AuthentiCare Rejections
Overview
AuthentiCare (a Gainwell product) processes billing and receives EVV data in Kansas, New Hampshire, Arkansas, New Mexico, and other states. This data is delivered to AuthentiCare by Ankota as part of your regular billing process.
To recap the AuthentiCare process,
- To bill and export data to AuthentiCare, 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, your invoices are built and your data is sent to AuthentiCare
- Visits must be billed to export the first time
- You can re-export from the Visit Approval Dashboard when correcting rejections, but billing is required to export to AuthentiCare at this time
- After exporting your data, you will watch for rejections in the Visit Approval Dashboard
- Rejections can be filtered for from the VAD filters
- Rejections can be seen inside each visit
- When visits are accepted, you will manage the release of your claims via the Provider Dashboard in AuthentiCare
NOTE: unlike many aggregators, AuthentiCare is a single-file export. They do not require client and caregiver exports prior to visit delivery.
Rejections
Once you have the list of errors, you will correct the errors as needed and re-export the visits. Currently, rejections are unlikely due to the lack of requirements, but clients or caregivers could be rejected if they are not found in the database. The most common error is that visits were not billed so they could not be exported, in which case you will not receive a rejection. See below for a list of rejections, their meanings, and how to proceed.
Error | Meaning | What to Do |
Consumer Does Not Exist | Client association with the provider does not exist | The client information likely could not be matched/accepted. Update the profile so that it includes all the required, accurate data for your state, then re-export the visit. (Assuming visits are already billed, filtering for the client on the Visit Approval Dashboard, selecting all visits, and then clicking Export is usually the fastest way to export for employees.) |
Provider Not Found | Provider does not exist | There may be an issue with your AuthentiCare registration or your provider IDs. Contact Ankota for assistance. |
Worker Does Not Exist | Worker association with the provider does not exist | The caregiver information likely could not be matched/accepted. Update the profile so that it includes all the required, accurate data for your state, then re-export the visit. (Assuming visits are already billed, filtering for the employee on the Visit Approval Dashboard, selecting all visits, and then clicking Export is usually the fastest way to export for employees.) |
Service ID Does Not Exist | Invalid Service ID used. [Arkansas only: Service ID should be the unique AuthentiCare ID provided in the specs.] | There may be an issue with your AuthentiCare service type export ID or you may be attempting to export a visit type that AuthentiCare does not accept. Contact Ankota for assistance. |
Consumer Not Related | Data scoping error with an entity (EntityXref) associated with the claim | Contact Ankota for assistance. |
Worker Not Related | Data scoping error with an entity (EntityXref) associated with the claim | Contact Ankota for assistance. |
Service ID is Not Part of ProviderList | Service ID is not in the list of services provided by the provider | There may be an issue with your AuthentiCare service type export ID or you may be attempting to export a visit type that AuthentiCare does not accept. Contact Ankota for assistance. |
Claim ID not in AuthentiCare to delete | Claim does not exist in AuthentiCare or Claim ID has already been exported | Contact Ankota for assistance. |
DataScoping Error | Data scoping error with an entity (EntityXref) associated with the claim | Contact Ankota for assistance. |
Claim date is past XXX days | Claim start date is past XXX days (where XXX is config item set to 720). | The claim will no longer be accepted because it is past the acceptable claim deadline. |
Claim start date cannot be in the future | Claim Start date is in future. | The claim start date cannot be in the future. Check the visit, correct it as needed, and then re-send. |
Claim End date cannot be in the future | Claim End date is in future. | The claim end date cannot be in the future. Check the visit, correct it as needed, and then re-send. |
Claim Start Date is greater than Claim End date | Claim Start date is greater than Claim End date. | The claim dates cannot be backwards. This error it not possible in Ankota. |
Claim duration is invalid | Invalid Claim Duration (Difference between claim start and claim end is less than XX minutes, XX=1 and config driven) | There is no claim duration and therefore the claim was not accepted. Check the visit, correct or cancel as needed, and re-send if there is a billable duration. |
| [warning only] Invalid Activity code | Unknown Activity Code [Note: Claim is not rejected] | No action is needed. |