NetSmart (Formerly Tellus) Billing

Overview

Tellus (now NetSmart) acts as a clearinghouse for EVV visits in Pennsylvania, Virginia (Anthem Healthkeepers Plus), Georgia (Tellus/Conduent), Florida, Kentucky, and Nebraska. Ankota automatically provides Tellus data as per state standards. This article provides a simplified overview of the general Tellus process and Ankota's unique integration with Tellus.

Note: Tellus training webinars are the definitive source for all Tellus access and training. For more information, see https://4tellus.com/training/

Index

• Critical Pathway
• Preparation
• Cancellations
• Moving Data to Tellus
• Releasing Billing in Tellus
• Corrections
• Rebilling in Tellus (DENIED claims)
• Rebilling in Tellus (OVER AUTH claims)
• Rebilling in Tellus (Claims never went to Payer)

Critical Pathway

The process to ensure billing success in Tellus is outlined in the sections below.

Preparation

• Register with Tellus per state requirements.
• If upgrading to a paid account (such as for non-Anthem payers in Virginia), do so.
  • As of the last update in 2022, cost was $400/payer for set-up plus $15 per month.
  • If adding non-Anthem payers, clients, caregivers, and authorizations must be added manually into Tellus prior to visit submission.
• For Highmark, complete the Self-Registration process at https://mobilecaregiverplus.com/pa-highmark-wholecare/
• For Anthem Virginia, contact Customer Support to gain access to the Netsmart Provider Portal: https://mobilecaregiverplus.com/pa-highmark-wholecare/
• Implement and manage Ankota as usual:
  • Enter caregiver and client information, ensure visits are closed, review the Visit Approval Dashboard, calculate billing, and complete draft invoices.
  • Enter the Admission ID in the authorization. Anthem authorizations require unique billable IDs usually starting with VAQ.
• Manage cancellations as needed. All cancellations require a caregiver name (see Cancellations section).
• During Visit Approval Dashboard management, use Tellus Reason Codes as needed.
  • State requirements vary. Know what codes are needed.
  • Generally, a missing clock-in/out, missing GPS location, and missing telephony data all require reason coding.
  • Georgia customers will likely want to use auto-coding of approved secondary addresses.
  • Some states reject visits which are too far from the scheduled location (e.g., 0.25 miles+ in Georgia). Visits off by more than 120 minutes in start time require a VSTR reason code such as 9104 or 115.
• Review Tellus Responses as they arrive.
  • REJECTED response files mean those visits were never accepted in Tellus.
  • In some states, response files only arrive after completing invoices (Virginia); most other states send an update 48 hours prior to schedule and an update for every status change afterward.
  • Identify rejection reasons and make corrections as needed.

Cancellations

For visits sent to Tellus, cancelled visits must be assigned to a caregiver. Visits without a caregiver name will be rejected. Caregiver names are collected by Tellus to provide transparency for advance cancellations, making a caregiver's reliability/attendance visible. The caregiver name may be a simple placeholder; for this reason, "Caregiver Not Available" is a defaulted "caregiver" in many systems.

Best practice:

• For companies where clients are routinely assigned different caregivers, assign a visit cancelled in advance to "Caregiver Not Available" before cancelling. This makes it clear this is a scheduling issue and not a caregiver attendance issue.
• For companies where clients typically work with the same caregivers, leave the visit assigned to the defaulted caregiver before cancelling. This makes it clear this is an availability issue with that specific caregiver.
• If a caregiver cannot cover a visit but there is enough notice to find coverage, simply assign the visit to the alternate caregiver. There is no need to cancel when successfully rescheduled.

To add a generic "Caregiver Not Available" (first name: Caregiver, last name: Not Available), do so at any time, or ask Ankota Support to add this caregiver.

