HHAeXchange Data Delivery & Visit Management

Overview

Per state requirements, Ankota directly feeds required data to HHAX, a data aggregator serving numerous states, based on complex technical specs. This data becomes part of a library of data made available to the state for internal monitoring. (The content and format of this data is determined by the state in accordance with federal law.)

After reviewing the data, HHAX sends Ankota responses confirming the acceptance or rejection of those visits. If the visits are rejected, HHAX will usually provide a brief explanation as to why. Ankota logs those responses in the Visit Approval Dashboard for review. Rejections are also highlighted on the Ankota Landing Dashboard.

HHAX always requires caregiver profiles to be accepted before visits will be accepted.

Billing is sometimes completed through HHAX, and sometimes through 837s, depending on the state and payer.

The critical workflow to understand is:

• Use the Landing Dashboard to identify and complete needed actions
• Use the Approval Assistant to review Needs Action visits
  • HHAX requires visits with important errors to have both REASON and ACTION codes
  • Review remaining visits which the Approval Assistant cannot resolve individually
  • Ankota will export upon billing
• Manage Rejected visits on the Visit Approval Dashboard by reviewing the rejection, correcting, and manually re-exporting
  • If the Approval Assistant wasn't used to review the visits before sending, double check the rejected visits in the AA
• Bill via HHAX or 837 as appropriate when visits are accepted

Index

• Data Preparation
  • The Approval Assistant
  • Individual Visit Review
• Data Lifecycle
• Data Management Best Practices
• Data Responses & Rejections
  • Integrated Responses
  • Rejections
  • Corrections
• Other
  • Essential Transportation / Essential Errand / Shopping

Data Preparation

Data preparation typically covers the following:

• Adding missing data entry
• Adding missing (reason, action, or exception) codes
• Unexpected duration requiring approval or change
• Individual review of some visits with unique issues
• Visit Approval
• Ensuring caregivers have caregiver IDs and codes
  • Caregiver code and ID are the same for first-time EVV users
  • The caregiver code will be the HHA caregiver code if the organization previously used the HHA EVV system
  • If caregivers were deactivated in HHA, they must be reactivated in HHA or caregiver profile delivery will trigger the creation of a new duplicate causing all visits with that caregiver to be rejected

To speed up this process, Ankota usually recommends using the Approval Assistant in the Visit Approval Dashboard to rapidly identify missing data, missing codes, and duration issues prior to approval. Any remaining unapproved visits can be individually reviewed, and then data is delivered.

The Approval Assistant

The Approval Assistant is used for mass review of Needs Action visits. It has four key sections:

• The Data Entry section catches missing data. It will link to the profiles of clients or caregivers missing information along with telling you what is missing.
• The Codes section will make coding suggestions as appropriate for your state and aggregator and resolves the related red warnings. This section particularly speeds up the review process.
• The Durations section will help make duration changes if necessary. This is a powerful section primarily intended for private pay and CDS.
• The Approval section allows approval of visits with no red warnings left. (Visits which still have red warnings will not be approved.)

The Approval Assistant resolves the majority of all issues that require attention or changes in order to be accepted by HHAX. The most complex step is typically coding. Coding requires the admin to recognize the errors that occurred and apply a code to reflect the error, which will result in the state accepting the visit. Most errors which would cause a rejection can be prevented with a code. The most common codes will automatically be suggested by the Approval Assistant. Missed coding is the most most common reason for visit rejection, so it is always beneficial to use the Approval Assistant.

Individual Visit Review

After completing a review of Needs Action visits with the Approval Assistant, wait a few minutes before refreshing the Visit Approval Dashboard to pull up all remaining Needs Action visits. There should be significantly fewer visits remaining.

Next, walk through each visit individually by clicking the paper-and-pencil "Edit" icon

and reviewing the red warnings which could not be resolved by the Approval Assistant. Typically these are unusual warnings. Resolve them, make other adjustments as needed (see additional notes below), then approve the visit, and the visit will be exported.

Regarding other visit adjustments, those will vary based on the visit. Actions may include:

• Reviewing unresolved red warnings
• Fixing the issues the red warnings flagged
• Marking the red warnings as reviewed/completed (turning them green)
• Correcting times if needed
  • Always click Save Visit Details to recalculate billable/payable after adjusting times
• Reporting care plan items if needed
• Checking the Close Visit box if needed
• Adding coding if needed
• Approving the visit (even if it is approving it to be Never Bill/Never Pay)

Data Lifecycle

The Ankota/HHAX data lifecycle is initiated by visits passing screening or being approved in Ankota. Appropriate, state-required visits are then sent to HHAX, who reviews them and sends feedback to Ankota. Any rejected visits are then reviewed by the Ankota user in the Visit Approval Dashboard, corrected, and re-sent to HHAX. (Rejected visits are much rarer when customers use the Approval Assistant on Needs Action visits.)

Data Management Best Practices

Prepare Appropriately

• Fill out all the necessary fields prior to scheduling visits for clients or caregivers
• Regularly work through the Visit Approval Dashboard so issues don't pile up

Use Dashboards

• Check the Landing Dashboard regularly
• Complete the action items visible there (manage visits)

Use the Approval Assistant Wisely

• Work through Needs Action visits one category at a time

• The Approval Assistant works best for groups of Needs Action Medicaid visits which must be delivered to an aggregator
• The Approval Assistant can be used with non-Medicaid visits for cleaning and visit management, but it was not designed for those visits
• The Approval Assistant can be used to review Rejected visits if the Approval Assistant was not used to begin with and key steps were missed
  • Be sure to filter appropriately when reviewing Rejected visits

• Work top to bottom in the Approval Assistant
• Give each section time to process
• Manage visits first, then approve

Data Responses & Rejections

Integrated Responses

Aggregator responses (rejections and acceptances) are automatically integrated into the Ankota Visit Approval Dashboard. Depending on the size of the data delivery and the timing of the export, responses may appear anywhere from a few hours later to a day later.

