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WellSky Claims Processing System

Individual entering data into a computer while seated at a desk.

As part of the Division’s Current 2 Future Initiative, a vendor was selected to help DDD update its claim system in order to be compliant with state and federal regulations and to resolve the AHCCCS HIPAA TCS Compliance Claims Processing System Notice to Cure. This determination was based on DDD not utilizing the Healthcare Common Procedure Coding System (HCPCS) and standard Centers for Medicare & Medicaid Services (CMS)& claims forms when reimbursing Qualified Vendors for submitted claims.

This will include the use of standardized Health Insurance Portability and Accountability Act (HIPAA)& Transactions and Code Sets (TCS) in lieu of DDD proprietary codes currently being used by vendors when submitting claims. WellSky, a vendor offering healthcare software solutions, was selected for this project.

Vendors must submit claims on official, nationally-recognized forms using the WellSky system. The current DDD billing template has been replaced by these forms. Vendors will have three options for submitting claims:

  1. Submit an electronic 837 form
  2. Manually enter claims directly in WellSky for each authorization
  3. Submit a CMS 1500 form in paper form

Along with using the proper HCPCS/CPT codes, the rates will be adjusted to match the appropriate billing unit. Most of the HCPCS/CPT codes are billed in 15-minute increments. The adjustment to the rates will be a calculation to adjust from an hourly rate to a 15-minute rate. This adjustment will not decrease the revenue in comparison to billing for a full hour.

Below is a screenshot of the WellSky claims system in which HIPAA compliant electronic claims transactions are processed.

Frequently Asked Questions

The Division has created a Frequently Asked Questions document that is continually updated. Please check this document before attending one of the question and answer sessions or before submitting a new question as it may have already been answered.

*Updated* WellSky System Issues/Updates/Fixes

Frequently Asked Questions

Required Action

Qualified Vendors will have access to three accounts that will be used to submit claims billings. The Vendor’s contract main point of contact or designee must designate these billing users by identifying them in the FOCUS system. Contract main points of contact or designee can assign these users following these three steps:

  • Login in to the Focus and select the Admin Tools application.
  • Choose “Users” at the top of the page.
  • Click the “Assign” button in the column labeled “Access to WSHS” for up to three individuals who will be able to access the claims system.

Qualified Vendors will issues relating to their login or password should send their issue via email to [email protected].

Resources

Training

The Division’s Provider Relations team has been contacting Qualified Vendors to ensure they have assigned a WellSky administrator in Focus.Over 50 training sessions were offered between May and August. If you are listed as a designated WellSky user and need to gain access into WellSky but have not attended training, please email [email protected] to request to be added to the list for any upcoming trainings. At this time, all training sessions will be held virtually through Google Meets and you must have a computer to attend a training session. WellSky training is a prerequisite for claims submission. Not attending training and gaining access to WellSky will cause a delay in claims payment.

837 Certification

An 837 Certification Form must be submitted to and approved by DDD before a user will gain access to the parallel prod environment.

Only those providers that will be submitting electronic 837s need to be certified. If a third-party biller represents multiple DDD agencies, they only need to submit ONE Certification Form.

Troubleshooting Guides:

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