Moving Data to Tellus (Automatic)

• Once billing invoices are completed, Ankota sends the file in a completed status (no uploads or extra actions needed).
• If data is accepted (per the response file), it moves to the Tellus Work List and the visit can no longer be edited in Ankota.
• If the visit is rejected (per the response file), Tellus did not accept it to the Work List and it can still be edited in Ankota.
  • Correct the visits in Ankota.
  • Re-send visits via batch billing (re-completing existing invoices) OR via Visit Approval Dashboard data export.
  • After making corrections, it is acceptable to re-complete an entire invoice batch to trigger visit re-delivery; already accepted visits in the batch cannot be overwritten.
  • The individual visit "Export" button on the Visit Approval Dashboard sends just one corrected visit at a time; ideal for Reason Code errors corrected on the Visit Approval Dashboard.
  • Critical errors may require cancelling the entire invoice and associated payroll to correct the visit (such as wrong name, payer, rate, or time) before re-creating the invoice and re-exporting data.
  • Archiving/deleting visits is a last resort; consult with Ankota before taking this measure.

Reminder: Once the visit reaches completed status, it moves to the Tellus Work List and is available to release for billing in Tellus. Once visits are accepted in the Tellus Work List, Tellus will no longer accept further updates from Ankota. Any remaining issues must be fixed in Tellus at that point.

Releasing Billing in Tellus

Review accepted visits in the Tellus Work List and make corrections as needed. Unmatched claims, claims denied due to authorization, or claims with $0 must be corrected. Do not skip fixing unmatched claims, or claims will be denied.

• View the error.
• Address the error as needed in Tellus, usually by clicking the exclamation point (!) and entering a reason code.
• If a reason code cannot be selected in Tellus, there is probably a critical error that must be fixed in the visit above. Critical errors include no authorization, no units/hours left on the authorization, or wrong visit type code (such as T1019 instead of T1019 TF).
• If it is an issue that will cause an error in the future, like a wrong primary diagnosis code, also fix it in Ankota.
• Once fixed, with the affected visit(s) selected, click the Rematch button.
• If the error is not understood, reach out to Tellus support. In Georgia, first-line support for Tellus is Conduent.

If a visit is complete but the visit status DETAIL is HOLD on the Visits page (not the Work List), critical data is missing. Correct as follows:

1. Open the visit in Tellus.
2. Select the visit.
3. Regenerate the claim.
   • Do not regenerate the claim UNLESS the visit status is complete. If the visit is not closed, regenerating could break the visit.
4. The visit to claim status will now say SUCCESS.
5. If this does not work, immediately reach out to Tellus; this is a Tellus issue.

Note: If no visits for a client are matching, check that clients and authorizations are in Tellus. If not, take action.

• Release all Matched claims.
• Watch Tellus Claims for pending, accepted, and paid or denied status.
• If the state provides an 835, process the 835.

Releasing matched billing in Tellus can be made automatic, but review for rejections/unmatched visits is still required. Different states require different actions on missing clients/authorizations. For example, in Georgia, reach out to Conduent for support. In Virginia, manually enter the payers, clients, and authorizations for non-Anthem clients, but reach out to Tellus for Anthem clients.

Corrections

Rebilling in Tellus (DENIED claims)

If claims have made it all the way to Claims and are DENIED on the Claims page, the claim is dead in the water. Appeal by re-billing the same visit with a new visit ID. See the full article on rebilling with a new visit ID for details.

Rebilling in Tellus (OVER AUTH claims)

If claims receive a warning that they are over authorization, there may be visits in Archive with units counting against the authorization. To correct: move the Archived visits back to the Worklist, change the time back to 1 minute, then move the visit back to the Archive.

Rebilling in Tellus (Claims never went to Payer)

If claims never reach the Payer after releasing them from the Work List, use the following workflow:

1. Open a Support Ticket in NETSMART.
2. Create an Export from the Claim Review page.
3. Attach the Export (.CSV) to the Support Ticket.
4. Include in the ticket that consent is given to NETSMART to escalate the ticket to their Level 2 and Level 3 Helpdesk.
   • Level 2 will review the visits to confirm they are in ACCEPTED status.
   • Once confirmed at Level 2, the visits are then sent to Level 3 Helpdesk for re-submission to the Payer.
5. Reach out to the Payer after 3–4 business days to confirm receipt of visits for further processing and payment.