Georgia Workflow

Overview

(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 Georgia.)

In the state of Georgia, 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 regular EVV services, Ankota also delivers visit data to Netsmart/Conduent on a near-real-time basis to ensure the state's requirements are met.

This article covers:

• Set-up
• Testing
• Pre-Billing
• Billing Management for Medicaid non-EVV Visits
• Billing Management for Medicaid EVV Visits
• Remittance Advice Management (835s)
• Corrected Claims
• Further Details

Critical Pathway

For a simple overview of key admin system maintenance, see the Georgia Critical Path PDF.

Set-up

Ankota users in Georgia must register for Tellus/Netsmart EVV. (Ankota will deliver visit data to Tellus/Netsmart.) 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 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.

The state of Georgia prefers mobile app over telephony for EVV. If clients must use telephony, the appropriate registration form must be filed and state approval received to continue using telephony. Per confirmation 8/30/21, FOBs are not allowed (use the Lifeline Medicaid phone if needed). Also confirmed 8/30/21, as an alternative to mobile app usage on the caregiver's smartphone, clients with smartphones may download the Ankota Caregiver mobile app and permit caregivers to clock in/out on that app if desired. To apply for client telephony registration, download and submit the Georgia EVV IVR Request Form - Provider Agency for Traditional Members to the state.

Testing

No state testing processes are required. Organizations may begin billing Tellus/Netsmart and GAMMIS 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 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
• Tellus/Netsmart visits require Reason Codes if they are missing critical EVV data such as a clock-in, clock-out, GPS data, or telephony data
• Cost sharing / copay functions can be managed in Ankota if desired — request configuration if this feature is not present

Prevention of Errors/Unmatched/Rejected Claims

• 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 that name spellings, First Name/Last Name separation, Medicaid ID, and DOBs are entered correctly
• If those preventative actions fail, watch for Rejection Response Files and address those issues as needed

NOTE: Ankota will automatically code secondary client addresses (clients with listed additional addresses) to ensure acceptance by Netsmart.

Deadline - Thursday at midnight for in-home (Oct. 2021 update): The claims submission deadline is Thursday at midnight to be in the Friday payment cycle. Providers can no longer wait until Friday noon to submit EVV-applicable claims. This submission occurs via the Netsmart (Tellus) solution.

Deadline - Friday at noon for Adult Day

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

Billing Management for Medicaid non-EVV Visits (GAMMIS billing)

Non-EVV visits (all visits except T1019, T2025, and S9122) should be billed via the state portal.

1. Schedule visits as usual; caregivers clock in and out as usual
2. Manage visits as usual
3. Calculate Billing
4. Review the Billing Report (Client) and complete invoices
5. Bill through the GAMMIS portal manually OR export the Merged Health Care Claim and upload the file into the state Medicaid portal. The Merged Health Care Claim option will be rolled out to all Ankota Georgia Medicaid clients as it becomes available in 2022.

Billing Management for Medicaid EVV Visits (Tellus/Netsmart billing)

Currently, EVV visits are listed as T1019, T2025, and S9122 (pediatrics) visits. These are the only visits to be billed in Tellus/Netsmart. If the wrong visit types have been accidentally sent over to Tellus/Netsmart, those visits can simply be archived in Tellus/Netsmart and billed through the GAMMIS portal as usual.

See the Tellus/Netsmart billing overview for details, including critically important articles for reason codes, reading response files, managing cancellations, and managing data exports.

Note: Tellus/Netsmart should receive all authorizations directly from the state, so if a client is missing an authorization in Tellus/Netsmart, reach out to Conduent right away. (For support regarding any claims issues in Georgia, first reach out to Conduent for Tier 1 support at 833-701-0012, GAEVVSupport@Conduent.com, or www.GAEVV.com for chat.)

Remittance Advice Management (835s)

Remittance advice files, or 835s, are provided in response to filing Medicaid claims. These are effectively state receipts of payments. These files can be uploaded to Ankota for automatic application of payments in the A/R records. GAMMIS can make this available.

• Process Remittance Advice (upload 835 receipts received from MMIS into Ankota)
• Post Manual Payments
• Review Billing Reports (see also: Collections Report, Exceptions Report)

Corrected Claims

Generally, claims corrections are handled one of two ways:

1. Update the claims in Ankota and re-send
2. Update the claims in the location where they were sent (such as Tellus/Netsmart or the state GAMMIS portal)

For more information on errors and how to manage them, see Managing Data Corrections.

GAMMIS

For GAMMIS billing, correct claims by canceling the invoices and associated payrolls, correcting the data, and rebuilding the invoices as needed for upload. For partially paid claims that should not be reversed, use the Corrected Claims process.

Tellus

The key to understanding how data is managed between Ankota and Tellus/Netsmart:

• Visits that receive acceptance response files from Tellus/Netsmart in Ankota successfully transferred a status update to Tellus.
• Visits that receive rejected response files from Tellus/Netsmart 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.
• Rejected visits in Ankota must have data corrected in Ankota first, then the data must be re-sent to Tellus/Netsmart by moving the invoice from Draft to Complete. (For information on what data to correct, check the response file.) A rejection response is an opportunity to fix an issue and still send out the data.
• Completed AND accepted visits will move to the Work List and will be available to release for billing in Tellus/Netsmart. At this point, any errors in Work List claims must be corrected in Tellus/Netsmart, and Tellus/Netsmart will no longer accept further updates from Ankota. To resolve claims issues in Tellus/Netsmart, review the error messages and take action. For more Tellus training, see Training Webinars at Mobilecaregiverplus.com.

It is generally recommended to use the Approval Assistant to simplify the Tellus visit corrections process. Only use the Duration adjustments section if there are known, strict limitations on the allowed work duration for the selected visit type.

For support regarding any claims issues in Georgia, first reach out to Conduent for Tier 1 support at 833-701-0012, GAEVVSupport@Conduent.com, or www.GAEVV.com (for chat).

Further Details

• For a more detailed walkthrough on the Tellus claims billing process, see the Tellus/Netsmart walkthrough.
• For more information on rejection reasons, see Tellus/Netsmart Response Files.
• For more information on reason codes, see Tellus/Netsmart Reason Codes.
• For more information on multiple address management in Georgia, see Georgia Second Address Automatic Reason Coding.
• For more information on rebilling claims already released from Netsmart but never received by the Payer, see Rebilling (Claims were never received by Payer).