Your voice matters, and we appreciate your active engagement in the merger process. Much of that engagement has come in the form of questions and requests regarding provider rate increases, and we wanted to share a little insight into where we are regarding rates as we near the merger:
- As we become a merged organization, we would like to take some time to review the specific expectations of the three MCO’s for supports/services. This review will also include a comparison of current rates for specific services for each MCO.
- We will track the rate increase requests we have received from providers and utilize them throughout our review and alignment process.
- Due to this review and work towards unified scopes of service and rate alignment, there will not be rate changes made by individual MCO’s. Current 2016 rates will carry over to 2017 until a thoughtful analysis can be completed.
- During 2017, we look forward to opportunities to engage non-residential providers in discussions as we work towards unified scopes of service and rate alignment. We encourage you to look for these opportunities on our merger website: www.mcomerger.org
Thank you for your continued partnership. For more information, see the Frequently Asked Questions below.
Not finding an answer to your questions, submit your question here.
WPS use to request therapy claims to be sent to ContinuUs, 28526 US Hwy 14, Lone Rock, WI 53556 . What address should be used for Part B coins and therapy claims now?
Process for therapy claims:
- Claims for members who were with ContinuUs: Claims with a date of service prior to 12/31/16 should continue to be sent to the Lone Rock address. Claims with a 2017 date of service should be submitted directly to WPS at PO Box 211595, Eagen, MN 55121.
- Claims for members who were with CCCW: The process has not changed. All out-patient therapy claims should continue to be mailed to Stevens Point.
- Claims for members who were with WWC: The process has not changed. Therapy claims should be submitted directly to WPS.
Claims for dates of service prior to 12/31/16 should be submitted according to each MCO’s individual claims processing procedures.
DME authorizations do require authorizations even if the claim is secondary to Medicare. This allows the claim to be accepted by WPS and processed for payment.
What will be the address to submit claims and the payer ID to submit claims electronically for the new plan?
Claims will continue to be submitted to WPS using the same mailing address.
The claim filing period will continue to be 90 days for timely filing.
Community Link, Inc.
Where do we send claims as of 01/01/2017. Do we send them to Community Link, Inc? Is the address still PO Box 211595 Eagan, MN 55121?
Claims should continue to be sent to WPS at the indicated address in Eagan, MN.
We currently upload our claim submissions electronically on a specific spreadsheet for WWC. Will this currently be the same spreadsheet after the merger? Also, when on the website for submission to WPS, you have to choose who it is for. Will this automatically change or will it still be under WWC?
Providers who utilize the Move-It account submission process with WPS can combine ContinuUs claims and WWC claims on one spreadsheet for dates of service on or after 01/01/2017. Providers who utilize the Move-It account submission process for CCCW claims will experience no change. The WWC folder will be renamed as Community Link Inc. as of 01/01/2017.
I like the way we are able to a print the "Provider Forms" for Traditional Adult Family Home Providers. It is an (easy) and (convenient) way to make a copy of a needed form. Will you please consider keeping it this way?
Thanks for sharing your feedback. The process you described will remain as is for now as we plan to maintain individual websites until we can review processes and forms.
We are a ContinuUs provider. I need to proactively add this new managed care organization my insurance policy, can you please let me know what address I should use?
3349 Church St. Suite 1
Stevens Point, WI 54481
Will all 3 payors follow the same guidelines are far as what documentation is required to request an auth, retro periods, length of the auth given?
The new entity will be working toward merging all guidelines and forms with a goal of completing that task in the next year.
In the tools that we use to determine how to request an auth for each payor we have, we have a different way of requesting an auth for all 3 of the payors that are merging. I need to make sure that starting 1/1/17 we will need to make sure that we should go thru the WWC portal to request and follow up on all auth requests?
The WWC portal will be used by ContinuUs and WWC to communicate authorization information. CCCW will continue to use their current portal.
Providers who are already set up on the WWC portal should review their users to ensure they have access set up for any locations added related to ContinuUs services. If changes are needed, please work with your portal administrator to update user access.
Portal application and further instructions will be sent to providers during the week of October 17th.
How does this affect billing etc. for services in Minnesota with one client? We now do paper billing but receive other information through portals.
You will receive more information about portal access and training. You may submit claims the same as you do now.
