Frequently Asked Questions For Providers

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.

Process for therapy claims:

  1. 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.
  2. 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.
  3. Claims for members who were with WWC:  The process has not changed.  Therapy claims should be submitted directly to WPS.
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Claims for dates of service prior to 12/31/16 should be submitted according to each MCO’s individual claims processing procedures. 

 

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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.

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Claims will continue to be submitted to WPS using the same mailing address. 

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The claim filing period will continue to be 90 days for timely filing. 

 

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Community Link, Inc.

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Claims should continue to be sent to WPS at the indicated address in Eagan, MN.

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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. 

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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.

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3349 Church St. Suite 1

Stevens Point, WI 54481

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The new entity will be working toward merging all guidelines and forms with a goal of completing that task in the next year.

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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.

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Portal application and further instructions will be sent to providers during the week of October 17th.

 

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You will receive more information about portal access and training. You may submit claims the same as you do now.

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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.

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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.

 

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Providers will soon receive information about provider portal training. A video will also be available to support providers. More details to come.

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No-you will not be able to see claims status the same.

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Yes, additional information regarding access to the portal will be coming soon.

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Yes, additional information regarding access to the portal will be coming soon.

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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.

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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.

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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.

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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.

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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.

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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.

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WPS will continue to be the Third Party Administrator (TPA) for the merged organization.

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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.

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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.

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This has not been determined, and will need to be discussed and decided. More information to come.

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Forums may be among the methods utilized to support providers, but this has not been determined at present.

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