Authorizations

Overview

Medicaid and V.A. clients will be provided with plans from the state authorizing appropriate care plan items and hours. (Alternately, if a client is private pay, your organization will have contracted hours with the client, which you may wish to track via authorizations).

General client set-up is to first enter demographics, then authorized units. By adding this authorization, the Ankota system will not only track the client's used units against the authorization and prevent over-billing, the authorization will also be provided as a reference when scheduling.

For the next step in adding a client, go to Care Plans.

IMPORTANT: The Ankota default is to apply the authorization and BLOCK the caregiver clock-in if the client does not have:

• an active authorization for this visit type
• with good units left for the date
• that permits work today (not limited by days of week)

Some customers have this feature disabled ("Skip Auth Check"), but otherwise it is the default.

Simple Authorization Overview

Standard Authorizations

Adding an Authorization

To begin, go to the Authorized Units tab within the client's record.

Next, select + Add New and enter the Start Date and End Date as well as the other authorization information. A client may have one or several active authorizations, so long as there is no more than one active authorization per visit type.

Critical notes:

• An Admission ID is usually necessary on your authorization to confirm the billable ID for their insurance; this training is part of your implementation (see more below).
• For historical records, when a client receives a new authorization, enter an end date in the previous authorization and begin a new authorization for the updated contract. Add any necessary instructions in the Instructions box. Otherwise, add or select the information in each window from top to bottom.
• For Add New Visit Type, this creates a whole new visit type. Typically, skip this button and go to the drop down if you already have the visit type in your environment.

• Overlapping authorizations will result in billing errors.
• In the case of variable monthly authorizations, select the variable monthly option and enter the units on a month-by-month basis for year-long authorizations.
• When scheduling variable monthly authorizations, you can schedule out the full year using the best average time.
• You can titrate (adjust) these schedules later to match the required units as needed.
• Titration can also be automated.

Variable Monthly Authorization with Option to Schedule All Months

Biweekly Authorizations

Biweekly Authorizations are entered somewhat differently than standard authorizations.

To start:

• Build a simple two-week authorization using the Date Range function
• Be sure to include ONLY the first two weeks
• Be sure to include the total # of units for two full weeks
• Then COPY that authorization
• In the copy, change the suggested end date to the actual end date
• Repeat every: 2 weeks

Admission ID

Depending on your organization's needs, the admission ID may be required or not; this is typically based on whether an MCO insurance requires a second ID beyond the Medicaid ID. Historically rare, it is fast becoming the standard because of the increase in MCOs.

If you have been directed to enter the admission ID, enter the billable ID (such as the Medicaid ID or MCO ID) in this field consistently in all authorizations. Otherwise, billing will not succeed. In some cases, data will not be accepted by the clearinghouse without this field being filled out.

Defining Rules

After entering the basic authorization information, define the rule of the authorization:

1. With the authorization open, scroll to the bottom.
2. Select + Add Rule
3. Enter the time period through the drop-down
4. Enter the authorized units
5. A summary of hours per day will be calculated based upon the data in the rules, the type, and the time (this is only a summary and a suggested guideline).
6. Save

Editing Units on Active Clients

To edit units on active clients:

1. Click Clients
2. Select the client
3. Click Authorize Units
4. Click Edit
5. Scroll to the bottom, edit the number of units, press tab to see units per visit, then click Save.

Authorization Transition

Auth Transition Overview

Many private pay and CDS clients need to transition from one authorization to another within the same period. Common examples include:

• After a set number of CDS units are used, remaining services should transition to CDS ILW (typically monthly Medicaid)
• After a threshold of standard hours is reached, additional hours should move to a bulk discount visit type (typically weekly for private pay)

The Authorization Transition feature allows you to automate either kind of transition by linking two authorizations together.

How to Set It Up

1. Create both authorizations
   • The "originating" authorization (e.g., CDS)
   • The "next" authorization (e.g., CDS ILW)
2. Link the authorizations — In the originating authorization, select the next visit type in the Auth Transition section.

3. Schedule using the originating authorization — Schedule visits for the combined total units of both authorizations for the full period. Example: If Auth 1 = 100 units and Auth 2 = 100 units (monthly), schedule 200 units.

How It Works

The system tracks usage against the originating authorization first. Once those units are exhausted, Ankota will:

• Automatically convert remaining scheduled visits to the next authorization's visit type
• Split any in-progress visit, ending the original visit and creating a new one under the next authorization
• All remaining visits in the period will continue under the new authorization

Example

First, prep the authorizations and the schedule:

• A Personal Care CDS authorization is set for 496 units per month
• It is linked to a Personal Care CDS ILW authorization for 496 units per month
• You schedule visits for the full combined total of 992 units, or about 8 hours/day

Once the 496 CDS units are used (about 15.5 days in a 31-day month):

• The current visit will split
• The old visit will remain CDS
• The second visit for the day will be CDS ILW
• All remaining visits for the month will also convert to CDS ILW

Key Reminders

Always:

• Schedule using the originating authorization first
• Include the full combined units for the period
• Let the system handle the transition automatically once limits are reached

Scheduling

Scheduling without an Authorization

It is possible to schedule without a true authorization. In some states or by request, visit types may be defaulted to require an authorization, but not an authorization number. Even if an authorization is required, Ankota only turns on the requirement for an actual authorization number by special request. A "placeholder" can be entered in the authorization number field and completed later.

There are three options:

• Schedule without an auth for visit types that do not require one (such as office management visit types)
• Schedule with an auth that has "placeholder" in the authorization field (most regular Medicaid visit types)
• Override: system requires an actual number (turned on only by request)

Notify Caregivers of Remaining Authorization in Telephony/Mobile App Ionic

To configure:

1. Go to Settings
2. Service Settings
3. Payer (could also be listed as "visit plan category")

4. Select a category and EDIT

5. Scroll to the bottom and check configuration: Notify Caregiver of Remaining Authorization in Telephony/Ionic Mobile App

6. Click Save

Authorization Flags on Individual Client Calendars

One option for managing authorizations is to have them reflected on individual client calendars (configuration by request).

These authorizations reflect active authorizations, specifically the units that are scheduled, used, and remaining as well as the critical date range, visit type, and the approved units.

One blue banner reflects each individual authorization rule. If an authorization has more than one rule, such as 50 units/week but 2,000 units for the complete date range, two banners will be shown.