Grants/Funds Management and billing
WITS includes robust capabilities for billing, including integrated Contract Management billing, client self-pay, and third party billing. Regardless of billing type, WITS allows providers and administrators at the state and county level to minimize the number of incorrect claims submitted for payment by using data set up screens and business rules. For instance, the State may determine that certain services are not payable if the client is not enrolled in a specific program or level of care. Contractors may limit the providers who can bill their funding sources for specific services. If services must be authorized, providers cannot bill for non-authorized services, or services rendered outside of the authorized date range. In most cases, the provider will be allowed to enter the clinical information for a delivered service, but will stopped from creating a claim item for a particular funding source if these rules are not met. This greatly reduces the burden that states, counties, and other payor administrators have in reviewing and rejecting claims that should not have been allowed in the first place.
contract management billing
Contract Management in WITS allows an entity (contractor) that has money for treatment, recovery, prevention, or other services, to manage contractual relationships with other entities (providers) that will use the money. The Contract set up will govern the use of those funds overall as well as for each fiscal period, and for each provider. Both the state and SCAs in Pennsylvania may act as contractor entities in WITS, and may have different contracts with different parameters set up with the same providers. Use of Contract Management allows generated claim items for clients to be batched and billed by providers, adjudicated and paid by the contractors, and explanation of benefits to be created and applied to provider claim items, all within the confines of the system.
- Many different contractors can have their own parameters and rules regarding the setup of contracts, even if the contracts are with the same providers. Each contractor’s rules will be applied differently, and funding sources will be tracked separately.
- Many different funding sources, such as Block Grant, State Governor’s Funds, and Grant Funds
- The breakdown of each funding source into different subgroups, including age or gender, level of care, special population groups such as Pregnant Women or IV Drug Users
- Each Contractor can set rules about how that money can be accessed by each provider. Rules can vary by provider, funding source, or contract period. These include FFS billing, invoice billing, prior authorizations, specified means testing at the client level, or client eligibility requirements.
- Some states also use this feature as a way to provide incentives to providers or introduce payment models to the world of State or Grant funding.
WITS also integrates standard HIPAA billing transactions for third party billing, and has robust capabilities for self-pay and client balance tracking. All billing types can work together, and providers, counties and states can accurately assess the braided funding used to reach specific outcomes in the treatment of individuals.
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