Oregon Workflow
Overview
In Oregon, applicable Medicaid-funded personal care and home health services are subject to Electronic Visit Verification (EVV) requirements. Ankota is integrated with the Oregon DCI Data Aggregator, operated by Acumen, to deliver required EVV data for Ankota customers.
For Ankota users, this means caregivers can continue to complete EVV visits through Ankota. Ankota sends the required client, caregiver, and visit information to the Oregon aggregator and receives processing responses back into Ankota.
Please note that while Ankota will support you during implementation and guide you whenever possible, your organization's enrollment, state/provider registration, payer contracts, and other provider responsibilities remain your organization's responsibility.
For additional information, see:
This article covers:
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Set-up
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Testing
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Pre-Billing
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Billing Management for Medicaid Visits
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Data Delivery and Responses
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Correcting Rejected Visits
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Further Details
Set-up
Acumen/DCI Set-up
Ankota will configure the connection necessary to send EVV data to the Oregon DCI Data Aggregator as part of your Oregon implementation.
Before visits can successfully aggregate, Oregon must be able to validate the associated client and caregiver. The payer, program, and service associated with the visit must also be valid for your agency.
Client Data
The following information must be entered correctly in Ankota for Oregon EVV clients:
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First Name
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Last Name
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Oregon Medicaid ID / Client ID / Prime Number
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Time Zone
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Residential Address
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Address Line 1
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City
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State
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ZIP Code
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Country
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Oregon uses the client's Medicaid ID, also called the Client ID or Prime Number, as the unique client identifier. Do not use the client's Social Security Number for this purpose. The client's address must also be a valid Oregon address. Middle name, Address Line 2, phone number, and service start/end dates may also be transmitted when available.
Caregiver Data
The following information must be entered correctly in Ankota for Oregon EVV caregivers:
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First Name
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Last Name
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Email Address
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Social Security Number
- ALSO enter the caregiver's SSN in the Caregiver Code field in Ankota.
Oregon uses the caregiver's SSN as the unique employee identifier.
: A caregiver must contain a valid SSN in the Caregiver Code field before Oregon EVV data can be successfully submitted for that caregiver.
Middle name, employee number, hire date, and termination/end date may also be transmitted when applicable.
Payer, Program and Service Set-up
The payer, program, and service associated with a visit must be valid for Oregon and configured for your agency.
Oregon validates that:
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The agency has an active contract with the payer.
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The agency has an active contract with the program.
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The program is associated with the payer.
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The service is valid for the applicable payer/program combination.
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Any applicable modifier is valid for the service.
Current Oregon EVV programs/services include ODHS-IHCA services such as S5125 and T1019 and applicable OHA-HHA home health revenue codes.
Testing
Ankota has completed the vendor-level integration/testing necessary to communicate with the Oregon DCI Data Aggregator.
During your organization's implementation, Ankota will assist with confirming that your configuration and data are successfully transmitting.
Do not assume successful transmission simply because a visit has been completed in Ankota. During initial implementation, verify that client, caregiver, and visit information is being accepted by the aggregator.
After implementation, we particularly recommend checking data delivery whenever you begin services for a new client or a new caregiver.
Pre-Billing
Successful Oregon EVV data delivery starts when the client and caregiver are created. The processes below will help prevent rejected EVV data.
Caregiver Management
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Make sure each Oregon EVV caregiver has all required demographic information.
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Enter the caregiver's SSN in the Caregiver Code field.
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Make sure the caregiver has a valid email address.
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Correct caregiver information promptly if the caregiver is rejected by the Oregon aggregator.
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Confirm successful data delivery for new caregivers.
Client Management
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Enter the client's Oregon Medicaid ID / Client ID / Prime Number.
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Make sure the client has a complete Oregon residential address.
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Schedule visits using your normal Ankota scheduling workflow.
Visit Management
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Caregivers clock in and out through Ankota.
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Review and clear the Visit Approval Dashboard.
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We recommend using the Approval Assistant to simplify visit management.
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Apply an Oregon reason code when required for manual or edited visit information.
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Approve visits as appropriate.
Prevention of Errors/Rejected Visits
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Watch warnings on the Action Center for missing client, caregiver, authorization, or other required information.
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Watch warnings on the Visit Approval Dashboard.
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Use the Approval Assistant to address visit issues before approval.
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Regularly check Oregon responses for rejected data.
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Correct and re-send rejected visits promptly.
The Landing Dashboard will highlight items requiring attention.
This mirrors how your NJ article handles Pre-Billing: Caregiver Management → Client Management → Visit Management → Prevention of Errors.
Billing Management for Medicaid Visits
Oregon EVV Visits
For applicable Oregon Medicaid services:
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Complete the Pre-Billing process above.
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Caregivers complete EVV visits through Ankota.
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Review Needs Action visits and make necessary corrections.
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Apply Oregon reason codes when required.
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Approve visits as appropriate.
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Ankota automatically sends applicable EVV information to the Oregon DCI Data Aggregator.
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Review returned responses.
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Correct and re-send rejected visits as needed.
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Complete your normal billing process.
EVV data delivery and Medicaid claim billing are related compliance processes, but they are not the same transaction. A completed or billed visit in Ankota should not be assumed to have successfully aggregated; monitor the returned Oregon EVV status as well.
Data Delivery and Responses
Ankota automatically sends applicable client, caregiver, and visit data to the Oregon DCI Data Aggregator.
Responses are returned to Ankota and can be monitored through the Visit Approval Dashboard.
You may see statuses including:
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No Response
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Sent to Export
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Sent
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In Process
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Accepted
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Rejected
Accepted indicates successful processing.
Rejected indicates that the data contains an issue that must be corrected.
Pay particular attention to the first visits associated with new clients and caregivers to make sure their records have been successfully validated.
Correcting Rejected Visits
To correct a visit rejected by the Oregon aggregator:
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Review the rejection in the Visit Approval Dashboard.
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Correct the underlying client, caregiver, payer/program/service, or visit information in Ankota.
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Add or correct an Oregon reason code when applicable.
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Approve the corrected visit as appropriate.
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Re-export the visit.
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Check the Visit Approval Dashboard later to confirm that the corrected data is Accepted.
Common rejection causes can include:
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Missing or incorrect client Medicaid ID / Prime Number
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Missing or incorrect caregiver SSN/Caregiver Code
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Missing caregiver email
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Invalid or incomplete client address
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Invalid payer, program, or service
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Missing required reason code
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Client or caregiver records that have not successfully validated
Oregon Reason Codes
Oregon requires a reason code for applicable manually entered or edited EVV data.
Only one reason code may be submitted per visit.
Caregiver/Provider Reason Codes
| Code | Reason | Note |
|---|---|---|
| 10 | Provider – Clocked In/Clocked Out Mistakenly | |
| 20 | Provider – Forgot to Clock In/Clock Out | |
| 30 | Provider – Manual Entry Due to FOB Error | |
| 40 | Provider – Manual Entry Services in Community | |
| 50 | Provider – No Internet/System Issues | |
| 60 | Provider – Telephony Unavailable | |
| 70 | Provider – Other | required |
Provider Agency Reason Codes
For applicable In-Home Care Agency corrections made on behalf of the employee:
| Code | Reason | Note |
|---|---|---|
| 80 | Provider Agency – No Plan of Care | |
| 90 | Provider Agency – No Service Authorization | |
| 100 | Provider Agency – Other | required |
Further Details
These additional Ankota resources may also be helpful:
For Oregon-specific information: