ACAP Information for Providers

Become an ACAP Provider

Keystone Autism Services (KAS) continuously searches for in-network providers to increase and maintain access to care. The ACAP network is made up of both behavioral health and physical health providers. Both of these services are covered benefits. In addition to in-network providers, KAS can also have out-of-network agreements in order to improve access to care that is not available through an in-network provider option.

Requirements

Requirements of In-Network Providers with ACAP as MA Providers

• Submit documentation of Medical Assistance status (e.g. letter from DHS)
• Complete and sign a Provider Agreement
• Complete and sign a Business Associate Agreement (BAA)
• Submit proof of liability insurance (usually a declaration page)
• Submit copies of applicable practitioner/facility licenses. Attestations and electronic listings can be used for compliance with this requirement as well.
• Submit W-9 (if not billing on standardized claim form)
• Confirmation of no exclusions
• For Respite and Habilitation services, understanding/implementing training requirements

Requirements of Out-of-Network Providers

Out-of-network agreement requirements are the same as in-network procedures, with the exception of submitting MA status documentation.

Vendors & Other

In some cases, the above two contract options do not apply. Agreements for those types of services are managed using vendor procedures. The requirements to be a vendor service provider with ACAP are:

Complete and sign a Business Associate Agreement
Submit proof of liability insurance (usually a declaration page)
Submit copies of applicable service type licenses and certifications (e.g. chemicals for lawn treatment). Attestations and electronic listings can be used for compliance with this requirement as well.
Submit W-9 (if not billing on standardized claim form)
Confirmation of no exclusion

Other Requirements
Depending on the type of service being rendered, requirements as a provider can include but are not limited to:

Provision of encounter forms (unless billing on standard claim form such as UB-04, 1500, Dental Claim Form
Submitting clinical documentation regarding progress toward goals quarterly (at minimum)
Timely billing (within 45 days of service delivery)

Provider Manual

KAS has a Provider Manual with important information. It’s important for you to review this document. For the services you are providing, resources, guidelines, and procedures regarding clinical documentation will be reviewed in a separate meeting.

Documents

Documents
To access provider-related documents, please select from among the links below.

Provider Manual 2022
Provider Autism Training Procedure
Provider Autism Training Procedure Signature Template
Encounter Form – Multiple Dates
Encounter Form – Single Date
Encounter Form Single Date with Clinical Summary
Provider Treatment – Plan Template
Provider Treatment Plan Template Guideline/Example
Provider Autism Resources