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CPS Basics. The Centralized Performance System Medical Module. CPS Logon Page. Forgot Your Password? Use the link at the bottom of the screen. CPS Organizational Chart. HYPERLINKS. On any page you within CPS one can click on the blue hyperlink to see additional details .
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CPS Basics The Centralized Performance System Medical Module
Forgot Your Password? Use the link at the bottom of the screen
HYPERLINKS • On any page you within CPS one can click on the blue hyperlink to see additional details. • In the summary or on the workbench you can view a specific penalty type (Rejected not Resubmitted (RNR), Timely Filing or Timely Payment) by clicking on any of the blue hyperlinks.
Centralized Performance System Overview • Performance information is detailed and summarized in CPS on a monthly basis. • A batch is the sum of all of an insurer’s medical bill data submitted and processed by the Division in a single calendar month.
Toggling Between Claims Handling Entities Use the drop down box on the right of the screen in the middle of the page
The View All Screen allows viewing of all Medical Bills submitted in a batch. • At the bottom of this section you can select to download the information in Excel or CSV format.
Sending a Batch to the Workbench… Use the hyperlink to send the batch to your workbench
Selecting a Batch In the box below there are two batches on this workbench.
AssigningInsurer Statuses to RNR,Filing and Payment Penalties : • Dispute: The Insurer/TPA has reviewed the medical bill data information and does not agree that a penalty should have been assessed. • Concur: The Insurer/TPA has reviewed the medical bill data information and agrees that the penalty is valid. • Data Correction Sent: The Insurer/TPA has reviewed the medical bill data and the information on the bill is incorrect and needs to be corrected.
Examples of Insurer Status Once you have reviewed the bill and reached a decision to concur, dispute or make a data correction you must select a box on each line. If the decision is the same for all bills you can “select all”.
Data Correction Sent • There may be times when incorrect received or paid date information is submitted to the Division. • If an incorrect received or paid date is submitted you should correct the data. • Set the bill to Data Correction Sent. You will not be able to submit the batch until the status changes to Data Correction Received. • The status will not change until the data is corrected by your submitter in MDS (Medical EDI).
Notes Overview • View Notes from the Workbench or Summary Pages • Add Notes only from the Workbench • Notes may include attachments • All notes are PERMANENT!
Two Different Levels of Notes… CPS Medical Note Types: • Batch Notes: Apply to the batch as a whole. • Detail (Penalty) Notes: Apply to a specific penalty, RNR, Filing or Payment.
Adding Penalty Notes • Each time a RNR, Filing or Payment penalty is disputed a note must be added to explain the reason for the dispute. • ALL Disputes must be accompanied by a note. • Batches cannot be submitted to the Division until each penalty that requires a note has one.
Allowed Attachments Include: When adding attachments the following file name extensions are acceptable • Htm • Html • Pdf • Txt • Doc • Docx • Xls • Xlsx • Tif • Tiff • Rtf
This is how Batch Notes lookin the System… To review a batch note click on the blue hyperlink under notes. To review a batch document click on the blue hyperlink Request To View. To add a note click on the blue hyperlink under notes.
Add Note text and click “Add Notes.” You can also upload documents with the accepted file name extensions.
Batch Submission • Before submitting a batch all penalties must have an Insurer Status of Concur, Dispute, or Data Correction Received. • A note must be added to each penalty with an Insurer Status of Dispute. • Note attachments are optional.
Performing a Final Check… • Select the Perform Final Check tab to see if all bills have been reviewed and worked.
How to perform a final check… • All penalties that have not been worked will have a status of New. • The system WILL NOT automatically indicate which bills require notes. (HINT: Add Notes when you dispute the penalty to avoid confusion later.) • Use the Insurer Status and Notes column headers to quickly sort the data grids and locate the incomplete items on the penalty details pages.
Submit • Clicking the Submit button will initiate the system’s review of the batch. • If any penalties have not been regarded OR if any disputed penalties do not have a Note the system will prompt the user. • Batches that pass the Final Check are submitted to the Division for evaluation.
The Confirmation Page… After you have clicked the “submit” button…
If the batch is not complete… After you have clicked the “submit” button…
If submission is successful: • The batch is no longer on the Insurer’s workbench. • The batch is viewable on the Insurer’s summary pages. • The batch has been moved to the workbench of a Specialist at the Division of Workers’ Compensation.
And then? • Each Insurer has a designated specialist at the Division. • The Specialist assigned to the submitted batch will process it in a timely manner. • The Specialist will review all disputed penalties and the notes/attachments associated with them. • The Specialist will determine if any of the disputes are acceptable according to current law, Administrative Rules and the policies of the Division of Workers’ Compensation.
Penalty Recalculation … • In general, a batch penalty amount can decrease according to the number of disputed penalties that are accepted by the Specialist assigned to the account. • Data corrections can change penalty amounts.
Penalty Recalculation cont… • If a Notice of Violation (NOV) has been sent and the batch has been processed by the Insurer/TPA and the Division Specialist, it is possible (but not necessary) to request a new Notice of Violation. • Payment for the batch can be made without a new NOV.
Finally… • The Specialist will recalculate the batch if any disputed penalties were accepted. • The batch will be returned to the Insurer’s workbench. • The Insurer can choose to pay in full or make a partial payment. • Special note: If an insurer has Timely Filing penalty in exceeds of $10,000, the penalty will be recalculated so that each untimely filed bill above $10,000 will be assessed a penalty of $5
For now: • Let us assume that the batch will be returned and the Insurer has decided to pay for the batch in full or make a partial payment. • All other scenarios will be addressed in the next session.
Viewing Batch Payment Information • Once a batch has been submitted to the Division it is no longer accessible on the Insurer Workbench. • The batch is accessible on the Summary pages. • Payment Information can be accessed there or from the Payments tab.
Batch Payment Information Click on “Pending Payment”.
For Traditional Check Payments The Payment Screen To pay click the “New Payment” hyperlink
Batch Payment Options: • There are two payment options available at any time. • A Full Payment is simply the total batch payment amount. • A Partial Payment is the sum of all concurred penalties in a batch. • Let’s discuss when to use each method.
Partial Payment • A partial payment can be made if the Insurer receives the initial review of the batch penalties and feels that some or all of the disputed penalties that were denied by the Specialist should be reviewed again by the Division of Workers’ Compensation. • The CPS automatically calculates the partial payment amount as the sum of all concurred penalties in the batch. • Disputed penalties that were accepted by the Division are nullified and do not have an effect on the batch penalty amount.
Full Payment • A Full Payment can be made whenever the Insurer feels that all batch penalties have been sufficiently evaluated and reviewed and no further action is necessary. • Once the full payment amount is received by the Division the batch balance will be adjusted to zero and the batch will close. • At this point the batch is only viewable on the Summary Pages.
