Florida Workflow

Overview 

(As always, private pay is generally self-regulating within the confines of state law and regulatory processes. This article focuses on Medicaid in the state of Florida.) 

In the state of Florida, 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 Tellus/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:

Critical Pathway

Set-up

Testing

Pre-Billing

Billing Management for HHAx

Billing Management for Tellus

Remittance Advice Management (835s)

Further Details

Critical Pathway

For a simple overview of key admin system maintenance for Tellus, see this overview with linked steps: Florida Critical Path.pdf Open in Firefox for best view.

Set-up

Ankota users in Florida must register for Tellus EVV. 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.

Testing

No client testing processes are required. Organizations may begin billing Tellus 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 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
• Prevent 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)

Billing Management for HHAX

Non-EVV visits should be billed via the state portal. More information to come.

• 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

Billing Management for TELLUS

Tellus accepts visits/billing or AHCH (state Medicaid) and Anthem. this may come under Simply HealthCare + IHCS, Aetna better Health, Florida Community Care, Magellan Complete care, or UnitedHealthcare.

See here for a detailed overview of Tellus billing. This overview includes or links to information on:

• reason codes for Tellus
• releasing billing
• reading Tellus response files
• managing cancellations 
• rebilling

You will also want to review managing data exports, which clarifies single-export corrections.

The key to understanding how data is managed between Ankota and Tellus is as follows:

• Any visits which receive acceptance response files from Tellus in Ankota successfully transferred a status update to Tellus. 
• Any visits which receive rejected response files from Tellus 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.

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.

• 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 a more detailed walkthrough on the Tellus claims billing process, see the Tellus walkthrough.

For more information on rejection reasons, see Tellus Response Files.

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