Ohio Workflow

Overview

While there is a default vendor for EVV management in Ohio, the state allows for approved alternate EVV vendors such as Ankota. To ensure consistency in procedures across the state, Ankota has several additional requirements and procedures outlined below for all Ohio vendors.

(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 Ohio.) 

This article covers:

• Set-up
  • Sandata Registration
  • Sandata Requirements
  • Ohio Unique Requirements
• Testing
• Pre-Billing
• Billing/Payroll Overview
  • Billing
  • Remittance Advice
• Integrated Responses
• Corrected Visits
• Further Details

Critical Pathway

TBD.

Set-up

Sandata Registration

In order for Ankota to send your data to the state, Ankota must be provided with your Sandata credentials. Credentials are effectively a user name and password for Sandata that is assigned to you and shared with us.

Ankota users in Ohio must register with Sandata in order to set up, complete their EAS training, and receive those credentials. You can register here.

You will need this information at some point in the registration process:

• 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, COO, sharon.dodge@ankota.com, 844-4-ANKOTA, extension 703.

When you complete your EAS training, Sandata will provide credentials in return. Please send Ankota the following information as soon as you’re able:

• Any Sandata communications
• Your provider Medicaid ID and the categories or visit types they apply to

If you need any assistance in completing this Sandata registration, contact your implementation specialist, who can walk you through this process.

Sandata Requirements

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

Caregiver Requirements

• Caregiver First Name & Last Name
• 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
• Caregiver SSN
  • if you do not wish to use the SSN, you'll need to enter a unique ID in the SSN field (a unique second ID is required by the state), such as FCSR ID + 0

Client Requirements

• Client ID
• 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 First Name & Last Name
• Client phone: if a phone is entered, it must be labeled Home, Mobile, Business, or Other
• Client address
• Client time zone
  • Ankota supplies this automatically
• Payer assignment

Customer (Agency) Requirements

• Medicaid Provider ID (provide this to Ankota if you have not already)
  • Make sure you are aware of all of your Medicaid Provider IDs
  • Be sure to complete the EAS training; this triggers the release of your credentials to Ankota (data can not be sent without credentials)
• Company email at the Org. Details level
• An email for each administrator
• (Primary diagnosis codes are not required by Sandata, but they are required for 837 billing)

NOTE: task/care plan item delivery is not required in Ohio as of the July 2024 specs.

Sandata Transmission

All EVV data must be sent to Sandata every 24 hours, even for visits placed on hold. This is done as part of our normal procedures. Once a client is live in Ankota, that data is sent. Please note that all appropriate data must be included for seamless transmission, including IDs, caregiver codes (both caregiver ID and caregiver code must be entered for each caregiver), payer, etc. 

Ohio Unique Requirements in Ankota

There are many unique Ohio requirements for EVV management, most of which are naturally part of the Ankota system. There are a few which differ slightly from Ankota's normal operations:

• A unique email must be used for the caregiver's log-in ID
• Each exception to a visit must have an exception code applied to it
• There are several potential Ohio IDs; this critical process of ID management is outlined here
• Confirming service is a three-part process where the visit type/service, times, and receipt of service are all confirmed separately
  • If visit data is changed after the visit is closed, the three-part confirmation can be affected
  • For example, if times are changed after the visit is closed by an admin, the confirmation of times by the client is null and void

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

• Manage Needs Action visits as usual
• Review rejected visit responses in the VAD as they come in
• Make corrections as needed
• Re-export data as needed

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)
    • May also use My Clients/on-the-fly self-scheduling feature as needed
• 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
    • Apply Sandata reason codes as needed
• Prevention of Errors/Unmatched/Rejected Claims
  • Watch your warnings on the Action Center (such as missing client IDs) and address as needed
  • Watch your warnings on the Visit Approval Dashboard and address as needed
  • Apply Reason Codes as needed

Billing/Payroll Overview

Billing

To bill, 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, you are ready to bill via EDI file.

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. ERAs are sent less often now, typically 11 days after the end of the billing cycle.

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

Integrated Responses

Acceptance/Rejection status from Sandata is integrated into the Visit Approval Dashboard as well as the Landing Dashboard. 

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 and then the visit can be immediately re-exported. 

We generally recommend you use the Approval Assistant to simplify your visit corrections process. 

For more information on errors and how to manage them, see Managing Data Corrections.

Further Details

These additional resources may be of use to Ohio clients:

• The Ankota Training Overview, including videos
• Daily Adjustments
• Manual Visit Entry