Colorado 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 Colorado.)

In the state of Colorado, Medicaid billing is fairly straightforward. Billing currently is through the Gainwell portal. Select Medicaid visits are also required to be sent to the state's default aggregator, Sandata. For Ankota users, that means in addition to the regular EVV services provided, Ankota will also deliver visit data to Sandata to ensure the state's requirements are met.

This article covers:

• Critical Pathway
• Set-up
• Testing
• Pre-Billing
• Billing/Payroll Overview
• Imported Response Files & Data Management
• Further Details

Critical Pathway

For a simple overview of key admin system maintenance, see the Colorado Critical Pathway PDF overview with linked steps.

Set-up

State Registration

If not already enrolled with the state, enrollment is required. See the state's enrollment information for details.

Sandata Registration

Ankota users in Colorado must register with Sandata. This registration ensures Sandata will accept their data and gives providers access to the Sandata log-in. Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation.

To register with Sandata, email COCustomerCare@sandata.com and support@sandata.zendesk.com with the following information:

Agency Information:

• Agency Name
• Medicaid ID Number
• Contact Name
• Contact Phone Number
• Contact Email
• Authorization to speak directly to your vendor: YES

Vendor Information:

• Vendor: Ankota, LLC
• EVV Vendor Contact Name: Sharon Dodge
• EVV Vendor Contact Number: 844-4-Ankota, x. 703
• EVV Vendor Contact Email: sharon.dodge@ankota.com
• EVV Product Name: Ankota EVV

Sandata Requirements

In addition to the standard set-up of adding clients, caregivers, authorizations, care plans, and scheduling visits, Colorado Medicaid providers should ensure the following is available in their system:

• ONE home phone number per client
• Company email at the Org. Details level
• Client Medicaid ID in the client's Medicaid ID field (even if it is already in the client ID field)
• SSN for caregivers (at least the last 5 digits)
• Medicaid Provider ID (provide this to Ankota if not already given)
• Copy the caregiver ID into the caregiver code for all active caregivers. Do not assign a caregiver code to "fake" caregivers, such as Ankota Support
• An email for each administrator
• Reason codes for manual reason coding as needed in the system (Ankota will add; assign manually as needed)

IMPORTANT NOTE: Only one home phone number can be sent per client profile, and this must match in all telephony visits or there will be a location exception. For this reason, it is recommended to only register the client's home phone number, so Ankota will always prompt to code visits with non-matching phone numbers as appropriate (usually Exception Code 15).

Testing

For Sandata, no state testing processes are required other than the initial Ankota testing process.

Pre-Billing

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 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 by the office
• Ensure visits are closed, then review and clear the Visit Approval Dashboard
• Sandata visits require Reason Codes to be applied as needed in the Visit Approval Dashboard

Error Prevention

• Watch warnings on the Action Center (for missing auths, primary diagnosis codes, IDs, etc.) and address as needed
• Watch warnings on the Visit Approval Dashboard and address as needed
• Ensure name spellings, Medicaid IDs, and DOBs are entered correctly
• Set reason codes as needed during VAD approval
• Manage rejections

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

Billing/Payroll Overview

Billing

To bill, 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, bill via Gainwell.

Visit records in the State Solution are transmitted nightly. Visits are available for matching in the Gainwell Claims System the day after a visit is recorded and verified. Claims must be billed after service has been completed and a visit has been recorded to ensure proper matching. If a visit has been adjusted, those changes will be available for matching in the Gainwell Claims System the day after the adjustment.

This data is exported when the visit passes screening OR when the visit is approved. (On Hold and Needs Action visits are not sent over.)

Remittance Advice Management (835s)

Remittance advice files, or 835s, are provided in response to filing Medicaid claims. These are 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)

Imported Response Files & Data Management

File Management

After connection with Sandata, Ankota will provide decoded, easy-to-read response files. See:

• Sandata Response Files (Overview)
• Accessing Sandata Response Files
• Reviewing Sandata Response Files

Correcting Visits

To correct all rejected visits after making the error correction in Ankota:

1. Review Sandata Response Files
2. Correct visits as needed
3. Bill through Gainwell as usual

When correcting errors identified in the imported response files, errors generally fall into one of a few categories:

For Reason Code Errors:

1. Pull the imported response file
2. Review the errors
3. Search the Visit Approval Dashboard for the visit IDs reported as having errors
4. Correct the reason code and Save
5. Click the Export button to re-send this individual visit

For missing Clients or Caregivers:

1. Pull the imported response file
2. Review the errors
3. Notify Ankota Support which client or caregiver file was not successfully delivered
4. Ankota will re-send the file
5. Re-send the visits

For wrong visit types, client, caregiver, dates, or times:

1. Pull the imported response file
2. Review the errors
3. Go to the Billing report page
4. Filter for the visit with the error
5. Cancel the associated invoice
6. Unapprove the visit
7. Make the changes
8. Reapprove the visit
9. Re-run billing

For other errors, reach out to Ankota Support for guidance.

Further Details

These additional resources may be of use to Colorado clients:

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