California Workflow

Overview

(As always, private pay is generally self-regulating within the confines of state law and regulatory processes. This article focuses on Medicaid billing, particularly Medicaid billing with the Sandata aggregator, in the state of California.)

In the state of California, Sandata data delivery is now required for a number of visit types. This article will help guide you through this process of general company management as well as Sandata data management.

This article covers:

Critical Pathway

For a simple overview of key admin system maintenance, see this overview with linked steps: California Critical Pathway.pdf

Set-up

Sandata

Ankota users in California must register with Sandata and with the state. This registration will ensure Sandata will accept their data and give providers access to the Sandata log-in. Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation.

To register with Sandata, providers must email Sandata the following information:

Subject: Request for EVV Vendor Certification (Ankota)
Body:
- Provider name: YOUR COMPANY NAME
- Provider contact name and email address: NAME, EMAIL
- Vendor name: Ankota LLC
- Vendor address: 1 Franklin Street, Suite 360B, Boston, MA 02110
- Vendor contact name & contact information: Sharon Dodge, Director of Implementation, sharon.dodge@ankota.com, 844-4-Ankota, extension 703.

Write to Sandata in order to receive your credentials. (Think of your credentials as the user/password that will allow Ankota to send your data.) Then please send Ankota the following information:

Any Sandata communications
Your provider Medicaid ID and the categories and/or subdepartments they apply to
Your production credentials as you receive them

You will also take the Sandata training. Sandata will provide credentials in return. Please send Ankota the following information:

Any Sandata communications, including your credentials (we can not send your data without credentials)
Your provider Medicaid ID and the categories and/or subdepartments they apply to

In addition to the standard set-up of adding clients, caregivers, authorizations, care plans, and scheduling visits, California Medicaid providers will want to ensure the following is available in their system:

Caregiver ID
Caregiver Code
- Copy the caregiver ID into the caregiver code for all active caregivers
- This enables deliver of your caregivers to Sandata
- Do not assign a caregiver code to "fake" caregivers, such as Ankota Support
Client ID
Client Jurisdiction ID and Payer ID (assign in the Client Registration tab in the client's profile)
Client Medicaid ID in the client's Medicaid ID field (even if it is already in the client ID field)
Client date of birth (DOB)
Client phone: if a phone is entered, it must be labeled Home, Mobile, Business, or Other
Medicaid Provider ID (provide this to Ankota if you have not already)
- Make sure you are aware of all of your Medicaid Provider IDs
Company email at the Org. Details level
An email for each administrator

After California customers have data flowing through to Sandata, they will:

Review imported response files as they come in
Make corrections as needed
Re-export data as needed (by individual visit, group selection, or invoice re-completion)

Testing

For Sandata, no state testing processes are required other than the initial Ankota testing process.

Pre-Billing

Successful billing starts at the beginning of the client's creation. The processes below will lead to successful billing.

Client Management
- Setting Authorized Service for Clients (entering authorizations)
- Schedule Visits - Calendar-Based Scheduling (or for those who prefer the classic approach, Creating Visits from Patterns)
Visit Management
- Caregivers complete visits
- Visits are approved automatically or visits are approved by office
  - More specifically, ensure visits are closed, then review and clear the Visit Approval Dashboard
  - Note that Sandata visits require Reason Codes to be applied as needed in the Visit Approval Dashboard
Error Prevention
- Watch your warnings on the Action Center (for missing auths, primary diagnosis codes, IDs, etc.) and address as needed
- Watch your warnings on the Visit Approval Dashboard and address as needed
- Ensure that the client's name, Medicaid ID, and DOB is entered correctly
- Set reason codes as needed during VAD approval

Billing/Payroll Overview

Billing

To bill Sandata-required visit types, perform your usual visit review and billing processes in Ankota. In other words, after ensuring visits are closed, reviewing the Visit Approval Dashboard, calculating billing, and completing draft invoices, your data is exported.

Please note that completing your invoices is ALSO the process which pushes out your visit data to Sandata. Even if you do not use Ankota's EDI file billing, you will need to run billing and complete your invoices in order to push out your data and meet the state's requirement unless you use the export override on the Visit Approval Dashboard.

Remittance Advice Management (835s)

Remittance advice files, or 835s, are provided in response to filing Medicaid claims. Think of these like state receipts of payments. These files can be uploaded to Ankota for an automatic application of payments in the A/R records. For guidance on this process, see the links below.

Process Remittance Advice (Upload 835 "receipts" received from MMIS into Ankota)
Post Manual Payments
Review Billing Reports
- See also: Collections Report, Exceptions Report

Imported Response Files

Although billing is not yet based on data delivered to Sandata, typically you will not receive imported response files until after you bill. For more information on this process, click the links below. (Remember, the state requires you to send successful data to Sandata.)

Corrected Visits (Sandata)

When correcting visits, the errors generally fall into one of a few categories, each of which is managed differently. In general, fundamental errors require backing out billing in order to correct the visit, then re-invoice, whereas reason code or demographic information can typically be updated in the Visit Approval Dashboard and then the visit can be immediately re-exported from the VAD. For more information on errors and how to manage them, see Managing Data Corrections.

Further Details

These additional resources may be of use to California customers:

The Ankota Training Overview, including videos
Managing Data Exports