Visit Approval Dashboard

Overview

The Visit Approval Dashboard, previously called the Visit Closure Report, is where closed visits that may have exceptions to your billing and payroll rules can be addressed. This is where the dates, times, reason codes, and other information can be adjusted. In addition, if one of your rules is broken (including GPS clock-in/out rules), the visit will be flagged here. Once these visits are corrected and approved, they can proceed to billing and payroll. Ankota recommends daily review of the Visit Approval Dashboard.

Article topics include:

Accessing the Visit Approval Dashboard

Begin by going to the Main Menu and clicking on Scheduling, then Visit Approval Dashboard. (Some agencies request for this to be moved to Billing or Reporting; if you do not see this report under Scheduling, go to Billing or Reporting.)

While the settings on this page are adjustable, they are generally defaulted to view all visits that require action (Visit Status: Needs Action) which occurred in the past week for all clients and caregivers. By simply clicking the turquoise View Report button, the list of all visits in the past week which need your attention will be pulled up. Needs Action is typically set as the Review Status default. Note the Needs Action status is flagged pink to help make it clear you are in review mode.

Note the visit count will appear next to your buttons after searching for visits.

Status Listings

There are numerous status listings with various meanings. Here are some examples of standard status listings:

A status of Needs Approval with a type of Regular means something doesn't match the expected value, such as a wrong phone number, or the visit duration is off from the tolerance limit.
A status of Needs Approval with a type of Needs QA means the visit is missing something that needs your attention before it can be approved, such as required skills, missing authorization, visit type requires review, no travel time between visits (when travel time tracking is required for the environment), or overlapping visits. Needs QA approval access can be removed while still allowing the visit details view.
A status of Approved with a type of N/A means you have already manually approved this visit and it is ready for billing and payroll.
A status of Passed Screening with a type of Regular means the visit closure has automatically passed all checks and the visit is ready for billing and payroll.
A status of Passed Screening with a type of Under Review means the visit closure has not automatically passed all checks and you must use the Rerun Rules function to finish closing out visits for billing and payroll.
A status of On Hold typically means the caregiver clocked in, but not out, and you will need to speak with the caregiver, then close the visit and report the care plan items. (Note: some companies may choose to have other types of visits placed on hold, such as visit that were never clocked into to begin with and were still in the status of Scheduled until being placed on hold.)

Search

Visits can be searched one of two ways: by filtering for the appropriate data, or by entering the visit ID.

The filters can be used as needed to find the exact group of visits desired. This is particularly useful when filtering to re-send all visits for a caregiver, or of a specific error type. Once filtered, the system will also give you a visit count.

When you are in review mode, the Needs Action status in the Review Status filter is also highlighted pink to make it clear that you're in review mode and looking at visits that are not closed and are not available for billing or payroll. Note that Review Status is the Ankota internal status, not an external status from HHAx, Tellus, Sandata, etc.

Visit IDs can be searched even if there are leading or trailing blank spaces (usually because of copy and paste), and even if the filters don't correctly match. In other words, even if you're filtered for a two-month date range for visits that Need Action, if you enter a visit ID with blank spaces in front of the ID and then search, the system will search all visits and find the correct visit.

For organizations which export data to clearinghouses or aggregators which are integrated with Ankota, you can also filter by the visits' Export Status. (Note that Review Status is the Ankota internal status, not an external status from HHAx, Tellus, Sandata, etc.)

There is now a *new* filter called Company ID. This helps filter visits by Medicaid ID, Provider Medicaid ID, or NPI on the Visit Approval Dashboard.

Reviewing Visits

After clicking the View Report button, a list of visits will populate below. To view more details, click the pencil "edit" icon at the end of the row to open the visit's full detail report.

Violations

If a visit has been held up for review, most likely there is a violation of one of your company rules. To begin your visit review, scroll down to the bottom of the page to view the full report. Anything requiring review will be flagged in red. In the example below, you see numerous rule violations.

These line items are purely calls to action. Clicking on each red warning and marking it as resolved is for recordkeeping purposes only.

For example, in the screenshot above you see there is a warning that the pay amount is zero. To correct this, you would open the caregiver's profile, enter a new pay rate, save, and then return to the Visit Approval Dashboard to mark this item as resolved.

Once you entered the update and clicked Resolve, this would update your record and change the warning to a Resolved status in green.

Similarly, each of the remaining red warnings would need to be reviewed and action would need to be taken before marking them as resolved.

