Massachusetts 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 Massachusetts.) 

In the state of Massachusetts, 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. For Ankota users, that means in addition to our regular EVV services which we provide, we also deliver your visit data to My Timesheet to ensure your state's requirements are met. This article will help guide you through this process.

This article covers:

Set-up

Testing

Pre-Billing

Integrated Responses

Remittance Advice Management (835s)

Further Details

Critical Pathway

For a simple overview of key admin system maintenance, see this overview with linked steps: Massachusetts Critical Pathway PDF.pdf

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Set-up

State Registration

ASAP providers must register with the state as using a third-party solution (complete two bullet points below only). Please request the form and upload it to the state through your Managed File Transfer. 

• Complete and return this excel form: Provider Identification Spreadsheet_MA EVV Data Aggregator_12-07-20.xlsx. (Instructions can be found on page 9 in the Massachusetts Registration.docxfile.)
• Complete and return the Alternate Electronic Visit Verification System Attestation of Compliance Form on page 15 of the Massachusetts Registration.docxfile. Instructions can be found on page 14 of this same file. If necessary, this form can be submitted separately from the other forms in the Provider Identification Packet. 

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 Massachusetts must also 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, Director of Implementation, 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
• 9 Digit Unique # (SSN or 9-digit caregiver state ID recommended)
• Employee email not required, but must be valid if included

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
  • must be labeled Home, Mobile, Business, or Other
• Client address
• Payer assignment

Note clients must have the Voice Signature and the Service/Times additional confirmation in the mobile app per the state.

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 Massachusetts as of the August 2024 specs.

Testing

Currently state testing is ongoing prior to the 2024 Sandata launch date.

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)
• Visit Management
  • Caregivers complete visits or timesheets are entered manually through the office
    • Note clients must have the Voice Signature and the Service/Times additional confirmation in the mobile app per the state.
  • Visits are approved automatically or visits are approved by office
    • More specifically, ensure visits are closed, then review and clear the Visit Approval Dashboard of all Needs Action visits
• 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

• Finally, manage your rejections

The Landing Dashboard will highlight all necessary actions, including managing visits as needed.

Billing Management for Medicaid EVV Visits

Most visits are required to be delivered to Sandata; Ankota will only export the required visits.

The Massachusetts EVV billing process is as follows:

• Register with the state
• Set up in Ankota
• Schedule visits as usual; caregivers clock in and out as usual
• Watch the Landing Dashboard for task reminders
  • Needs Action (unbilled visits with issues) 
    • The Approval Assistant will help highlight missing data, uncoded visits, and visits with duration issues to make Needs Action visit management fast and easy
  • Rejected visits (approved exported visits that were rejected by the state)
• Bill visits as usual in Ankota
  • status updates are sent throughout this process
• Visits are automatically exported upon billing and marked approved for billing

To summarize,

Integrated Responses

Note that additional details on Sandata rejections are integrated into the Visit Approval Dashboard as well as the Landing Dashboard. 

Remittance Advice Management (835s)

Visit payments can be recorded manually, or uploaded as 835s (electronic remittance advice files) into Ankota. These 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. 

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

Further Details

For more information on rejection reasons, see Reading Sandata Responses.

For more information on reason codes, see Sandata Reason Codes.

For a guide to managing mass visit cleanup, see Historic Visit Cleanup.