The Centralized Performance System Medical Module

CPS Basics

CPS Logon PageCPS Logon Page

Forgot Your Password? Use the link at the Forgot Your Password? Use the link at the bottom of the screenbottom of the screen

CPS Organizational ChartCPS Organizational ChartLogon

Home

Medical Main

Summary Batch

Overview

Workbench Batch

Overview

Payment Home

Printed Reports

Management

Summary Penalty Overview

Workbench To Do List

Batch PaymentsAccount

Administration

Summary Penalty Details

Workbench Penalty Details

Payment Details TPA Assignment

HYPERLINKSHYPERLINKS

On any page you can click on the On any page you can click on the blue hyperlink to see additional blue hyperlink to see additional details.details.

In the summary page or on the In the summary page or on the workbench you can view a specific workbench you can view a specific penalty type (RNR, Timely Filing or penalty type (RNR, Timely Filing or Timely Payment) by clicking on any Timely Payment) by clicking on any of the blue hyperlinks.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 insurers medical bill data submitted and processed by the Division in a calendar month.

Summary Batch OverviewSummary Batch Overview

Summary Penalty OverviewSummary Penalty Overview

Summary Penalty OverviewSummary Penalty Overview

Toggling Between Claims Handling EntitiesToggling Between Claims Handling Entities Use the drop down box on the right of the screen Use the drop down box on the right of the screen in the middle of the pagein the middle of the page

The View All Screen allows viewing of all The View All Screen allows viewing of all Medical Bills submitted in a batch.Medical Bills submitted in a batch.At the bottom of this section you can select to download the At the bottom of this section you can select to download the

information in Excel or CSV format.information in Excel or CSV format.

MS Excel Output…MS Excel Output…

CSV Output…CSV Output…

Sending a Batch to the Workbench…Sending a Batch to the Workbench…Use the hyperlink to send the batch to your workbench

Selecting a BatchSelecting a BatchIn the box below there are two batches on this workbench.

The Workbench Overview To Do ListThe Workbench Overview To Do List

Timely Filing Penalty Detail Overview…Timely Filing Penalty Detail Overview…

RNR Penalty Detail Overview…RNR Penalty Detail Overview…

Timely Payment Penalty Detail Timely Payment Penalty Detail Overview…Overview…

AssigningAssigning RNR,RNR, Filing and Payment Penalty Filing and Payment Penalty Statuses:Statuses:

Insurer Statuses: Insurer Statuses:

Dispute: Dispute: The Insurer/TPA has reviewed The Insurer/TPA has reviewed the medical bill data information and the medical bill data information and does not agree that a penalty should does not agree that a penalty should have been assessed.have been assessed.

Concur:Concur: The Insurer/TPA has reviewed The Insurer/TPA has reviewed the medical bill data information and the medical bill data information and agrees that the penalty is valid.agrees that the penalty is valid.

Examples of Insurer StatusExamples of Insurer Status Once you have reviewed the bill and reached a decision to concur, dispute or make a data correctionyou must select a box on each line. If the decision is the same for all bills you can “select all”.

Data Correction SentData Correction Sent There may be times when incorrect received or There may be times when incorrect received or

paid date information is submitted to the Division.paid date information is submitted to the Division. If an incorrect received or paid date is submitted If an incorrect received or paid date is submitted

you should correct the data.you should correct the data. Set the bill to Data Correction Sent. You will not Set the bill to Data Correction Sent. You will not

be able to submit the batch until the status be able to submit the batch until the status changes to Data Correction Received.changes to Data Correction Received.

The status will not change until the data is The status will not change until the data is corrected by your submitter in MDS (Medical EDI).corrected by your submitter in MDS (Medical EDI).

Notes OverviewNotes Overview

View NotesView Notes from the Workbench or from the Workbench or Summary PagesSummary Pages

Add NotesAdd Notes only from the Workbench only from the Workbench

Notes may include attachmentsNotes may include attachments

All notes are All notes are PERMANENT!PERMANENT!