Common violations include:

Visit start time < _ minutes from scheduled duration
- The duration is shorter than the permitted allowance.
Visit start time > _ minutes from scheduled duration
- The duration is longer than the permitted allowance.
Visit start time +/- minutes from scheduled start time
- The scheduled start time was missed
Visit end time +/- minutes from scheduled end time
- The scheduled end time was missed
Less than _percent of tasks complete or already done
- The percent of tasks did not meet the "tolerance" expected; the tolerance is the limit that you requested
Warning if bill amount is 0
- There is no billing amount either because the visit was incomplete, too short, or the billing rate is not set up
- If the visit had an appropriate length, speak to your Ankota specialist and ask for the rates to be checked
Warning if pay amount is 0
- There is no pay rate for the caregiver or the visit is incomplete or too short
Mobile - Non departure GPS location > _miles difference
- The caregiver clocked in outside of the allowed distance from the location of service
- Click "Show Map" to see 0 (location of service), 1 (actual arrival), and 2 (actual departure)
Mobile - Non arrival GPS location >_miles difference
- The caregiver clocked out outside of the allowed distance from the location of service
- Click "Show Map" to see 0 (location of service), 1 (actual arrival), and 2 (actual departure)
Missing or invalid address
- No location of service (typically client home address) is listed
No arrival call or non-patient arrival phone
- The caregiver either did not call or did not use the correct registered phone number for the client on arrival
No departure call or non-patient departure phone
- The caregiver either did not call or did not use the correct registered phone number for the client on departure
Violation - No Admission ID
- The admission ID (or MCO member ID) is not included on the authorization
Visit is overlapping
- The visit is overlapping with another visit and neither visit is allowed to overlap
Visits closed by or arrived by admin
- These visits typically require coding if your data is delivered to HHAx, Sandata, or Tellus
Violation - Missing Worker ID
Violation - Missing Worker Code
Violation - Missing Payer Descriptor on Visit
Violation - Mobile Rework Visit
- The violation is a “marker”. It is simply making it easier to filter for any visits that were sent for rework.
Visit with Essential Transportation or Errands at Arrival or Departure Not at Client Location and more than _ Miles

If the "tolerance" (difference allowed/set parameter) is not what is desired, ask your Ankota specialist for an adjustment. Many rules can be adjusted or even entirely turned off.

Missing "Approve" Button on Visits

There is a unique kind of rules violation where the Approve button will disappear from your Visit Approval Dashboard. Most commonly, this is the result of one of the following:

Overlapping visits. If you have overlapping visits that are not specifically approved for overlaps, the Approve button will be taken away until the overlap is corrected.
- To correct the overlap,
  - Click on the Reported Value link to the overlapping visit
  - Identify the overlapping visit
  - Filter for the overlapping visit on the Visit Approval Dashboard
  - Change the Corrected Arrive and Departure Date/Time options so it no longer overlaps
  - Click Save Visit Details
  - The Approve button will reappear on both visits once they are no longer overlapping
Travel time less than 1 minute. If a caregiver is clocking out from one client to another and it takes less than 1 minute to move from one location to the next, the system will flag this. You will need to space out the visits' times using the Corrected Arrival Date/Time and Corrected Departure Date/Time options.

Re-run Rules for Selected Visits

Within the Visit Approval Dashboard there is a button called Run Rules. If you select the visits by using the checkboxes to the left and then click Run Rules, the selected/filtered visits have all rules run again. If an error that was flagged on the visit no longer applies, the violation will be marked Resolved and the red line will turn green with the current date and time in approximately 2 minutes.

This function is limited to 1,000 visits maximum. If more than 1,000 visits are filtered, a pop-up that says "Rules can be re-run only if there are 1,000 visits or less selected. Please select fewer visits" will appear.
If no changes are identified there will be no update on any violations (whether approved or not)
Expected violations will be affected include missing IDs, missing authorizations, missing bill rates, missing pay rates, etc.
Wait 2 minutes after clicking the button to take effect
Run Rules can only be used once on a visit, so complete all updates before running rules

For example: John Doe was entered without a Medicaid ID. An admin goes in to review visits from last week and realizes the issue affected every visit from last week. She fixes the Medicaid ID, then re-runs rules on last week's visits for John. She waits 2 minutes, then refreshes. Each Medicaid ID violation is marked as resolved by the system. If that was the only error, those visits no longer need approval.

Approving Visits in the Dashboard

Once you have completed your review of any rules violations, you are likely ready to approve the visit and look at the Visit Detail Report at top. All visits in the Visit Approval Dashboard in the status of Needs Action must be reviewed and approved in order to flow through to Billing and Payroll. See below for more on special functions of the Visit Approval Dashboard.