We still submit our claims by snail mail. Will that still be an option? will the addresses change? Room and Board/part A vs Therapy/coins part B, corrected claims and appeals all have different addresses to which to mail claims, will that change and be just "one" address to cut back on confusion?
For providers who submit claims via mail, please continue to use: Family Care
c/oWPS Health Insurance
PO Box 211595
Eagan, MN 55121
If you are a current ContinuUs provider of therapies, you will receive communication regarding the new process.
Will the existing authorization automatically be termed on 12/31/2016 and moved from Midas to WWC with a start date of 1/1/2017 or does this have to be provider initiated?
Yes, authorizations will be terminated as of 12/31/16 in Midas. Existing auths will be entered using a start date of 1/1/17. Current authorization period will remain, with original end date in place. No action needed by the provider, other than to participate in training.
Authorizations will begin to appear in November with completion by late December.
Providers will soon receive information about provider portal training. A video will also be available to support providers. More details to come.
Authorization information will have to be obtained through the WWC Systems... Will claim status information also be available through the same system?
No-you will not be able to see claims status the same.
(ContinuUs Specific) It is my understanding that I will no longer be able to access the MIDAS portal to view my authorizations and claims and that this is the site I will now need to use. I was not able to find self registration. could you please tell me what I will need to do to utilize the provider portal. Thank you.
Yes, additional information regarding access to the portal will be coming soon.
(ContinuUs specific) The most recent business announcement we received stated that you were switching from the Midas Portal to the WWC system.
Yes, additional information regarding access to the portal will be coming soon.
I am just wanting to get some information on how this will affect me as a DME and DMS provider? I am having a hard time finding any information about changes that may be occurring. Will you continue to use local suppliers? Any information that you can provide will be helpful.
Currently there is an ongoing evaluation of current contracting process and procedures. At this time there has not been any decisions made specific to changes in contracting processes. The intent of the merged organization is to continue to maintain the current contracts with providers within all three of the organizations’ existing Provider Networks. We would not see this changing within the merged organization. As decisions are made that will affect external stakeholders, including providers, they will be communicated in advance of the change.
I am wondering about the provider portal. With your merger coming, I would love to suggest that you keep your WWC authorization portal as it is the best that I have seen. It is the most user friendly and process convenient for provider usage. Better than Midas and Forward Health Portal.
Thank you for the suggestion. The three MCO’s are currently evaluating all processes and technology platforms. At this time there has not been any decisions made on a long term solution specific to provider portal. As decisions are made that will affect external stakeholders, including providers, these changes will be communicated in advance.
Providers should not experience any major changes with how you are being supported after the merger. All three organization value partnership and collaboration with our contracted Providers. You should experience these values currently and after the merger. Any changes to process will be communicated well in advance, and resources/trainings will be available.
There is intent to bring consistency to the processes, procedures, and forms utilized by providers. We do not anticipate having these completed prior to merger. Communication will continue with providers as those changes occur.
There is an ongoing evaluation of current contracting process and procedures, including rates. We do not anticipate any major changes to rates during the merger, with the exception of ContinuUs’s changes in Residential Rate Methodology. Any changes to processes or rates will be communicated well in advance.
Please continue to utilize the same contact mediums you are currently accessing. We do not anticipate a lot of changes for providers specific to support during and after the merger. If there are changes to staff roles and contact information, these will be communicated.
WPS will continue to be the Third Party Administrator (TPA) for the merged organization.
The merger will not affect authorizations or your reimbursement for those active authorizations. The process will remain the same for review of authorization by the member’s Care Management team and authorizations will only be changed if there are member specific changes to the member centered plan.
The merger should not impact you continuing to be a contracted provider. The intent of the merged organization is to continue to maintain the current contracts with providers within all three of the organizations’ existing Provider Networks. There is value to having a robust provider network both in supporting ongoing quality and increased member choice. We would not see this changing within the merged organization. As decisions are made that will affect external stakeholders, including providers, they will be communicated in advance of the change.
Holds: For providers who are potentially suspended with one organization, but may be in good standing contractually with one of the other current MCOs, which way will we default moving forward? How will that be decided?
This has not been determined, and will need to be discussed and decided. More information to come.
Forums may be among the methods utilized to support providers, but this has not been determined at present.