Note from specialgathering:  Once again, I’ve stolen from Aaron Nangle’s newsletter for Special Gathering weblog.  I wanted to use this as an opportunity to remind you of the great work he is doing.  And to let you know that if you would like to subscribe to his newsletter you can do so by going to WaiverProvider.com

Much of what he has to say this month, applies to only providers and Support Coordinators but parents and advocates need to understand what is happening to providers through APD.

Will Providers and Support Coordinators be Working For Free?

Do You Have Your Service Authorization?

Provider and Support Coordinators, do you have your service authorization? The new fiscal year starts on July 1, 2008.

You Can Work Without a Service Authorization, But Don’t Expect To Get Paid.

Do you have your service authorizations for the new fiscal year? Many of you do not. And, even if you do- they are most likely outdated with the old provider rates. You can work without a service authorization, but don’t expect to be paid. In this time of fiscal crisis and uncertainty, APD could very well say, “Thank you for your donation.” It has happened before, we just predict this year to be much worse.

There is Very Little The Support Coordinator Can Do.

The Allocation and Budget Control System (ABC) is now controlled by the Agency For Persons With Disabilities (APD). Therefore, APD puts the cost plan budgets into ABC, which in turn, will create service authorizations for providers. Support Coordinators can only VIEW and PRINT service authorizations. They can not even make a simple provider change. So, come July 1st, if you don’t have your service authorization.

Services Are Medically Necessary

When services have been deemed as medically necessary, the provider is faced with a difficult choice. Should my company work without a service authorization, and risk not getting paid? In many cases, that is not even an option. Not providing the service is in essence, neglect.

Are You Up To Date With The Billing Changes?

ACS is No Longer The Medicaid Billing Agent.

ACS is no longer the Medicaid Billing Agent. The new agent is EDS. This went into affect on June 19, 2008. ACS is no longer accepting or processing WINASAP or 837 X12N electronic claim transactions.

During the week of June 30, 2008, providers will not receive a payment from Medicaid.

According to Medicaid, “This week for non-payment is standard operation.”