Payer Descriptor on Visit

The Payer Descriptor field in the Visit Approval Dashboard reflects the payer descriptor (sometimes known as Agency, Referring Party, or another name your organization chooses) assigned to the visit, NOT to the client. If no payer descriptor is assigned, the field will be blank. A blank Payer Descriptor field is an issue if your organization uses payer descriptors, and not an issue if your company does not use them.

If the payer descriptor field is incorrect on this visit, this payer descriptor can be fixed on the Visits page. NOTE: you cannot change a payer descriptor on a visit if the visit is invoiced or paid.

Example 1: a new client is assigned to the payer descriptor of Medicaid and then scheduled for Medicaid visits in January. The client is assigned to Anthem at the start of February in their profile. New visits are scheduled for February, and the current client payer descriptor of Anthem is assigned to them. However, if you look at the January visits on the Visit Approval Dashboard or on the Visits page, Medicaid will be the payer descriptor on those January visits.
Example 2: a new client is NOT assigned a payer descriptor (even though the organization uses payer descriptors). If the visits are scheduled before the payer descriptor is assigned to the client, then the Payer Descriptor field will be blank on those visits. To fix this, you will need to open the client's visits on the Visits page and assign the Payer Descriptor.
Example 3: The organization does not use payer descriptors. The Payer Descriptor field will remain blank in the Visit Approval Dashboard and elsewhere as a result.

Approval Hold, Close Visit, and Visit ID

For incomplete visits, or visits with possible overlaps, the following features are useful:

The Approval Hold button allows you to set a special Approval Hold status for any visit. This status can be specifically searched for under the visit status Approval Hold and will also be included in the Needs Action category. This hold function is useful in many instances, but one of the most commonly used ones is to track missing paper timesheets. For example, one of your caregivers calls from home after a shift and provides the visit information because their phone had died when they were at the client's house. While on the phone with them, you correct the departure time, entered care plan item status, etc., but you don't yet have the actual signed paper timesheet that is necessary for this visit to be billable/payable. You set the status to Approval Hold. This happens with three other caregivers, and you repeat this process with each of their visits. At the end of the week, when all paper timesheets have been turned in, you sort for the status of Approval Hold so you can efficiently upload paper timesheets and approve these visits for billing and payroll.
The Close Visit check box allows you to close the visit from this location. Make sure you have confirmed or edited the Corrected Arrival/Departure times if needed.
The Visit ID link will open the visit on the Visits page for you in another tab, which is particularly useful for checking overlaps.

Corrected Dates/Times, Save Visit Details, and Approve Visit Button

Corrections in Ankota require the use of the following buttons:

The Corrected Arrival Date/Time and Corrected Departure Date/Time are where administrators can make corrections to reported arrival and departure times. This will not create EVV data, but in the event a caregiver failed to or was unable to clock in or out on time, and the caregiver's visit times were confirmed, the administrator can adjust the times in the Corrected fields. Note: If you correct the arrival and/or departure date/time, it will change the method to Manual. This is due to it being a manual adjustment.
Clicking the Save Visit Details button saves the corrected dates/times and recalculates the durations. Note you must click Save Visit Details button both to save AN to recalculate the Scheduled Time, Visit Time, Billable Time, and Payable Times.
The Approve Visit button allows you to completely or partially approve a visit. Options include:
- Needs Approval (still in VAD under Needs Action, not available for billing/payroll)
- Approved for Billing and Payroll (DEFAULT)
- Approved for Payroll (changes status to Needs Approval for Billing, shows up on Calculate Payroll; still treated as needing approval/shows up under Needs Action category)
- Approved for Billing (changes status to Needs Approval for Payroll, shows up on Calculate Billing; still treated as needing approval/shows up under Needs Action category )
- Pay but Don't Bill (changes status to Pay but Don't Bill, shows up on Calculate Payroll; disappears from VAD)
- Bill but Don't Pay (changes status to Bill but Don't Pay, shows up on Calculate Billing; disappears from VAD )
- Never bill, Never pay (changes status to Never bill, Never pay; treated as correctly closed; no longer needing approval/does NOT show up in Needs Action category; does NOT show up under Calculate Billing or Calculate Payroll)

Approval Pop-up

During the final approval of a visit, a new window will pop up with additional options.

NOTE: most states with aggregator requirements (Sandata, Tellus, HHAx, etc.) will need reason coding during visit approval
If the time does not need to be corrected and there are no violations or other items needing adjustment, you can proceed directly to clicking the Approve Visit button. This will bring up a list of approval reasons your company determined was appropriate. Select the necessary one, add notes if needed, and then click the appropriate Approval button.
All visits in the Visit Approval Dashboard in the status of Needs Action must be reviewed and approved in order to flow through to Billing and Payroll.

