The Challenge
ILRC manages financial services for Medicaid-funded personal assistance services (PAS), a process that involves multiple complex steps:
- Tracking client service authorizations against worker claims
- Processing payroll for assistance workers
- Managing billing across multiple systems
- Ensuring claims don’t exceed state authorizations
- Maintaining compliance with state reporting requirements
The multi-system process was prone to errors that could result in denied claims. Staff needed a way to verify that worked hours stayed within authorized limits before processing payroll and submitting claims to managed care organizations.
The Spectrumware Solution: PAS CATS
Spectrumware developed and supports PAS CATS (Personal Assistance Services Claim Authorization Tracking System), a custom Microsoft Access application that serves as the central hub for all financial data related to ILRC’s PAS program.
Core Functionality
Claims Import and Validation
Staff import electronic visit verification (EVV) claims data from Authenticare. PAS CATS automatically compares worked hours against state authorizations and generates reports that flag over-utilization to prevent denied claims.
Automated Accounting Integration
The system generates custom-formatted files for direct upload into ILRC’s CYMA accounting system, automating the process of:
- Processing worker payroll
- Creating invoices for managed care organizations (MCOs)
- Applying MCO payments
Regulatory Compliance
PAS CATS generates the state-mandated annual Excess Funds report, ensuring ILRC meets all regulatory requirements.
The Results
- Improved Claims Accuracy: Automated authorization checking prevents over-utilization and reduces the risk of denied claims.
- Streamlined Operations: Data flows automatically between claims and accounting systems, eliminating manual data entry and reducing errors.
- Regulatory Compliance: Automated reporting ensures ILRC meets state requirements without manual report compilation.
- Efficient Financial Management: ILRC can manage the complex finances of their PAS program through a single centralized system.
“Thank you to all of you over at Spectrumware for continuing to work with us, you are a great group to work with and we greatly appreciate all of you. 😊”
—Cindy Unruh, Executive Director
Independent Living Resource Center
If your organization faces similar challenges managing complex financial workflows or regulatory reporting, contact us at Info@Spectrumware.net to discuss how custom software could streamline your operations.