Two Different Levels of Notes…Two Different Levels of Notes…

CPS Medical Note Types:CPS Medical Note Types:

Batch Notes:Batch Notes: Apply to the batch as Apply to the batch as a whole.a whole.

Detail (Penalty) Notes:Detail (Penalty) Notes: Apply to Apply to a specific penalty, RNR, Filing or a specific penalty, RNR, Filing or Payment.Payment.

Adding Penalty NotesAdding Penalty Notes

Each time a RNR, Filing or Payment Each time a RNR, Filing or Payment penalty is disputed a note must be added penalty is disputed a note must be added to explain the reason for the dispute.to explain the reason for the dispute.

ALLALL Disputes Disputes mustmust be accompanied by a be accompanied by a note.note.

Batches cannot be submitted to the Batches cannot be submitted to the Division until each penalty that requires a Division until each penalty that requires a note has one.note has one.

Allowed Attachments Include:Allowed Attachments Include:When adding attachments the following file name extensions are acceptable

Htm Html Pdf Txt Doc Docx Xls Xlsx Tif Tiff Rtf

Viewing Batch Level Notes and DocumentsViewing Batch Level Notes and Documents

This is how Batch Notes lookThis is how Batch Notes lookin the System…in 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.

Notes must be addedNotes must be addedfrom the Workbenchfrom the Workbench

Click the “Notes” hyperlink…Click the “Notes” hyperlink…

Add Note text and click “Add Notes.” You can also upload documents with Add Note text and click “Add Notes.” You can also upload documents with the accepted file name extensionsthe accepted file name extensions

Batch SubmissionBatch Submission

Before submitting a batch all penalties Before submitting a batch all penalties must have an Insurer Status of must have an Insurer Status of ConcurConcur, , Dispute, or Data Correction Received.Dispute, or Data Correction Received.

A note must be added to each penalty with A note must be added to each penalty with an Insurer Status of an Insurer Status of Dispute.Dispute.

Note attachments are optional.Note attachments are optional.

Performing a Final Check…Performing a Final Check…

Select the Perform Final Check tab to see if all bills have been Select the Perform Final Check tab to see if all bills have been reviewed and worked.reviewed and worked.

How to perform a final check…How to perform a final check…

All penalties that have not been worked All penalties that have not been worked will have a status of will have a status of NewNew..

The system The system WILL NOT WILL NOT automatically automatically indicate which bills require notes. indicate which bills require notes. (HINT: (HINT: Add Notes when you dispute the Add Notes when you dispute the penalty to avoid confusion later.)penalty to avoid confusion later.)

Use the Use the Insurer StatusInsurer Status and and NotesNotes column headers to quickly sort the data column headers to quickly sort the data grids and locate the incomplete items on grids and locate the incomplete items on the penalty details pages.the penalty details pages.

SubmitSubmit Clicking the Clicking the SubmitSubmit button will initiate the system’s review of the batch. 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 If any penalties have not been regarded OR if any disputed penalties do not have a NoteNote the system will prompt the user. the system will prompt the user.

Batches that pass the Final Check are submitted to the Division for evaluation.Batches that pass the Final Check are submitted to the Division for evaluation.

The Confirmation Page…The Confirmation Page…

After you have clicked the “submit” button…

If the batch is not complete…If the batch is not complete…After you have clicked the “submit” button…

ERROR MESSAGE…..ERROR MESSAGE…..

If submission is successful:If submission is successful:

The batch is no longer on the The batch is no longer on the Insurer’s workbench.Insurer’s workbench.

The batch is viewable on the The batch is viewable on the Insurer’s summary pages.Insurer’s summary pages.

The batch has been moved to the The batch has been moved to the workbench of a Specialist at the workbench of a Specialist at the Division of Workers’ Compensation.Division of Workers’ Compensation.

And then?And then?

Each Insurer has a designated specialist at the Each Insurer has a designated specialist at the Division.Division.

The Specialist assigned to the submitted batch The Specialist assigned to the submitted batch will process it in a timely manner.will process it in a timely manner.

