Pre-Billing Problems and Resolutions

The Prebilling process helps to identify and correct potential errors prior to the Billing phase. These resources will provide insight into the validations and resolutions for Visits held in the Prebilling Exception page, best practices and troubleshooting steps to resolving various validations.

Prebilling Overview

8 min.

 

Problem

Resolution

Authorization

  1. Click the Patient Name link to access the profile.

  2. Select the Calendar page from the Index.

  3. In the Last 3 Authorizations section, review the authorization rules of the Contract associated with the visit.

  4. In the Calendar section, click the visit times to open the Visit window.

  5. Adjust the visit information to satisfy the authorization rules.

Caregiver Compliance

  1. Click the Caregiver Name link to access the profile.

  2. Select the Compliance page from the Index.

  3. Check the Compliance Status for the Contract that authorized the visit.

  4. Click Compliance Check to view compliance rules and determine the issue.

  5. Correct validation issue(s).

Clinical Documentation (Skilled Visits only)

  1. Click the Edit Edit icon icon to open the Visit window.

  2. Select the Visit Info tab.

  3. In the Clinical Documentation section to enter the Clinical e-Doc. Click Add link to manually enter or click the Paperclip icon attachment icon to upload the document.

Custom Validations

Custom Validations is a catch-all Prebilling status for any custom Prebilling rules which have been configured for an Agency. 

Incomplete Confirmation

  1. Click the Edit Edit icon icon to open the Visit window.

  2. Go to the Visit Info tab.

  3. Click the Call button link to search for a usable EVV confirmation.

  4. If no EVV confirmation is present, manually enter the Visit Start Time or Visit End Time, depending on which one is missing a confirmation.

  5. Click Save.

Insufficient Duty Minutes

  1. Click the Edit Edit icon icon to open the Visit window.

  2. Select to the Visit Info tab.

  3. In the Audit section review the Duty Sheet POC value. The number in the parenthesis is the total time for performed Duties.

  4. Edit the Visit Start Time or Visit End Time to match the Duty minutes to the visit duration.

OT/TT Not Approved

The OT/TT Not Approved validation only checks visits authorized by linked payers. If a visit is held because of this validation indicates that a user has requested Travel Time or Overtime from a linked-Contract and the Contract has neither responded nor rejected the request.

This visit remains in Prebilling as OT/TT Not Approved until the linked Contract has responded/approved the request.

Overlapping Shifts

Shift Overlapping / Caregiver Overlapping

  1. Click the Edit Edit icon icon to open the Visit window.

  2. Go to the Visit Info tab.

  3. Update either the Visit Start Time or Visit End Time.

  4. Click Save.

POC Compliance

  1. Review the Contract’s Required Compliance rules.

  2. Click the Edit Edit icon icon to open the Visit window.

  3. Go to the Visit Info tab.

  4. Manually enter the Duties to satisfy the Required Compliance rule.

  5. Click Save.

Restricted Caregiver

  1. Click the Caregiver Name link to access the profile.

  2. Select the Absence/Restriction page from the index.

  3. In the Restrictions section, edit either the Restriction Start Date or Restriction End Date for the visit to fall outside the restricted date range.

Timesheet Not Approved

  1. Click the Edit Edit icon icon to open the Visit window.

  2. Select the Visit Info tab.

  3. In the Audit section, select Timesheet Approved checkbox.

  4. On the Upload Scanned Timesheet field, click the Paperclip icon attachment icon to upload the Timesheet.

  5. Click Save.

Unbalanced Visit

  1. Click the Edit Edit icon icon to open the Visit window.

  2. Go to the Schedule tab.

  3. Adjust the Schedule Time to satisfy your Agency’s/Office’s Unbalanced Tolerance time.

  4. Click Save.

With TEMP Caregiver

  1. Click the Edit Edit icon icon to open the Visit window.

  2. Go to the Schedule tab.

  3. Enter the Caregiver Code in the Caregiver Code field. Use the ? link to search for a Caregiver the Code is not known.

  4. Click Save.