Kentucky 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 Kentucky.) 

In the state of Kentucky, there are some unique billing processes. 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 on a regular basis. For Ankota users, that means in addition to our regular EVV services which we provide, we also deliver your visit data to Therap to ensure your state's requirements are met. This article will help guide you through this process. 

Please note providers bill via 837s to KYMMIS, and all visit edits/approvals will take place in Ankota.

Kentucky transitioned to Therap (from Tellus/Netsmart) during the month of January 2025. For more details, click here.

This article covers:

Critical Pathway

Set-up

Therap

Data Requirements

Testing

Pre-Billing

Billing Management for Medicaid Visits

Remittance Advice Management (835s)

Corrected Claims

Further Details

Critical Pathway

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

Set-up

Ankota users in Kentucky must register with Therap and complete 3 forms. This registration will ensure Therap will accept customer data and provider users a Therap log-in to double check data success. Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation.

Therap 3rd Party EVV Registration

Further information here on registration.

• To: KYSUPPORT@therapservices.net and copy info@therapro.com 
• Subject: Request for EVV Vendor Certification (Ankota)
• Body:
  • Agency Name
  • Agency Provider ID Number(s)
  • Agency NPI
  • Agency Contact Person
  • Agency Contact Title
  • Agency Contact Email
  • Agency Contact Phone
  • Agency Street Address
  • Agency City
  • Agency State
  • Name of EVV System Vendor/Company - Ankota LLC
  • Name of EVV System/Solution - Ankota
  • EVV System Contact Name - Sharon Dodge
  • EVV System Contact Email - sharon.dodge@ankota.com
  • EVV System Contact Phone - 844-4-Ankota, extension 703

Once you email / register, Therap support will send you three documents to complete:

• Therap End User Legal Agreement (EULA)
• Business Agreements
• Aggregator Attestation.

https://www.therapservices.net/kentucky-evv-aggregator-implementation-request-form/

Data Requirements

Kentucky collects the following information (this is the information that MUST be added to your system prior to data delivery):

Clients

• First Name Last Name
• Date of Birth
• Medicaid ID
• Address
  • Note some additional information will be sent if entered, such as the phone number; these entries must be entered in a valid format

Caregivers

• First Name last Name
• Mandated Staff ID (auto-created by Ankota)
• SSN
  • Used to create the mandated Staff ID

Testing

No state or Therap testing processes are required, although Therap credentials must be provided to Ankota. Organizations may begin billing KYMMIS per the directions below once they have been configured to do so by their Ankota specialist. 

Pre-Billing

NOTE: Now that customers have transitioned to Therap, providers will need to bill via 837s to KYMMIS, and all visit edits/approvals will take place in Ankota.

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 Therap visits require coding if they are missing critical EVV data such as a missing clock-in, clock-out, GPS issue, or telephony issue
      • (Please note that some coding options have been activated as they are inapplicable in the Ankota system.)
    • Note that cost sharing / copay functions can be managed in Ankota if desired - request configuration if you do not have this feature
• Error Prevention
  • Use the Approval Assistant
  • Ensure client/caregiver data accuracy (name spellings, First Name/Last Name separation, Medicaid ID, SSNs, and DOBs)
  • And if those preventative actions fail, watch for rejections and address them as needed

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

Billing Management for Medicaid Visits

NOTE: Providers will bill via 837s to KYMMIS, and all visit edits/approvals will take place in Ankota.

To ensure you are ready to export an EDI file for billing, simply 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 will export the Merged Health Care Claim.

To file your claim, upload the 837 claim you created to KYMMIS. 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. KYMMIS can make 837s available. 

For expanded guidance on this process, see the links below. 

• Calculate Billing
• Complete your Billing Draft
• Export your Merged Health Care Claim
• Process Remittance Advice (Upload 835 "receipts" received from MMIS into Ankota)
• Post Manual Payments
• Review Billing Reports
  • See also: Collections Report, Exceptions Report

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. KYMMIS can make this available. 

• Process Remittance Advice(Upload 835 "receipts" received from KYMMIS 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 KYMMIS portal)

For KYMMIS 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. 

Further Details

For a more detailed walkthrough on Therap, see the Therap walkthrough.

For general Ankota support, see:

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