Kansas State 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 Kansas.

Critical Pathway

For Kansas data delivery, you must:

1. Register with Authenticare
2. Set up clients, caregivers, authorizations, any NANDA/NOC/NIC, and care plans in Ankota
3. Set bill rates
4. Manage red warnings on visits through the Visit Approval Dashboard
5. Bill visits
6. Manage rejections via the Visit Approval Dashboard:
   • Filter for rejected visits
   • Check the rejection
   • Fix the issue
   • Re-export the visit

For a quick review of the billing process, see the Process Review walkthrough.

Set-up

Authenticare / Fiserv

1. Fill out the EVV Declaration Form.
2. Email the completed form to kdhe.evv@ks.gov.

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 Services for Clients (entering authorizations)
• Schedule Visits – Calendar-Based Scheduling (or the classic approach, Creating Visits from Patterns)

Visit Management

• Caregivers complete visits
• Visits are approved automatically or by the office. Ensure visits are closed, then review and clear 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 First Name and Last Name spellings, Medicaid IDs, SSN, and DOBs are entered correctly.
• Manage rejections.

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

Billing / Payroll Overview

Billing

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 the data is sent to Authenticare.

Critical Note: Completing invoices also AUTOMATICALLY pushes visit data to Authenticare. Authenticare visits must be billed in order to be auto-exported. The Export button on the VAD can be used to export a second time, but nothing will deliver until the visit is billed.

After exporting data, manage the release of claims via the Provider Dashboard in Authenticare.

Rejection Management

Rejected visits must be regularly managed. Click rejected visits on the Landing Dashboard to open a new tab with all rejected visits for the selected time period (adjustable), or filter for all Rejected visits on the Visit Approval Dashboard. Open each visit, read the rejection, and take action as needed.

All clinicians must be registered with Authenticare or they will be rejected with the error "Clinician does not exist."

Remittance Advice Management (835s)

If billing via 837, remittance advice files should be received. If the RA is received as an 835, these files can be uploaded to Ankota for 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)

Corrected Visits

When correcting visits, errors generally fall into a few categories, each managed differently. Fundamental errors require backing out billing to correct the visit, then re-invoicing, whereas reason code or demographic information can typically be updated and the visit can be immediately re-exported.

Currently there are effectively no rejections due to the lack of requirements; issues usually stem from formatting or clients and caregivers not being found due to registration issues or inaccurate data.

Further Details

Additional resources:

• Ankota Training Overview (including videos)
• Daily Adjustments
• Manual Visit Entry