Georgia 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 Georgia.)
In the state of Georgia, 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 the state's default EVV provider as their statuses change. For Ankota users, that means in addition to our regular EVV services which we provide, we also deliver your visit data to Netsmart/Conduent on a near-real-time basis to ensure your state's requirements are met. This article will help guide you through this process.
This article covers:
Billing Management for Medicaid non-EVV Visits
Billing Management for Medicaid EVV Visits
Remittance Advice Management (835s)
Critical Pathway
For a simple overview of key admin system maintenance, see this overview with linked steps: Georgia Critical Path PDF.pdf
Set-up
Ankota users in Georgia must register for Tellus/Netsmart EVV. (Ankota will deliver visit data to Tellus/Netsmart.) This registration will ensure Tellus will accept their data and give providers access to the Tellus log-in. After registering for Tellus, log in and make sure that Tellus has all of your clients, client addresses (including secondary locations), and authorizations.
Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation.
Please note the state of Georgia prefers mobile app over telephony for EVV. If you have clients who must use telephony, you must file the appropriate registration form and receive the state's approval to continue using telephony. Per confirmation 8/30/21, FOBs are not allowed (use the Lifeline Medicaid phone if needed). Also confirmed 8/30/21, as an alternative to mobile app usage on the caregiver's smartphone, clients with smartphones may download the Ankota Caregiver mobile and permit caregivers to clock in/out on that app if desired. To apply for client telephony registration, download this form and submit it to the state: Georgia EVV IVR Request Form - Provider Agency for Traditional Members.docx
Testing
No state testing processes are required. Organizations may begin billing Tellus/Netsmart and GAMMIS per the directions below once they have been configured to do so by their Ankota specialist.
Pre-Billing
General Management
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 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
- Note that Tellus/Netsmart visits require Reason Codes if they are missing critical EVV data such as a clock-in, clock-out, GPS data, or telephony data
- Note that cost sharing / copay functions can be managed in Ankota if desired - request configuration if you do not have this feature
- Prevention of Errors/Unmatched/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
- Ensure that name spellings, First Name/Last Name separation, Medicaid ID, and DOBs are entered correctly
- (And if those preventative actions fail, watch for Rejection Response Files and address those issues as needed)
- NOTE: Ankota will automatically code secondary client addresses(clients with listed additional addresses) to ensure acceptance by Netsmart.
- Deadline - Thursday at midnight for in-home
- Oct. 2021 update: Note that the claims submission deadline is now Thursday at midnight to be in the Friday payment cycle. Providers can no longer wait until Friday noon to submit EVV-applicable claims. This submission will occur via the Netsmart (Tellus) solution.
- Deadline - Friday at noon for Adult Day
Billing Management for Medicaid non-EVV Visits (GAMMIS billing)
Non-EVV visits (all visits except T1019, T2025, and S9122) should be billed via the state portal. See here for further details.
- Schedule visits as usual; caregivers clock in and out as usual
- Manage visits as usual
- Calculate Billing
- Review the Billing Report (Client) and complete invoices
- Bill through the GAMMIS portal manually OR Export the Merged Health Care Claim and upload the file into state Medicaid portal
- Please note the Merged Health Care Claim option will be rolled out to all Ankota Georgia Medicaid clients as it is available in 2022
Billing Management for Medicaid EVV Visits (TELLUS/Netsmart billing)
Currently, EVV visits are listed as T1019, T2025, and S9122 (pediatrics) visits. These are the only visits to be billed in Tellus/Netsmart. See here for further details on Tellus/Netsmart visits. If you have accidentally sent over the wrong visit types to Tellus/Netsmart, please note these visits can simply be archived in Tellus/Netsmart and billed through the GAMMIS portal as usual.
See here for a detailed overview of Tellus/Netsmart billing. (This overview includes a link to the critically important articles for reason codes and reading response files, as well as how to manage cancellations. Another helpful article is managing data exports, which clarifies other export options as well.)
Note: Tellus/Netsmart should receive all authorizations directly from the state, so if you see a client is missing an authorization in Tellus/Netsmart, reach out to Conduent right away. (For support regarding any claims issues in the state of Georgia, you must first reach out to Conduent for Tier 1 support at 833-701-0012, GAEVVSupport@Conduent.com, or www.GAEVV.com for chat.)
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. GAMMIS can make this available.
- 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 (such as Tellus/Netsmart or the state GAMMIS portal)
For more information on errors and how to manage them, see Managing Data Corrections.
GAMMIS
For GAMMIS billing, you can correct the claims as needed by canceling the invoices and associated payrolls, correcting the data, and rebuilding the invoices as needed for upload. If you have partially paid claims which you don't wish to reverse, you will need to use the Corrected Claims process.
TELLUS
The key to understanding how data is managed between Ankota and Tellus/Netsmart is as follows:
- Any visits which receive acceptance response files from Tellus/Netsmart in Ankota successfully transferred a status update to Tellus.
- Any visits which receive rejected response files from Tellus/Netsmart in Ankota did not successfully transfer a status update to Tellus.
- Once a visit is completed (closed/invoiced) AND accepted, that visit is no longer editable in Ankota. Any further updates must be made in Tellus.
Rejected visits in Ankota must have data corrected in Ankota first, then the data must be re-sent to Tellus/Netsmart by moving the invoice from Draft to Complete. (For information on what data to correct, check the response file.) If you see a rejection response, this is a great opportunity to fix an issue and still be able to send out the data.
Completed AND accepted visits will move to the Work List and will be available to release for billing in Tellus/Netsmart. At this point, any errors in Work List claims must be corrected in Tellus/Netsmart, and Tellus/Netsmart will no longer accept further updates from Ankota. To resolve claims issues in Tellus/Netsmart, review the error messages and take action. For more information on Tellus training, go to Training Webinars - Mobilecaregiverplus.com
We generally recommend you use the Approval Assistant to simplify your Tellus 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.
For support regarding any claims issues in the state of Georgia, you must first reach out to Conduent for Tier 1 support at 833-701-0012, GAEVVSupport@Conduent.com, or www.GAEVV.com (for chat).
Further Details
For a more detailed walkthrough on the Tellus claims billing process, see the Tellus/Netsmart walkthrough.
For more information on rejection reasons, see Tellus/Netsmart Response Files.
For more information on reason codes, see Tellus/Netsmart Reason Codes.
For more information on multiple address management in Georgia, see Georgia Second Address Automatic Reason Coding.
For more information on rebilling claims already released from Netsmart but were never received by the Payer, see Rebilling(Claims were never received by Payer)