Virginia Tellus

If you have not already done so, tell Generations Support that you are going to be using Tellus/Netsmart  so we can assign a trainer to work with you. 

Implementation consists of several parts:

• Contacting Tellus/Netsmart
• Preparing Generations 
• Tellus Interface in Generations. 
• Daily Operations
• Log File
• Errors
• Billing

Contacting Tellus

Contact Tellus and set your account up. If you already have a Tellus/Netsmart account, we still recommend contacting them to ensure they know that your account will be utilizing an interface from a third party; they may have some special instructions for your agency, such as:

• Complete subscription agreement with Tellus/Netsmart.
• Register for Tellus EDI process by sending an email to VAEVVSupport@Conduent.com, with agency name, address, contact name, email, phone number, EIN and NPI combinations, plus the name of your EVV vendor (Generations.)
• Tellus sends a secure email with the EDI URL, User Name, and Password.

We strongly suggest you start on this immediately as it can take several business days for Tellus/Netsmart to respond. We recommend you work on setting up your Tellus account and preparing the Generations database at the same time. 

Specifications

We strongly encourage you to review the Tellus specifications. While you don't need to understand the majority of the specifications, we recommend being aware of:

• specification variations by state, and
• error codes returned by Netsmart.

Generations Database Preparation

To be ready for the Tellus interface, work with Company Settings, Payors, Service Codes, EVV Reasons and Resolutions, Caregivers, Clients, and Schedules.

Company Settings

Review the Time / Task Signature settings in Admin > Company Settings and be sure that:

• Time / Task Signature is checked.
• Actual Times is selected.
• Enable Voice Signature is checked.
• For each client covered under Tellus, put a checkmark in "Require Caregiver Signature" and "Require Client Signature." This is done either here in Company Settings or on the Client's personal data page.

Payors

For each payor associated with state EVV, add Payor ID, State, Payor Program and check the State EVV box. 

• See below for list of Tellus Payer IDs and Payor Programs. 
• Make sure to enter the information exactly as it appears in the list below, including what is in the parenthesis. 
• For the EDI portion, contact your Tellus on what to enter.

Service Codes

The recommended best practice is to create separate Service Code descriptions for state programs. For example, for state personal care services your service code description might be "Personal Care" or "Personal Care T1019."  

• You must also add the correct HCPCS Procedure Code in the Alt Description field of the Service Code (i.e., T1019.)  
• You do not need to check the box for State EVV.

Caregiver Information

Several fields are required to meet the Tellus requirements:

• First Name
• Last Name
• Email Address
• SSN/SIN. The SSN is required by Tellus, and we send the full SSN.
• (Optional) State License #

Client Information

On the Client's Personal Data page:

• All Clients must have a EVV ID.
• Client Medicaid number must be entered into the Medical Record # field located in the client's profile under the Personal Data tab. If Payor uses a specific ID for the client in place of the Medicaid ID, enter the specific ID in the Client-Payor Master list found under the Client tab.
• Client address and geocode is mandatory.
• Client time zone is mandatory.
• Client diagnosis is mandatory. This should be entered in the Diagnosis/Code field located in the client's profile under the Personal Data tab. Diagnosis code needs to be entered with no periods, spaces, colons, or extra characters. For example, diagnosis code R29.6 should be entered as R296.
• Client name can only be a name, and it cannot include special characters. For example, Suzanne "Susie" Smith is not acceptable.
• Client phone number can only be a phone number and cannot include special characters. For example, 654-854-1254 daughter is not acceptable; 654-854-1254 is acceptable.
• Client data is uploaded with visits.  

Schedules

Add schedules as normal. 

• Be sure shifts for State EVV have payors assigned. 
• Only schedules with assigned Tellus payors go to Tellus.

Check Your Work

It is very important that your work is accurate because even the slightest discrepancy can cause issues with the interface. Here are several ways that you can use to double and triple check your work. This is optional, but can help find issues before you enter interface credentials into Generations.

• Service Code Master List: Be sure that the appropriate Service Codes have a procedure code in the alternate description field.
• Payor Master List: Double check the payor setup.
• Client List: Use the Column Chooser. Select all fields you just updated like EVV ID, date of birth, phone number, and Medical Record #.
• Caregiver List: Use the Column Chooser and show things like EVV ID, SSN, gender, date of hire, and so on.
• Completed Schedules and Tasks Report: If you're assigning Tasks to schedules, this is a good way to check to see that schedules do have appropriate tasks assigned. Go to Reports > Completed Schedules and Tasks Report. Filter to the correct Client Type, pick a date range, and be sure to choose "Schedules Without Tasks Assigned." 
• Report Writer: To check that you have additional payors and service orders, go to Reports > Report Writer. Choose the report source of client, and then the options of "additional payor" and "service order." This helps confirm that all clients have the payor on the additional payor tab and that a service order is created. 
• Report Writer: To verify that schedules have payors assigned, stay in Report Writer. Select the report source of schedules and pick a start date when you are going to start using the interface; the end date should be a couple of months out. You may need to play with that date range a little to be able to display all shifts. Once you have schedules displaying, use the Column Chooser to view service order, payor, and service; this will help you spot any schedules that do not have payors assigned.
  • You may need to apply client type to narrow down the list.
  • You can also export this to Excel for easier manipulation. Learn more about Report Writer.

