Virginia 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 Virginia.)
In the state of Virginia, there are some unique billing processes.
Aggregators: Anthem requires Netsmart as its aggregator and clearinghouse. Humana Healthy Horizons requires HHAX as its aggregator and clearinghouse. Data is exported upon billing in both cases in the state of Virginia. Note that while most payers allow for billing up to a year late, they have advised that "claims must be submitted within one calendar month to avoid claim denials."
-
Clearinghouses: most clearinghouses will handle all your claims for an additional fee, but some will provide free services for a single payer. Most customers find it easier to set up, test, and manage claims through a single portal, or at most two.
Aetna Better Health of Virginia is free through Office Ally
-
Humana Healthy Horizons is free through HHAx
Availity is no longer used with Humana as of October 29, 2025
Sentara prefers Availity
Molina is now Humana and is required to be sent through HHAx
Batch EDI claims submissions require a premium Availity subscription.
United Healthcare Community Plan does not have a preferred clearinghouse
Straight Medicaid is free through Conduent
For Ankota users, that means in addition to our regular EVV services which we provide, we also deliver visit data to the desired clearinghouse to ensure your state's requirements are met. This article will help guide you through this process.
IMPORTANT NOTE: As of February, 2025, we have been notified that the following MCO's are currently not accepting new Agencies:
Anthem
Molina
United Health Care
IMPORTANT NOTE: As of October, 2025, Humana visits must be billed through HHAx. You can not bill through another party, such as Availity.
This article covers:
Billing Management for Medicaid Visits
Remittance Advice Management (835s)
Critical Pathway
For a simple overview of key admin system maintenance, see this overview with linked steps: Virginia Critical Pathway.pdf
Set-up and Testing
Note that caregivers are required to have 1 profile in Ankota. (Admins can have both caregiver and admin profiles in order to access different levels of permissions.) Caregivers must be paid in a single payroll per Virginia standards.
NetSmart
Ankota users in Virginia must register for EVV so that their Anthem claims can be billed. (Ankota will deliver visit data to NetSmart/Mobile Caregiver Plus.) This registration will ensure NetSmart will accept their data and give providers access to the NetSmart log-in. Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation. Testing is not necessary.
Alternately, send an email to dl_evv_sales@ntst.com and provide them with the following information:
Agency Name
Contact Email
Phone Number
Payer – Anthem
Provider Name
Provider EIN
Provider NPI
Medicaid ID#
They will, in turn, will send you a confirmation within 24-48 hours. Should you not receive anything, please reach out to them at 833-4-TELLUS and check status.
NOTE: If you wish to upgrade to a paid NetSmart account (for non-Anthem payers in Virginia; Anthem is free) so that all your billing is through one clearinghouse, you can do so, but please note that the cost of adding payers has increased. As of the last update in 2022, it was $400/payer for set-up plus $15 per month.
HHAX Set-up
Humana Healthy Horizons claims are sent to HHAeXchange. Ankota users in Virginia under this plan providing any of the following services to must register for HHAeXchange: In-Home Personal Care, In-Home Respite, and Home Based Supportive Care (HCSS).
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. PLEASE NOTE: Non-EVV visits can and should be sent through Availity such as Service Facilitation visits.
To ensure success with HHA,
Register with HHA
Request the EDI payer rates be set up for Humana for your system
Deliver credentials to Ankota so your data can be delivered (user/pw for your SFTP)
Request Ankota set up your system for HHA data delivery, reason coding, Approval Assistant configuration, etc.
To register with HHA, providers must go to the Virginia HHAeXchange portal and complete this form. Also, please register to send your HUMANA visits through HHAx. You will need the following information:
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, COO, sharon.dodge@ankota.com, 844-4-Ankota, extension 703
If you want HHAx to bill your data, request that option
It is necessary to create a username/password through the SFTP Setup on HHAx portal for successful billing as well as having HHAx configure your account to bill HUMANA visits. Please watch the following video for instructions:
Please send Ankota the following information:
Your HHAeXchange username and password from the SFTP Setup
Any HHAeXchange communications
Your provider Medicaid ID, Tax ID, and taxonomy codes
Questions about VA EVV can be directed to:
Humana Healthy Horizons in Virginia: For plan specific questions, please email Humana Healthy Horizons in Virginia Provider Relations at VAMedicaidProviderRelations@humana.com.
