NetSmart (Formerly Tellus) Billing

Overview

Tellus acts as a clearinghouse for EVV visits in Pennsylvania, Virginia (Anthem Healthkeepers Plus), Georgia (Tellus/Conduent), Florida, Kentucky, and Nebraska. Ankota automatically provides Tellus data as per state standards. While Ankota has state guides and many detailed Tellus articles in this dedicated Tellus training category of the HelpSite, this article provides a simplified overview of the general Tellus process. 

NOTE: The Tellus training webinars are the definitive source for all your Tellus access and training. The article below is aimed at clarifying Ankota's unique integration with Tellus and reviewing some basic Tellus processes. For more information on Tellus training, go to https://4tellus.com/training/ 

INDEX

Critical Pathway

Preparation

Cancellations

Moving Data to Tellus

Releasing Billing in Tellus

Corrections

Rebilling in Tellus (DENIED claims)

Rebilling in Tellus (OVER AUTH claims)

Rebilling in Tellus (Claims never went to Payer)

Critical Pathway

The process to ensure billing success in Tellus is outlined below.

Preparation

• Register with Tellus per your state requirements
  • If you wish to upgrade to a paid account (such as for non-Anthem payers in Virginia), do so
  • Please note that the cost of adding payers has increased, and as of the last update in 2022 it was $400/payer for set-up plus $15 per month
  • If you add non-Anthem payers, note you will need to add the clients, caregivers, and authorizations manually into Tellus prior to visit submission
    • For Highmark, please complete the Self-Registration process, found here:https://mobilecaregiverplus.com/pa-highmark-wholecare/
    • For Anthem Virginia, please contact Customer Support to gain access to their Netsmart Provider Portal: https://mobilecaregiverplus.com/pa-highmark-wholecare/
• Implement & manage Ankota as usual
  • Enter caregiver and client information, ensure visits are closed, review the Visit Approval Dashboard, calculate billing, and complete draft invoices
  • Enter the Admission ID in the authorization
    • Anthem authorizations require unique billable IDs usually starting with VAQ
• Manage cancellations as needed
  • All cancellations require a caregiver name
  • See cancellations section below
• During Visit Approval Dashboard management, use Tellus Reason Codes as needed
  • State requirements vary! Know what codes are needed. 
  • In general, a missing clock-in/out, missing GPS location, and missing telephony data all will require reason coding
  • Georgia customers will likely want to use auto-coding of approved secondary addresses
  • Some states will also reject visits which are too far from the scheduled location (i.e., 0.25 miles+ in Georgia) 
    • Visits off by more than 120 minutes in the start time require a reason code - this requires a VSTR reason code to pass, such as 9104 or 115. 
• Review Tellus Responses as they arrive
  • REJECTED response files means those visits were never accepted in Tellus 
  • In some states, response files will only arrive after completing invoices (Virginia); most other states send an update 48 hours prior to schedule and an update for every status change afterward
• Identify rejection reasons and make corrections as needed

Cancellations

For visits sent to Tellus, cancelled visits must be assigned to a caregiver. (Visits without a caregiver name will be rejected.) Caregivers' names are collected by Tellus to provide transparency for all advance cancellations. In other words, this function makes a caregiver's reliability/attendance visible. However, this caregiver name can be a simple placeholder; for this reason, Caregiver Not Available is a defaulted "caregiver" in many systems. 

Best practice is as follows: 

• For companies where clients are routinely assigned different caregivers, assign a visit which is cancelled in advance to the caregiver Caregiver Not Available before cancelling. This will make it make it clear this is a scheduling issue and not a caregiver attendance issue.
• For companies where clients typically work with the same caregivers, leave the visit assigned to the defaulted caregiver before cancelling the visit. This will make it clear this is an availability issue with this specific caregiver. 
  • If a caregiver cannot cover a visit but you are given enough notice to find coverage with another caregiver, simply assign the visit to the alternate caregiver. There is no need to cancel the visit when the visit is successfully rescheduled.

If you would like to add a generic Caregiver Not Available (Caregiver first name, Not Available last name), you may do so at any time. Alternately, you may ask Ankota Support to add this caregiver.