The Specialist will review all disputed penalties The Specialist will review all disputed penalties and the notes/attachments associated with them.and the notes/attachments associated with them.

The Specialist will determine if any of the The Specialist will determine if any of the disputes are acceptable according to current law disputes are acceptable according to current law and the policies of the Division of Workers’ and the policies of the Division of Workers’ Compensation.Compensation.

Penalty Recalculation …Penalty Recalculation …

In general, a batch penalty amount In general, a batch penalty amount can decrease according to the can decrease according to the number of disputed penalties that number of disputed penalties that are accepted by the Specialist are accepted by the Specialist assigned to the account.assigned to the account.

Data corrections can change penalty Data corrections can change penalty amounts or installment liability. amounts or installment liability.

Penalty Recalculation cont…Penalty Recalculation cont…

If a Notice of Violation has been sent If a Notice of Violation has been sent and the batch has been processed by and the batch has been processed by the Insurer/TPA and the Division the Insurer/TPA and the Division Specialist, it is possible (but not Specialist, it is possible (but not necessary) to request a new Notice necessary) to request a new Notice of Violation.of Violation.

Payment for the batch can be made Payment for the batch can be made without a new N.O.V.without a new N.O.V.

Finally…Finally…

The Specialist will recalculate the The Specialist will recalculate the batch if any disputed penalties were batch if any disputed penalties were accepted.accepted.

The batch will be returned to the The batch will be returned to the Insurer’s workbench.Insurer’s workbench.

The Insurer can choose to pay in full or The Insurer can choose to pay in full or make a partial payment.make a partial payment.

For now:For now:

Let us assume that the batch will be Let us assume that the batch will be returned and the Insurer has decided returned and the Insurer has decided to pay for the batch in full or make a to pay for the batch in full or make a partial payment.partial payment.

All other scenarios will be addressed All other scenarios will be addressed in the next session.in the next session.

Viewing Batch Payment InformationViewing Batch Payment Information

Once a batch has been submitted to the Division it is no Once a batch has been submitted to the Division it is no longer accessible on the Insurer longer accessible on the Insurer WorkbenchWorkbench..

The batch is accessible on the The batch is accessible on the SummarySummary pages. pages.

Payment Information can be accessed there or from the Payment Information can be accessed there or from the PaymentsPayments tab. tab.

Batch Payment InformationBatch Payment Information

Click on “Pending Payment”.

The Payment ScreenThe Payment Screen

The Insurer has two payment options; send a check or “Pay Online”.

To pay by check click “New Payment”

For Traditional Check Payments

For Electronic Payments

Batch Payment Options:Batch Payment Options:

There are two payment options There are two payment options available at any time.available at any time.

A A Full Payment Full Payment is simply the total is simply the total batch payment amount.batch payment amount.

A A Partial Payment Partial Payment is the sum of all is the sum of all concurred penalties in a batch.concurred penalties in a batch.

Let’s discuss when to use each Let’s discuss when to use each method.method.

Partial PaymentPartial Payment

A partial payment can be made if the Insurer A partial payment can be made if the Insurer receives the initial review of the batch receives the initial review of the batch penalties and feels that some or all of the penalties and feels that some or all of the disputed penalties that were denied by the disputed penalties that were denied by the Specialist should be reviewed again by the Specialist should be reviewed again by the Division of Worker’s Compensation.Division of Worker’s Compensation.

The CPS automatically calculates the partial The CPS automatically calculates the partial payment amount as the sum of all concurred payment amount as the sum of all concurred penalties in the batch.penalties in the batch.

Disputed penalties that were accepted by the Disputed penalties that were accepted by the Division are nullified and do not have an Division are nullified and do not have an effect on the batch penalty amount.effect on the batch penalty amount.

Full PaymentFull Payment A A Full PaymentFull Payment can be made whenever the can be made whenever the

Insurer feels that all batch penalties have Insurer feels that all batch penalties have been sufficiently evaluated and reviewed been sufficiently evaluated and reviewed and no further action is necessary.and no further action is necessary.

