FAQ - SARs and Invoicing / Payment
- How are agencies paid for their services?
- Providers in the WIser Choice Network submit their billing in the form of Service Cature Worksheets. Service Capture Worksheets (SCWs) are created at BHD and mailed to providers weekly. One worksheet for each client for each week of service. If a client is authorized for more than one service at an agency, the agency may receive several SCWs for the client. During the first few weeks of an authorization, a provider may need to use a blank SCW if one was not received for the client. (If the provider has not received a SCW for a client after 3 weeks, the provider should contact the Central Intake Unit, Recovery Support Coordinator, or SAIL/AODA, as the client may not have authorization.) Currently Provider agencies may be paid several times a week. Providers may only provide and bill for those services that have been prior authorized.
- How do vouchers work?
- After a client's SAR (Service Authorization Request) is evaluated and approved, an authorization (voucher) is created that specifies a certain number of sessions/units of service (ex. 15 minutes of direct service time per unit) within a period of time for use by the client. The voucher is an agreement to pay for the services the client uses, up to the specified number of units and between the specified dates, or until the approval is withdrawn.
- What are some of the reasons a client's SAR approval may be withdrawn?
- Approval may be withdrawn from a client for a variety of reasons. For example, if the client has not appeared at set appointment times, if the client has been sent to a correction facility, or if the current level of care is no longer deemed appropriate. WIser Choice reserves the right to withdraw approval at any time, and will pay for services accrued through the date of withdrawn approval.
- What if a client name does not appear on the caseload list or on SCWs?
- Agencies should contact the referrer (central intake unit or the recovery support coordinator) to make sure that the client has an authorization. If authorized, the agency should submit SCWs for the services rendered, and the agency will receive payment for events for clients with authorization.
- What is a SAR (Service Authorization Request)
- A SAR is the document used to request funding for a service in the Access to Recovery program.
- Who can fill out a SAR?
- It is preferable that a client´s Recovery Support Coordinator submits Service Authorization Requests, but a social worker or an agency´s designated staff worker may fill out a SAR also.
- What information is required?
- For a new client, the information needed to fill out a Service Authorization Request is, first, the name & location of the Recovery Support Coordinator, second, demographic information about the client (name, DOB, SSN, address, children, etc.) and third, the justification of requested services. The SAR also requests a SCCP, but for a new client, an initial treatment plan is acceptable too.
- What is a SCCP?
- A Single Coordinated Care Plan is a document crafted in a Team Meeting attended by multiple systems (government, community, faith, social, family, etc.).
- How will I be contacted? What´s the response time?
- Most of the SARs we receive are via fax. The SAIL/AODA Unit faxes back the original SAR with the approval/denial area (page 2, bottom) filled in. ATR guidelines state that the response time should be between 24 and 48 hours.
- What processes does the SAR go through?
- When the SAR is received, it is stamped, logged, and entered into the database. Next, a panel of one to three people discusses a response to the request. After it has been approved or denied and the number of units has been determined, it is faxed back to the agency and filed.
- Are there wait lists? How is position determined, by need or wait? How long is the wait?
- Some of our ATR provider agencies have wait lists, the length of the wait varying with the agency and the service desired. The length of the wait determines the position on the wait list (with the exception of pregnant women, who are given priority).
- How come there aren´t more agencies so no one needs to wait?
- We are in the process of accepting RFP's for agencies or organizations that are interested in providing services for ATR clients. However, one of the focuses of the ATR Program is to make choices available, and to allow clients to wait for the agency/service of their choice. The purpose of wait lists is two-fold. One is to allow the freedom of choice and the second is for financial management. Funds must be used in a measured way throughout the year. Clients have the opportunity to try alternative services while they wait for the service of their choice to become available.
- What are the most common reasons for a denial?
- One of the main reasons for an initial denial is for lack of information. Upon receipt of more information, the request may be approved. Another reason for a denial is repeated requests for the same client for maintaining the current level of care. In this instance, maybe other services could be provided that might prove more beneficial to the client.
- How does "amount requested" work?
- The "amount requested" space located on the SAR is for a one-time payment, which may be used to support a client´s financial needs. That money may be used for furnishings, clothes, rent, utilities, tools, emergency use, food, bus tickets, etc.