Wellsky has duplicated data from that of FOCUS. Support coordinators and DDD management will still use FOCUS to manage authorizations and Clients. Wellsky has some sort of interface to keep that data up to date (hopefully).

Authorizations are also duplicated but they are given a Wellsky ID and that ID MUST be accompanied for each claim that is submitted to Wellsky.  This present a possible problem that, in our opinion DDD has not adequately addressed, and that is the area of late authorizations. In the past you could still upload billing even if FOCUS did not have a current authorization and the payment would be "pended" until support coordinators got around to adding a current Authorization. This is NOT the case with Wellsky. If you upload a claim where there is no Wellsky ID it will be denied and requires you upload only after it is within Wellsky. Stephanie Erickson at DDD suggested that if a support coordinator does not do their job in time you file a grievance with the department. This is the only suggestion they have come up for this at the moment and should be recognized as a big process related problem and one you should stay on top of more than ever.

Wellsky has two methods to submit claims to DDD.

1) Add each claim one at a time

and

2) Upload an 837 file. For information about 837 click here

Obviously entering claims one at a time is not cost effective based on margins so uploading an 837 file is the suggested method. To do so login to Wellsky and navigate to your top "provider" FOCUS id then hit the My Work tab. You should see the following screen

Select upload and you should be presented with the following screen

click the choose File button and find the output file that was generated by SpokeChoice, then hit upload.

You can click the download button to see any files that have been generated or upload by yourself.

There will be a variety of folders in which you should find submitted and 999 & 835 files. Those files will be used to determine errors and remittance data. To learn more about these file types click here.

You can find specific instructions in this like: EDI Analysis

At the current moment it is necessary for you to download your authorizations from Wellsky.

To do so start with your top level provider (FOCUS) ID (one without a dash). The type level Providers tab should show a split screen where you can select authorizations

Note: You should make sure you are at the top level of your provider numbers. If you are not you will be limited to only authorizations at a single location.

After selecting the Authorization tab at the top right you should see this link

Client Authorizations with Auth ID. This will Pop up another window ((make sure you allow 1990's popups with your browser). Here enter a years range so you get all authorizations, closed and open.

Then hit the View Report at top right. The authorizations should show. You'll see a little 1990's floppy disk. Select the pull down and select Excel

Once you have downloading your Wellsky Authorization file log into Spokechoice and upload that file.

Homecare-healthPlans-client authorizations Wellsky Upload

This will add the wellsky ID on to current FOCUS Authorizations.