Once the full payment amount is received Once the full payment amount is received by the Division the batch balance will be by the Division the batch balance will be adjusted to zero and the batch will close.adjusted to zero and the batch will close.

At this point the batch is only viewable on At this point the batch is only viewable on the Summary Pages.the Summary Pages.

How do I make a Partial or Full Payment?How do I make a Partial or Full Payment?

Enter Check InformationEnter Check Information

Payment Saved…Payment Saved…

Note: The insurer should print the “Payment Note: The insurer should print the “Payment Statement” to send with the payment to the Division. Statement” to send with the payment to the Division.

Payment Listed…Payment Listed…

The Centralized Performance System Indemnity Module

Administrative Functions

Administrative ActionsAdministrative Actions

The Insurer Administrator can:The Insurer Administrator can:

Create New Sub-Accounts.Create New Sub-Accounts.

Edit the Permissions of Existing Sub-Edit the Permissions of Existing Sub-Accounts.Accounts.

Lockout/Unlock Sub-Accounts.Lockout/Unlock Sub-Accounts.

Control TPA Access to Insurer batches.Control TPA Access to Insurer batches.

Creating New Sub-AccountsCreating New Sub-Accounts

Insurer Administrators have the Insurer Administrators have the authority to create sub-accounts for authority to create sub-accounts for their company and grant them their company and grant them permissions.permissions.

There is no limit to the number of There is no limit to the number of sub-accounts that can be created. sub-accounts that can be created.

To create a sub-account…To create a sub-account…

What happens next?What happens next?

Once the Once the Add NewAdd New link is clicked link is clicked the Account Administration Detail the Account Administration Detail Page is displayed.Page is displayed.

This page is essentially a blank user This page is essentially a blank user template. template.

Some information about a new user Some information about a new user must be entered to create the must be entered to create the account.account.

Click the “Add New” link…Click the “Add New” link…

Account Creation Part I…Account Creation Part I…

What access rights shall the user have?What access rights shall the user have?

• Account Access Rights (one of three Account Access Rights (one of three levels):levels):

View Items and Add Notes:View Items and Add Notes: This level of permission is This level of permission is intended for use by managers, auditors, or any other intended for use by managers, auditors, or any other agents the company wishes to empower to view agents the company wishes to empower to view ALLALL of the of the firm’s CPS data as well as add notes to CPS batches.firm’s CPS data as well as add notes to CPS batches.

View Items and Update Status:View Items and Update Status: This level of permission This level of permission is intended to be used by personnel who will actively is intended to be used by personnel who will actively process CPS batches before they are submitted to the process CPS batches before they are submitted to the Division of Workers’ Compensation. Users with this level of Division of Workers’ Compensation. Users with this level of permission can do everything listed above but can also permission can do everything listed above but can also assign penalties a status of assign penalties a status of Concur Concur or or Dispute.Dispute.

Submit Batches:Submit Batches: Users with this level of permission can Users with this level of permission can view and add notes to batches, assign penalty statuses, view and add notes to batches, assign penalty statuses, and submit batches to the Division of Workers’ and submit batches to the Division of Workers’ Compensation. By default this permission is given to each Compensation. By default this permission is given to each company’s Insurer Administrator. The Insurer company’s Insurer Administrator. The Insurer Administrator can decide whether to retain this privilege or Administrator can decide whether to retain this privilege or grant it to any number of sub-account users.grant it to any number of sub-account users.

Account Creation Part II…Account Creation Part II…The password will be sent via email to the addressee you will need to grant a level of access for this account. Once you have done this click save

To edit an existing sub-account…To edit an existing sub-account…

Click the “Edit” Link…Click the “Edit” Link…

Editing Existing Sub-account permissionsEditing Existing Sub-account permissions

The permissions of existing sub-The permissions of existing sub-accounts may be modified by the accounts may be modified by the Insurer Administrator as needed at Insurer Administrator as needed at any time.any time.

