Pennsylvania 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 in the state of Pennsylvania.)
In the state of Pennsylvania, there are some unique billing processes. This is because select Medicaid visits must be completed using electronic visit verification (EVV), and these verified visits are required to be sent to HHAeXchange (Health Choices Managed Care Organization or Fee-for-Service). Select Medicaid visits are also required to be sent to the state's default aggregator, Sandata. For Ankota users, that means in addition to our regular EVV services which we provide, we also deliver appropriate visit data to HHAeXchange to ensure your state's requirements are met. Then you can use our Merged Health Care Claim (837) to file non-EVV billing with the state via. Please note that while Ankota will support you during your implementation and guide you whenever possible, your tax paperwork, registration with individual payers, and registration with clearinghouses is ultimately your organization's responsibility. This EVV FAQ as well as this EVV overview provides more information on this from the state. This article will help guide you through this process at Ankota.
This article covers:
Sandata Set-up
Sandata Testing
Billing Management for Medicaid Visits
State/Gainwell Billing (NON-EVV visits)
Remittance Advice Management (835s)
PA Promise Claim Correction
Set-up
HHAX Set-up
Health Choices Managed Care Organization or Fee-for-Service plans are sent to HHAeXchange. Ankota users in Pennsylvania under any of those plans providing any of the following services to must register for HHAeXchange: PCA, Individual Supports (DDD), Community Based Supports (DDD), In-Home Respite (DDD and MLTSS), and Home Based Supportive Care (MLTSS).
In short, all services requiring an in-home visit are subject to the EVV mandate including self-directed services except for live-in caregivers. Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation, but registration ensures HHAeXchange will accept the data and give providers access to credentials and the HHAeXchange log-in.
To register with HHAeXchange, providers must email edisupport@hhaexchange.com the following information:
- Subject: Alt EVV - Ankota
- Body:
- Provider name: YOUR COMPANY NAME
- Provider contact name and email address: NAME, EMAIL
- Provider Medicaid ID:
- Provider Tax ID:
- 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
- If you want HHAx to bill your data, request that option
Questions about PA EVV can be sent to mahs.evv@dhs.state.nj.us. Additional questions about HHAeXchange can be sent to NJSupport@hhaexchange.com or (866) 245-8337.
HHAeXchange will provide credentials in return. Please send Ankota the following information:
- Your HHAeXchange credentials
- Any HHAeXchange communications
- Your provider Medicaid ID, Tax ID, and taxonomy codes
Pennsylvania collects the following information:
- Type of service
- Person Serviced
- Dates of Service
- Location of Service
- (Reason & Action codes if needed)
- Name of Caregiver
- Times of Service (start & end time)
- Client data
- Medicaid ID in the Medicaid ID field
- Other ID or same ID in the Client ID field
- Client address
- Primary diagnosis code (this must be the diagnosis CODE, not the description, and it must be the code assigned by the state, not a general valid diagnosis code)
- Caregiver demographic data
- First Name Last Name
- DOB
- SSN
- ID & Matching Caregiver Code (do not skip UNLESS you do not want the caregiver to send, like the Ankota Support caregiver)
- Gender
- Type: ‘Both’, ‘Skilled’, or ‘Non-Skilled’ (this is under Roles)
- no other Role is allowed by HHAx
- Hire date
- Valid email and phone format (if email and phone are entered)
- Valid Address (State and 5-digit ZIP required)
- Role - Skilled, Non-Skilled, or Skilled
Please note you can not send visit data until caregivers are successfully sent and received. Please also make sure your clients are on file with the state/HHAx per your payer. Per HHAx, "If you do not accept the [client] placements within a certain time frame they go to a pending queue...You do need to have someone check the system daily to accept new placements." You can email HHAx if you need them to re-set the clients to pending. Please also note clients must have active authorizations in order for clients' data to be accepted.
Note that not all visit types are required to go to HHAx. Click here for a list of visits that should be sent to HHAx.
Set-up
Sandata
Ankota users in Pennsylvania 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.
You will also take EAS training. Sandata will provide credentials in return. Please send Ankota the following information:
- Any Sandata communications
- Your provider Medicaid ID and the categories and/or subdepartments they apply to
Gainwell Set-up
Please note you will need to apply to Gainwell for a submitter ID, sometimes called a subscriber number, as soon as you contract with Ankota if you have non-EVV billing. Be advised there are EDI forms to fill out (101, 102 & 801) in order to obtain that ID, and after submission, the wait time is a minimum of 10-20 business days (often longer). These forms are typically required to be hard copies, physically mailed in.
Testing
HHAX Testing
No state testing processes are required for individual vendors at this time. (Ankota has completed required alt EVV testing.)