Show Map

To view actual GPS locations, click Show Map at the bottom of the Visit Approval Dashboard. Location 0 is the actual address of the visit's service location (usually the client's home address), Location 1 is the location of the arrival clock-in, and Location 2 is the departure location.

Changing Scheduled Times in the Dashboard

Most of the time, the scheduled time of any visit should remain the same. There are times when it may be useful to change the scheduled time in the Visit Approval Dashboard, however. (Please note this function may be turned off in your environment, based on your organization's preferences and/or state requirements.)

The most common situation where this occurs is in an organization where visits cannot be billed more than the scheduled time, but a caregiver works longer than planned, and you decide the extra worked time is valid and should be billed. For that reason, you would change the scheduled length in order to make the extra worked time billable.

For example: while watching the Schedule Board, you notice that a reliable caregiver went 2 hours long on a visit, from 10:00 a.m. to 2:00 p.m. (instead of 10 to 12). The caregiver calls you before you can call them. They explain that the client has family visiting tomorrow, and so the client asked for tomorrow's visit to be cancelled, and for the caregiver to work those hours today to make sure laundry is done, the kitchen is cleaned, and the house is tidied for their visit. The caregiver had tried to reach an administrator earlier without luck, and decided based on past experience with you that this would be okay. You agree this is reasonable, you cancel the visit tomorrow, and then you open today's closed visit that went 2 hours long in the Visit Approval Dashboard.

On the Visit Approval Dashboard, you open the visit details and hover your mouse over the Scheduled Departure Date/Time. You change the originally scheduled end time of 12:00 p.m. to be 2:00 p.m. So the scheduled visit length has gone from 2 hours to 4 hours. You click Save Visit Details, and the billable time updates from 2 hours to 4 hours. You approve the visit, and you're done.

Optional Authorization Tracking

Authorization tracking can be included in the Visit Approval Dashboard as well. (Please note this is not defaulted in older environments, and can be turned on by request.)

NOTE: while this next feature is on the client calendar, NOT on the VAD, it is a similar feature. Some customers wish to have clear visuals on their client's calendar of their running authorization, similar to the authorization tracker that is now defaulted in the VAD for most customers. To view authorized and delivered units as a special entry on the client calendar, contact Support and request this option be configured.

Exporting

Export management is outlined in detail in the Managing Data Exports article, but the critical notes are:

Data is exported automatically when billed
Data is exported automatically if the visit is passed screening (COMING SOON)
Data can be exported manually from the Visit Approval Dashboard
Visits can be searched using the Visit ID filter, regardless of other search fields

On the Visit Approval Dashboard, you can export visits either as a group using the mass Export button, or individually, from inside the visit details. Please note previously accepted visits can NOT be exported as a group. They can only be exported individually. This prevents accidental re-delivery of large groups of previously accepted visits, which would slow your system experience.

Integrated Responses

Responses from aggregators (such as HHAX, NetSmart/Tellus, Authenticare, Sandata) as well as responses from aggregators are in the visit details. There is also a Billing filter and a Billing column with the billing status of the visit.

Mass Actions

Mass actions can also be taken in the Visit Approval Dashboard. You can filter for visits, then select all visits, then click any of the following buttons:

Mark as Approved
Export
Approval Assistant (to efficiently manage and resolve issues on large groups of visits)
Run Rules (top of screen, to re-run rules and resolve warnings if the issue is resolved)
Complete Care Plan Items

The Mark as Approved button will allow you to mass approve visits.

The Export button will allow you to mass export visits.

The Approval Assistant button will pull up a pop-up window with several options to more efficiently manage and approve visits in groups. The Approval Assistant can be used to address missing data, reason coding, duration issues, and approvals. This is particularly useful for customers with 100+ clients.

The Run Rules button will review warnings on selected visits and resolve the warnings/mark green if they were closed. (For example, if a client was missing a Medicaid ID and it was flagged with a missing Medicaid ID warning, and you add the ID in and saved the client profile, you could select the client's visits in the Visit Approval Dashboard and click the Run Rules button, and those visits would resolve.)

The Complete Care Plan Items button, which is made available only in unusual situations, will allow you to mass complete care plan items on visits which had incomplete care plan items. When visits are selected and the button is clicked, all care plan items will be marked complete based on the response that is designated the completed option (which could be a different word, like "complete" or "fulfilled" depending on your company's chosen response). NOTE: If the visit is a Vital Signs visit, it will be left n/a. If a care plan item was already reported, nothing will change. This is the only mass action button that will remove the original red warning (the "no care plan items" warning). This is done to prevent a state feedback error.