For details on how to edit existing For details on how to edit existing user permissions please observe user permissions please observe the following step-by-step example.the following step-by-step example.

Sub-account fields to define include:Sub-account fields to define include:

Contact person:Contact person: This is the name of This is the name of the sub-account user.the sub-account user.

E-mail Address:E-mail Address: This is the email This is the email address the sub-account user wishes address the sub-account user wishes to receive CPS messages at if they are to receive CPS messages at if they are given privileges to do so by their given privileges to do so by their Administrator.Administrator.

The Account Administration Detail Page…The Account Administration Detail Page…

Update all information and save or delete to remove the record completely

The User’s Account Opens…The User’s Account Opens…

The selected user’s profile opens. The selected user’s profile opens.

Please make note of the usage of the buttons at Please make note of the usage of the buttons at the bottom of the screen as well. They are:the bottom of the screen as well. They are:

Buttons on the User Accounts Page are:Buttons on the User Accounts Page are:

Save Record:Save Record: Clicking this button will Clicking this button will commit any changes made to a user’s commit any changes made to a user’s record.record.

Cancel:Cancel: This button will cancel any This button will cancel any changes made to a user’s record since changes made to a user’s record since accessing their profile.accessing their profile.

Delete:Delete: Clicking this button will delete Clicking this button will delete the user’s account.the user’s account.

Optional Features…Optional Features…

Optional features of the Optional features of the User Accounts User Accounts Page Page are discussed here. These are discussed here. These features include:features include:

– Lockout:Lockout: Clicking inside the Clicking inside the LockoutLockout check check box will lock or unlock a user’s account. box will lock or unlock a user’s account. Lockout can occur by the Insurer Lockout can occur by the Insurer Administrator or by the Division of Workers’ Administrator or by the Division of Workers’ Compensation. The Compensation. The lockoutlockout checkbox checkbox provides functionality to use this feature of provides functionality to use this feature of the system.the system.

– Receive Pre-NOV Email:Receive Pre-NOV Email: If this checkbox is If this checkbox is checked the user will receive any Pre-Notice checked the user will receive any Pre-Notice of Violation e-mails sent by the system.of Violation e-mails sent by the system.

These User Profile Controls Look Like…These User Profile Controls Look Like…A snapshot of the A snapshot of the Lockout, SecurityLockout, Security and and Receive Pre-N.O.V.Receive Pre-N.O.V. controls: controls:

The Cc E-mail Control…The Cc E-mail Control…

In the event that multiple parties wish to In the event that multiple parties wish to receive automated messages from the receive automated messages from the CPS their e-mail addresses can be added CPS their e-mail addresses can be added to the to the Cc Email Cc Email text box under the text box under the “My “My Profile” tabProfile” tab..

Once their email address is input in the Once their email address is input in the Cc Email Cc Email box and the box and the SaveSave button is button is clicked all subsequent system generated clicked all subsequent system generated email messages of the CPS will be sent to email messages of the CPS will be sent to these persons.these persons.

A Close-Up of the Cc E-mail Control…A Close-Up of the Cc E-mail Control…

Lockout by the Division:Lockout by the Division: The Division of Workers’ Compensation reserves the right to lock The Division of Workers’ Compensation reserves the right to lock

any Insurer out of the CPS at any time.any Insurer out of the CPS at any time.

A system e-mail message shall be sent to the Insurer A system e-mail message shall be sent to the Insurer Administrator of the affected Insurance Company notifying them Administrator of the affected Insurance Company notifying them of the lockout.of the lockout.

All sub-accounts of the affected Insurer are locked out by default.All sub-accounts of the affected Insurer are locked out by default.

If the Insurer Administrator or a sub-account user attempts to If the Insurer Administrator or a sub-account user attempts to logon to the CPS a message is displayed informing them of the logon to the CPS a message is displayed informing them of the lockout and asks them to contact their Specialist at the Division of lockout and asks them to contact their Specialist at the Division of Workers’ Compensation for further information.Workers’ Compensation for further information.