Sandata Testing
Pre-Billing
Successful billing starts at the beginning of the client's creation. The processes below will lead to successful billing.
- Caregiver Management
- Add caregivers as usual; new caregivers are exported at end of day (after initial launch)
- If you get caregiver failures in your imported response files, correct the caregivers and then re-send the caregivers
- Do not send visits until caregivers are confirmed
- Client Management
- Client Entry
- Setting Authorized Service for Clients (entering authorizations)
- NOTE: Typically, in Pennsylvania, due to the location issue, we recommend authorizing the CATEGORY, not the VISIT TYPE.
- NOTE: We also recommend you use the Assigned Caregivers feature to allow the caregiver to choose the correct visit type (EVV or NONEVV) at the start of the visit type.
- Schedule Visits - Calendar-Based Scheduling (or for those who prefer the classic approach, Creating Visits from Patterns)
- Visit Management
- Caregivers complete visits or timesheets are entered manually through the office
- Visits are approved automatically or visits are approved by office
- More specifically, ensure visits are closed, then review and clear the Visit Approval Dashboard
- For HHAeXchange EVV visits,
- Prevention of Errors/Rejected Claims
- 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
- Finally, manage your rejections
The Landing Dashboard will highlight necessary actions, including managing visits as needed.
Billing Management for Medicaid Visits
HHAeXchange Billing (EVV visits)
Currently, the following services require EVV management and are sent to HHAeXchange. More information is available here. Please note group homes, DDD Supported Living Services (24-hour service), and self-directed personal care services do not require EVV at this time.
This process works as follows:
- (Pre-billing process above)
- Bill visits as usual in Ankota
- Do not bill overlapping months; for example, January and February visits should be in separate invoices
- Separate out EVV and non-EVV visits to avoid unnecessary rejections from the state
- Visit data is exported to HHAx upon billing in Ankota
- Read your imported response files (see section below)
- Manage corrections
- Re-send visits as needed, usually via the Visit Approval Dashboard
- Release billing in HHAx
- See this training video for more on releasing billing in HHAx
- Please note that once a visit is accepted in HHAx, if there is an issue, that issue must be corrected in HHAx
State/Gainwell Billing (NON-EVV visits)
- (Pre-billing process above)
- Bill visits as usual in Ankota
- Do not bill overlapping months; for example, January and February visits should be in separate invoices
- Separate out EVV and non-EVV visits to avoid unnecessary rejections from the state
- Bill the state with the exported merged health care claim in the Gainwell portal
- This should be the HIPAA-secure log-in; you can upload the file in the "upload" section
CareBridge Billing
N/A.
Imported Response Files
Reading Response Files
After you are connected with HHAx, Ankota will provide you decoded, easy-to-read response files. For more information on this process, click the links below.
Correcting Visits (HHAx)
To correct visits rejected by HHAx, you will need to make corrections in Ankota and then also re-export the visit. For directions based on the type of error, see Managing Data Corrections. We generally recommend you use the Approval Assistant to simplify your visit corrections process. Please note you should ONLY use the Duration adjustments section if there are known, strict limitations on the allowed work duration for the selected visit type.
Remittance Advice Management (835s)
Remittance advice files, or 835s, may be provided in response to filing Medicaid claims. Think of these like state receipts of payments. If you are provided with these files, they can be uploaded to Ankota for an automatic application of payments in the A/R records. Please note Ankota does not provide 835s; if you do not receive them from the state, you will need to arrange to receive this. For more on this process, see below.
- Process Remittance Advice (Upload 835 "receipts" received from MMIS into Ankota)
- Post Manual Payments
- Review Billing Reports
- See also: Collections Report, Exceptions Report
Corrected Claims
Generally, claims corrections are handled one of two ways:
- Update the claims in Ankota and re-send
- Update the claims in the location where it was sent
HHAX Claim Correction
To correct claims that were rejected in HHAeXchange,
- Review your HHAeXchange response files
- Correct the visits with errors as needed
- Re-send visits from Ankota by the appropriate method, either:
- single visit export
- batch visit export (re-completing the affected invoice, which triggers delivery to HHAeXchange)
State/Gainwell Claim Correction
To correct claims that were rejected in the state portal,
- Review your errors
- Correct the visits with errors as needed
- Re-export the 835 Merged Health Care Claim from Ankota
- Upload the 835 in the state portal/via Gainwell
Further Details
These additional resources may also be of use:
- The Ankota Training Overview, including videos
- Daily Adjustments
- Manual Visit Entry
- Private Pay Workflow
If you do not accept the placements within a certain time frame they go to a pending queue. I will go through the pending placements now and add more time. Please have someone accept them today or they will go back to the pending queue. You do need to have someone check the system daily to accept new placements.