Moving Data to Tellus (automatic)

• Once billing invoices are completed, Ankota sends the file in a completed status (no uploads or extra actions needed)
• If data is accepted (per the response file), it will move to the Tellus Work List and the visit can no longer be edited in Ankota
• If the visit is rejected (per the response file), Tellus did not accept it to the Work List and can still be edited in Ankota
  • Correct the visits in Ankota 
  • Re-send visits via batch billing (re-completing existing invoices) OR via Visit Approval Dashboard data export
    • After making corrections, it's ok to re-complete an entire invoice batch to trigger visit re-delivery, so the updated rejected visits can be sent again and accepted; the already accepted visits in the batch can't be overwritten
    • You may also use the individual visit "Export" button found on the Visit Approval Dashboard to send just one corrected visit at a time; this is ideal for Reason Code errors which are corrected on the Visit Approval Dashboard
    • Critical errors could mean you need to cancel the entire invoice and associated payroll so that you can correct the visit (such as wrong name, payer, rate, or time) before re-creating the invoice and re-exporting data
    • Archiving/Deleting visits is a last resort; please consult with Ankota before taking this measure

REMINDER: Once the visit has reached the status of completed, the visit will move to the Tellus Work List and will be available to release for billing in Tellus. Once visits are accepted in the Tellus Work List, Tellus will no longer accept further updates from Ankota. You will need to fix any remaining issues in Tellus at that point.

Releasing Billing in Tellus

• Review your accepted visits in the Tellus Work List; make corrections as needed
  • Unmatched claims, claims denied due to authorization, or claims with $0 need to be corrected. Do not skip fixing unmatched claims, or your claims will be denied!
    • View the error
    • Address the error as needed in Tellus, usually by clicking the exclamation point (!) and entering a reason code
    • If you cannot select a reason code in Tellus, there is probably a critical error that must be fixed in the visit above
      • Critical errors include no authorization, no units/hours left on the authorization, or wrong visit type code (such as T1019 instead of T1019 TF)
    • If this is an issue that will cause an error in the future, like a wrong primary diagnosis code, also fix it in Ankota
    • Once the error is fixed, with the affected visit(s) selected, click the Rematch button
      • If you don't understand the error, reach out to Tellus support
      • In Georgia, first line support for Tellus is Conduent
    • If your visit is complete but the visit status DETAIL status is HOLD on the Visits page (not the Work List), then you are missing critical data. You can correct this as follows: 
      • Open the visit in Tellus
      • Select the visit
      • Regenerate the claim
      • Do not regenerate the claim UNLESS the visit status is complete. If the visit is not closed, regenerating it could break the visit.
      • The visit to claim status will now say SUCCESS
      • If this does not work, immediately reach out to Tellus; this is a Tellus issue
    • NOTE: If no visits for a client are matching, check to see if your clients and authorizations are in Tellus. If they are not, take action.
• Release all Matched claims
• Watch Tellus Claims for pending, accepted, and paid or denied status
• If the state provides you an 835, be sure process your 835

Releasing matched billing in Tellus can be made automatic, but you will still need to review for rejections/unmatched visits. NOTE: Different states will require different actions on missing clients/authorizations. For example, in Georgia, you would reach out to Conduent for support. In Virginia, you would manually enter the payers, clients, and authorizations for non-Anthem clients, but would reach out to Tellus for Anthem clients. Etc.  

Corrections

Rebilling in Tellus (DENIED claims)

If your claims have made it all the way to Claims before you see an issue, and it is DENIED on the Claims page, the claim is dead in the water. Appeal by re-billing the same visit with a new visit ID. For more details, see the full article on rebilling with a new visit ID here.

Rebilling in Tellus (OVER AUTH claims)

If your claims receive the warning that they are over authorization, you may have visits in Archive that have units in them that are being counted against you authorization. To correct this, move the Archived visits back to the Worklist, change the time back to 1 minute, and then move the visit back to the Archive.

Rebilling in Tellus (Claims never went to Payer)

If your claims never get over to the Payer after releasing them from the Work List, please use the following workflow:

• Open a Support Ticket in NETSMART
• Create an Export from the Claim Review page
• Attach an Export(.CSV) to the Support Ticket
• Include in the ticket that you are giving consent to NETSMART to escalate ticket to their Level 2 and Level 3 Helpdesk
  • Level 2 will review the visit to confirm they are in the ACCEPTED status
• Once confirmation has been made in Level 2, the visits are then sent to Level 3 Helpdesk for re-submission to Payer
• Reach out to Payer after 3-4 business days to confirm receipt of visits for further processing and payment