Billing Operations: AOASCC’S Role in Provider Payment

AOASCC’s Role in the Service Order (SO) Prior Authorization (PA) Process:

• Care Manager calls Provider with referral based on:
  • Client choice
  • Rotation through list of over 400 providers
• Care Manager authorizes Prior Authorization in AOASCC's internal Access Agency system
• Verbal authorizations are mandated to be entered into the
  portal within 10 business days
• Information is uploaded to DXC Portal within 48 hours
• DXC Portal sends PA information to Sandata within another 48 hours
• Sandata allows scheduling, etc.
• AOASCC help clients gather eligibility documents and submit them to the State. NOTE: AOASCC DOES NOT DETERMINE ELIGIBILITY NOR CAN WE EXPEDITE DECISIONS WITH THE STATE

Misconceptions:

• AOASCC is not the State of Connecticut, we are a contractor responsible for care plan accuracy, assessment, and ongoing client monitoring
• AOASCC does not have access to Sandata or EVV and cannot see your Agency's information in Sandata
• AOASCC is unable to view provider billing information in the portal
• AOASCC is unaware of billing denials and relies on you, the Provider to inform us when eligibility or other issues arise
• AOASCC does not
  • Issue any payments
  • View or interact with Sandata system
  • Have visibility to provider's paid or denied claims
  • Authorize enrollment for providers
  • Authorize eligibility status

Provider Best Practices:

• Have a centralized non-employee-specific email for errors / scheduling. Example: providers@aoascc.org
• This ensures the chain of communications regardless of staff changes.
• Providers are responsible for informing AOASCC when a client is unavailable for services.
• This includes hospitalizations, skilled nursing stays, vacations, or any other service breaks.
• Claims for dates of service when a client is unavailable should not be billed.
• Payments for services that are not delivered to the client, or unauthorized services may result in audit findings by the State of Connecticut
• All changes in condition or concerns regarding the client's environment should be brought to the Care Manager's immediate attention.
• A list of AOASCC staff is available here for your reference: Contact List ›
• Email billing issues to providers@aoascc.org as soon as you discover them using the billing issue form.
• Alert AOASCC care manager to any eligibility issues that last longer than 90 days.
• Always check the PA in www.ctdssmap.com for accuracy.
• When contacting Sandata and EVV, provide the PA number found in the www.ctdssmap.com portal.
• Always send encrypted emails to providers@aoascc.org.
• If you do not have an encrypted email, fax forms to 866.644.1929.