Tellus Interface in Generations

The next step cannot be completed until setup is completed in Generations and you have contacted Tellus/Netsmart. Click the Interfaces dropdown menu at the top of the Generations Home screen and select Tellus.

Click the Interfaces dropdown menu at the top of the Generations Home screen and select Tellus. Then select the Main tab. 

• Set the Begin Schedule Processing date.
• Add checkmarks for each Payor associated with Tellus. Assigning a payor tells Generations to assign tasks to the client automatically; you only see the Tasks on the Schedule. After you add a checkmark to a Payor, you see two pop-ups. Agree to both. The first lets you know that any schedules assigned to the selected Payor after the start date will be updated to the Medicaid task list. The second confirms that this was completed.
• Enter in the Medicaid ID, NPI, and optional NPI Taxonomy..
• Click save.

Verify Visits

Keep watching the log and let us know when you start seeing things in that log file that indicate it's working - watch for a "success" or even and "error."

Daily Operations

Ever five (5) minutes, Generations sends confirmed schedules with no exceptions to Tellus; it takes about an hour for Tellus to return a response. On a daily basis, we strongly recommend that you:

• Review EVV schedules. Resolve Exceptions and Confirm Schedules.
• Review the Log File in the HHAX Interface in Generations and correct errors.
• (Optional) You can manually export clients, caregivers, and visits as desired. Manual exporting is not normally required, but may be used if directed to do so by Generations support.

Caregivers and Schedules

Caregivers can obtain signatures either via the app or a phone call. Either way, the client has the ability to confirm or deny the service. If the service is denied, Generations creates an exception that the agency has to document.

On the phone, EVV asks the client to press 1 to confirm service or 2 to deny service, and then to "sign" with their voice.

The signature, service approval, and time/task approval appear on schedules.

Exceptions

For shifts to be eligible to go to Tellus, you must acknowledge all exceptions and give reason and resolution for the exception. 

• Once all exceptions are acknowledged, then the shift is ready to send. To help identify exceptions, show the Exceptions Alert in EVV Schedules(click the column chooser and select Exceptions Alert.) Best practice when in EVV Schedules is to have the following columns displayed in the EVV Schedule view: 
  • Exception Alert
  • Schedule ID
  • Payor
  • Service
• If you make any change to the schedule after it is signed or confirmed, you are prompted to explain the exception with a reason and resolution.
• For example, let's say that you notice on Monday there is a schedule from Friday with a missing logout exception. You add a manual logout which confirms the schedule and resolves the exception. The schedule can now be sent to Tellus; it cannot be sent unless it is a completed visit with both a login and logout.

Exceptions

Reasons

Log

This log shows you any issues that need to be addressed. We strongly suggest you review this log daily. Contact Tellus for assistance with errors.

Errors

Errors are returned from the Tellus system. You may need to contact Tellus to determine issues. A full list of errors is available on the Tellus website under error codes returned by Netsmart. Here are some of the errors we have seen and the resolution in Generations.

Billing

Billing for claims occurs via the Tellus website. In Tellus you:

• Review the Work List.
• Release matched claims.
• Watch the Tellus Claims area for updates.

For more billing details, contact Florida Medicaid.

Key points

• Visits must exist in Tellus for the date of service on the 837p.
• Review visits in Tellus to ensure that they have all required information. For example, if there are outstanding exceptions for a visit, the visit status will be Incomplete.
• To be eligible for claims, visit status must be Verified. We recommend that only claims that are Verified in Tellus are submitted.
• Claims should only be submitted once all exceptions are resolved.
• Generations produces output of both the 837p and 837i for electronic billing.

Regarding Fractional Units

To meet Tellus VA payor requirements, Generations bills whole units when using the 837p for Tellus VA enabled payors.

• Create Schedules as normal. The Schedules must be associated with payors and services as designated in the Tellus Interface. If they are not associated with Tellus payors and services fractional units are not applied.
• Create Timesheets as normal. You do not see the billing override for fractional units on the Timesheets at this point.
• Generate the 837p and be sure to check the box to mark Timesheets as billed. Marking Timesheets as billed is what triggers the fractional carryover functionality.

Once you have generated the 837p, you can:

• See the billing override whole units in Edit Timesheets.
• Run the Banked Time Remaining Report that shows what time has been banked to use in the future and what has been used to make shifts have whole units. 
• Submit your 837p Claim File.
• Run the 837p Billing Reconciliation Report to help reconcile billing with your remittance. 

After The Claim Is Submitted

Once your claim is submitted, Virginia Medicaid checks the Tellus EVV system for the visits on the claim based on Provider Medicaid ID, Client Medicaid ID, date of service, procedure code, and visit units.

• If a visit in Tellus matches a claim, the status in Tellus changes to Processed. This means the claim matched, not that it will be paid.
• If you submit a claim and receive an EOB notice that there was an issue with the EVV information check visit information in Tellus and/or Generations against the claim.
• Contact the Virginia Medicaid for further details about how claims are processed.

While the majority of payor requirements are met by the built in configuration options provided by Generations, some payors may have unique requirements that require us to make programming changes in order to accommodate those requirements.  If programming changes are needed, most can be accommodated within 2 weeks. We are committed to ensuring agencies can bill to any payor electronically from Generations using the 837p and 837i forms.