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 the regular billing process.

AuthentiCare Process Recap

• To bill and export data to AuthentiCare, perform the usual visit review and billing processes in Ankota. After ensuring visits are closed, reviewing the Visit Approval Dashboard, calculating billing, and completing draft invoices, invoices are built and data is sent to AuthentiCare.
• Visits must be billed to export the first time. Re-exporting can be done from the Visit Approval Dashboard when correcting rejections, but billing is required to export to AuthentiCare at this time.
• After exporting data, 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, manage the release of claims via the Provider Dashboard in AuthentiCare.

Note: Unlike many aggregators, AuthentiCare is a single-file export. It does not require client and caregiver exports prior to visit delivery.

Rejections

Once the list of errors is available, 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 no rejection will be received. 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.