Once the Division unlocks the Insurance Administrator account, it Once the Division unlocks the Insurance Administrator account, it is the duty of the Insurer Administrator to unlock each of their sub-is the duty of the Insurer Administrator to unlock each of their sub-accounts (performed by a single click of a check box) and notify accounts (performed by a single click of a check box) and notify them that their account is once again operational. them that their account is once again operational.

Lockout / Unlocking of Sub-accountsLockout / Unlocking of Sub-accounts

The power toThe power to lock and unlock sub-lock and unlock sub-accountsaccounts can be used in two ways.can be used in two ways.

Let’s discuss both lockout scenarios. Let’s discuss both lockout scenarios.

Account lockout at the Insurer’s discretion:Account lockout at the Insurer’s discretion:

The Insurer Administrator reserves the The Insurer Administrator reserves the right to lock any of their sub-accounts at right to lock any of their sub-accounts at any time.any time.

Locking out a sub-account user is as easy Locking out a sub-account user is as easy as clicking inside a check box on the as clicking inside a check box on the Administration Page of the CPS.Administration Page of the CPS.

TPA AssignmentTPA Assignment

TPA name, contact, phone and email columns will be populated

You can change the security role of the TPA. You must put a check in the box under the “Select” column before the drop down menu will appear in the “Access” column.

Close Up…Close Up…

By clicking on the View hyperlink above you can view the TPA address

TPA Address Pop-Up…TPA Address Pop-Up…

The Reports Tab…The Reports Tab…

Select a date range…Select a date range…

Click on the “Generate Report” button

VOILA!!!VOILA!!!

Contact Outside of the System…Contact Outside of the System…

1.1. Refunds.Refunds.

2.2. Preservation of Rights / Requesting a Preservation of Rights / Requesting a Hearing by DOAH or the JCC.Hearing by DOAH or the JCC.

What About Refunds?What About Refunds?

The system shall automatically flag any The system shall automatically flag any batch that has a negative balance with a batch that has a negative balance with a status of status of “Refund Due.”“Refund Due.”

Specialists shall issue requests for any of Specialists shall issue requests for any of their client’s batches with the their client’s batches with the “Refund “Refund Due”Due” status. status.

An application for refund must be An application for refund must be completed by the Insurer or TPA before completed by the Insurer or TPA before the refund can be processed.the refund can be processed.

Preservation of Rights / Preservation of Rights / Requesting a hearing by DOAH:Requesting a hearing by DOAH:

The final administrative privilege discussed is used only if The final administrative privilege discussed is used only if a resolution to batch penalties cannot be found by a resolution to batch penalties cannot be found by working within the system.working within the system.

In the event an Insurer wishes to preserve their rights In the event an Insurer wishes to preserve their rights and/or request a hearing by the Department of and/or request a hearing by the Department of Administrative Hearings a written request must be filed Administrative Hearings a written request must be filed with the Division within 21 days of the Insurer receiving with the Division within 21 days of the Insurer receiving the Notice of Violation.the Notice of Violation.

The Notice of Rights and Notice of Violation are sent to The Notice of Rights and Notice of Violation are sent to Insurers by Certified Mail if batch penalties have not been Insurers by Certified Mail if batch penalties have not been resolved through the CPS during the Preliminary Notice of resolved through the CPS during the Preliminary Notice of Violation Stage. .Violation Stage. .

The 21-day clock begins when the Insurer signs the The 21-day clock begins when the Insurer signs the Certified Mail Receipt. Certified Mail Receipt.

Questions?Questions?

Should you have further questions or Should you have further questions or concerns contact your Specialist. The concerns contact your Specialist. The name of your assigned specialist can be name of your assigned specialist can be found at the bottom of your profile tab. found at the bottom of your profile tab. You can call 1-850-413-1608 and request You can call 1-850-413-1608 and request that person. If they are not available you that person. If they are not available you can request to speak with the Medical can request to speak with the Medical Administrator.Administrator.