esa.gov/share What’s New? District Websites Contact points Calendar of events Quarterly regional reports
15	Web-based Resources www.dol-esa.gov/share Training Front Line Supervisor Training Injury Compensation (CA-810) Return to Work Nurse intervention E-Newsletter Updates Hot Topics
16	Web-based Resources www.dol-esa.gov/share Calendar of Events District Level National Office
17	What’s Coming? AQS Report Suite Access to Chargeback specific reports for COP cases, cases within their first year of disability and long term cases.
18	What’s Coming? Claimant Query System Injured worker access to claim information via OPM’s Employee Express Sytem.
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36	FECA Overview What is the status of FECA?
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41	Long-term Disability Roll
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44	ACS… Where are we?
45	Status Overview ~200,000 providers enrolled. ~ 2,600 calls/day for bill inquiries. average hold time under 2 minutes. ~ 2,100 calls/day for medical authorizations. average hold time of 49 seconds.
46	Status Overview ~ 3.74 days for prior authorizations. 98% of bills processed within 28 days. Adjustments processed in an average 5.8 days.
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48	OWCP Efforts OWCP helping train ACS Client Service Representatives. Problem solving system has been developed: ACS Liaisons in each District Office District Office Trouble Shooters National Office Trouble Shooters
49	Continuing Efforts OWCP monitors ACS performance on a daily basis. Service Level Agreements (SLAs) measure key contract performance levels. Ongoing enhancements to ACS web portal
50	Update on Central Bill Pay and Medical Authorization
51	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
52	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
53	Accessing the ACS Web Portal via AQS Bring up desired case in AQS Click on Bill Inquiry
54	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
55	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
56	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
57	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
58	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:
59	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:
60	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
61	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.
62	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
63	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
64	Using the ACS Web Portal to Check Authorizations Click on Medical Authorization Inquiry
65	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
66	Using the ACS Web Portal to Check Authorizations
67	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
68	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
69	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
70	Using the ACS Web Portal to Check Bill Status It is possible for some line items to pay on a bill and others not
71	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
72	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
73	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