HHAeXchange: All providers can contact HHA by submitting a ticket via the Client Support Portal: https://www.hhaexchange.com/supportrequest
Virginia 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
Critical Notes:
If you are switching to Ankota from HHAx EVV, you must close out all visits and bill in HHAx (or notify them you do not wish to bill) before they will allow you to create your username and password for your integration. This means you cannot even have scheduled current/future visits remaining in the HHAX system or your integration with Ankota will be blocked.
Once you are ready to transition (and any visits in HHAX are closed out/billed), you can get your username and password credentials so that Ankota can deliver your data to HHAx to your SFTP folder path. Please create these in your portal and share them with Ankota. Ankota can then enter them and confirm the integration is ready to move forward with HHAx.
PA does not require caregivers. Also, not all visit types are required to go to HHAx.
For further questions, contact Pennsylvania HHAX 844-626-6813 option 3 OR phwproviderrelations@pahealthwellness.com or the general 888-801-1660 provider line, or simply use the HHAX portal to create a Support ticket through the right-hand menu.
Availity
Ankota users in Virginia must register for Availity if they wish to use them for non-Anthem MCOs. Ankota will set up Availity during implementation upon request. Testing is not necessary. A paid account is needed for some MCOs and for straight Medicaid. Be sure to complete the full set-up if you wish to have automated file transfer, including providing Ankota with your Availity FTP user name and password.
Conduent
Ankota users in Virginia must register with Conduent if they wish to use them. Ankota will set up Conduent during implementation upon request.
Click here for a complete walkthrough of the Conduent registration, set-up, and testing process.
Office Ally
Office Ally is the selected clearinghouse for Aetna Better Health of Virginia. They do accept some other MCOs without charge, but generally there is a fee for "Non-par" (non-participating) payers. This can be set up by request.
Pre-Billing
Successful billing starts at the beginning of the client's creation. The processes below will lead to successful billing.
-
Client Management
Client/Caregiver Entry
-
Setting Authorized Service for Clients (entering authorizations)
In VA, if a client receives services from a live-in caregiver and a regular caregiver, the decision whether they need an extra authorization for those live-in services is determined by the Payer. Each payer may handle the situation differently. Agencies are advised to reach out to case managers and/or Payer in this case (Sentara, Anthem, United Healthcare, etc....).
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
Critical note: For accurate DMAS reporting, when a caregiver works Respite time, they must report at least ONE Respite item. For the mobile app, they will report the Respite item using the drop-down list. For telephony, they will report a Respite code. See more here.
-
Visits are approved automatically or visits are approved by office
More specifically, ensure visits are closed, then review and clear the Visit Approval Dashboard
Critical note: For NetSmart, apply Exception Codes as needed (REQUIRED if missing EVV clock-in or clock-out)
-
-
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
Ensure that name spellings, First Name/Last Name separation, Medicaid ID, admission ID (on auth), and DOBs are entered correctly
Finally, manage your rejections
The Landing Dashboard will highlight necessary actions, including managing visits as needed.
Billing Management
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 NetSmart visits require Reason Codes if they are missing critical EVV data such as a clock-in, clock-out, GPS data, or telephony data
-
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)
NetSmart Billing
This is the detailed overview of Tellus billing.
Currently, only Anthem is required to go through NetSmart, and this is free. Providers may choose to send other billing through NetSmart for a start-up + monthly fee. (This overview includes a link to the critically important articles for reason codes and reading Tellus response files, as well as how to manage cancellations. Another helpful article is managing data exports, which clarifies single-export corrections as well as mass export corrections.)
Note: NetSmart should receive all authorizations directly from the state, so if you see a client is missing an authorization, reach out to NetSmart support right away.
Availity Billing
Availity is commonly used for Virginia MCOs but is NOT usable for Humana as of October 29, 2025. See here for a detailed overview of Availity, including billing, troubleshooting, and more.
Conduent Billing
Conduent is required for straight Medicaid billing in Virginia (although NetSmart and Availity will process them for a fee). See here for a detailed overview of Conduent, including billing, troubleshooting, and more.
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
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.
See the NetSmart, Availity, and Conduent articles for more on these processes.
Remittance Advice Management (835s)
Remittance advice files, or 835s, may be provided in response to filing Medicaid claims. Optima normally provides 835s through the Availity portal. 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)
-
See also: Collections Report, Exceptions Report
Further Details
These additional resources may also be of use:
The Ankota Training Overview, including videos