The exported data statuses will be shown as the data progresses:

• No Response — the data was not sent or not successfully sent
• Sent to Export — the file was created and queued for delivery
• Sent — the formatted file has been transmitted
• In Process — the data was confirmed as received by the aggregator/clearinghouse and is now under review
• Rejected or Accepted — the final status of all successfully exported and processed visits

The main concern will be to check for rejections, view the errors, make corrections, and export them. Filter the Visit Approval Dashboard by Date and Export Status to view rejected response files (make sure the Ankota Visit Status is set to Status: All):

The errors will show specifically in the visit details under Status, as in the screenshot below.

Rejections

Rejection Reasons

Visits can be rejected for a number of reasons, but typically it is one of the following:

• Client or caregiver data is wrong or missing
  • The Approval Assistant's Data Entry section helps prevent missing data errors
• The client is not authorized to bill this payer or visit type for the service date
• The visit has a basic EVV error and requires coding to allow acceptance by the aggregator
  • The Approval Assistant's Coding section helps prevent missed codes

The errors will show specifically in the visit details under Status, as in the screenshot below. Make corrections as needed and re-export.

Corrections

Once the error is known (visible in the visit's rejection details), correct the errors as needed and then re-export the visit(s). This may involve adjusting reason codes in the Visit Approval Dashboard before re-exporting a single visit, or completely backing out billing and payroll in order to correct a fundamentally wrong visit (with wrong visit dates, time, visit type, client, or caregiver) before re-exporting the visit.

Some common errors and the actions to take are outlined below.

Error	Meaning	What to Do
Invalid Edit Visit Reason Code value	The reason code was wrong or missing.	Update the reason code and re-send via single visit export.
Invalid Edit Visit Action Code value	The action code was wrong or missing.	Update the action code and re-send via single visit export.
Length of the External Visit ID cannot exceed 30 characters	The visit ID was too long.	This should not occur, but very old (pre-2022) visits sent retroactively may have been sent with too long an ID. They can be re-sent with a shorter ID.
101999: Can occur if there is an interruption in service	There was an error in data delivery.	Re-send the visit with a new visit ID.
Schedule Date should be the visit day or the next day of the visit (inclusive of EVV)	This visit was completed on a day it was not scheduled to be completed.	Reach out to Ankota Support for best practice based on the specific case.
Schedule duration is 0	There was no scheduled duration because the visit was caregiver-scheduled and the visit type does not have a default length.	Request Support set a defaulted scheduled duration for this visit type (suggested: 1 hour).
EmployeeZip length is less than 5	The zip code of the employee's address was not entered correctly	Correct the employee's address, then send the employee's data again.
Missing EmployeeSSN	The employee's SSN was not entered.	Correct the employee's SSN, then send the employee's data again.
unable to export, Employee not sent	The employee's file was not successfully sent.	Review and if needed correct the employee's file, then send the employee's data again.
EmployeeId missing; EmployeeId is empty	The employee's ID was not entered.	Correct the employee's ID and code, then export the employee's data again.
Member is not found based on Qualifier value	The client's Medicaid ID may be misentered or missing.	Check the Medicaid ID. If it is entered incorrectly, correct it. If it correct, reach out to the state.
Overlapping shifts are not allowed	Two possibilities: 1) Previous HHA schedules. Previously, your organization used HHA EVV and you had scheduled visits in HHA. These visits were not cancelled prior to moving to Ankota EVV, and these visits are now blocking the delivery of new visits. 2) Your scheduled times are overlapping. This can happen when there is an unplanned change of caregiver. For example, if Jane Doe is scheduled to work 9-5 but has to leave at 12 because she is sick, and John Doe covers her shift from 12-5, HHA will reject the second visit because of the scheduled times overlap.	1) Previous HHA schedules. Log into HHA and delete old, unnecessary HHA scheduled visits. The Ankota visits will import with the scheduled and actual times once this calendar is cleared. 2) Your scheduled times are overlapping. Adjust the scheduled times of the visit so there is no more scheduled overlap, then code as needed and re-export.

If a rejection reason is received that is not on this list, contact Support for more information.

Other

Essential Transportation / Essential Errand / Shopping

For transport care plan items, Ankota users have the option to turn on an Ankota warning, "Visit with Essential Transportation or Errands at Arrival or Departure not at Client Location." This feature requires configuration and is typically used only with Missouri HHAX visits. Generally, filter for visits with the Errands warning and manage them BEFORE using the Approval Assistant. This is the only exception to the general "Use the Approval Assistant first" guideline.

This warning works as follows:

• Request the function be turned on
• Define a maximum distance allowed for transport care plan items
• This warning will only be applied to visits where Essential Transportation, Essential Errand, or Shopping is a care plan item on the visit
• The visit will be flagged in Ankota when it is outside the geofence (typically 0.1 miles) but under the maximum for transportation (typically 25 miles)
• After the visit is flagged in Ankota, users will be able to quickly use the Approval Assistant to code the visit appropriately so that visits outside the visit location can be reason coded and exported
• Alternately, users can filter for the warning and then review the visits individually for coding and approval