Visits are uploaded to the Aggregator at 1 am the next morning "after" they are approved by administration.  It can take up to 2 full days for these visits to be available for DDD to able to verify. This means that if you upload your approve claims on the 15th and then submit billing on the 16th DDD will likely deny payment because the visits are not available to verify yet.

If you are not sure if they have synchronized you can determine if they have by going to Homecare-billing-client claims. Type in client name and period ending. Hit search and you will see a column called "synced". If it says NO and you attempt to bill, it WILL be denied.

Visit Maintenance. This term is used to either edit a visit and/or give a reason and resolution code to why the "exception" occurred. For example if a visit doesn't have a schedule associated with it and that provider is a live-in one must do "visit maintenance" and select a reason code of "live-in" with Sandata system. SpokeChoice values the time it takes to have Administrators do these tasks and automates much of the reason codes. In the example given if a schedule is not present and the provider is marked as a live-in to the client the SpokeChoice will automatically assign the reason code without any intervention on the administrators part.

Policy. This term is used loosely and not all "processes" or "technology" is possible to follow "Policy".  For example while there is a exclusions for live-in's to not have schedules it is their policy that everyone must have a schedule. Therefore it is the responsibility of each agency to follow "policy" even if the process or EVV system can not comply or is not supposed to comply.

Memo Field. This is a very difficult concept to understand but our best understanding is that no memo for any field is required but if an resolution took place on an exception noting it is within "policy" but adds to the administration burden. Therefore SpokeChoice will allow certain memo fields but they are not 100% required by technology but might be by "Policy".

Verification. This is a signature method to have the member or designee indicate the services were delivered. Again this not a federal requirement, after all EVV should be providing this proof.  AHCCCS/Sandata's method for this doesn't allow members/designees to verify after the fact without the providers device. They have exception codes not necessary for SpokeChoice because it is more simple to change and ask member/designee to approve the exceptions after-the-fact.

21 Days to get verifcation. You might see this in AHCCCS's requirement docs. This is because they do not have a method to get a signature remotely. Instead the provider needs to take their device back to the member/designee to get a code input, so they give out 21 days to get that done. If you have a claim that is older than 21 days our understanding is you can still enter it and have 21 days from that point to get it signed, which isn't necessary for SpokeChoice users due to the fact the member can sign in and sign it (verify) right away through a legal method.

An exception can be one of the following

• No schedule used
• Provider forgot to clock in later than 60 minutes past the scheduled time
• Provider forgot to clock out
• GPS not working and not captured
• Provider clock in but not on time
• Provider forgot to both clock in and clock out
• Providers device malfunctioned

Note: Clocking out early or later than schedule is NOT an exception.

An exception is a "policy rule" that was broken. All exceptions need to be "cleared" by giving a reason code. In most cases we allow the provider to give the reason code but it is the Administrators "responsibility" to "Acknowledge" them. This is done when you approve timecards. The Sandata system doesn't work that way and in fact AHCCCS's policy states that a provider can not add reason codes to clear them and the Administrator must communicate with some method to the provider and guardian to determine what the reason code should be. SpokeChoice uses an electronic method to communicate that "error" with the provider selecting the reason and is acknowledged by the guardian and then by the administrator during the approval process. We believe this process saves many hours not requiring manual communication. The fact is you as the administrator are clearing the exceptions by approving and visits are not sent until they are approved.

The payer will check with the aggregator (Sandata) to see if they should pay any submitted claims. The payer will ask the aggregator, "I have a request for payment for this amount of units on this date for this service code for this client. IE: Client Mary Jane on 1/15 for CPT code S5150 for 4 units. The aggregator will determine if the visit is "verified". This, again, means that all exceptions have been cleared. (Reason codes given for any exception). Note: SpokeChoice will not upload a visit without any exception having a reason code. So any visit that is in Sandata WILL BE Verified. As long as the response from the Aggregator is that the visit matches the criteria you WILL be paid. Keep in mind that exceptions are not to AHCCCS Policy. That is different from being paid. See below as to what happens if you are not complying to policy. If you need to see if the visit has been transfered to Sandata look at the claim and see if the "Synced" column says "yes". If you want to see it on Sandata's portal click here to learn how to do that.

SpokeChoice has the ability to turn off and on both the forgot clock in/out and request visit change. Although this is not totally necessary to do you might want to consider doing so. Turning it off will mean the provider needs to contact you to enter a clock in/out or request a visit change. Because it is so easy for the provider to do it inside Autovisit it becomes the "norm" and without being confronted as to why this is necessary you will find that a good portion of your providers keep doing it.

Here is the policy from AHCCCS as it relates to exceptions:

"AHCCCS and the Health Plans will monitor the data during a baseline period in an effort to develop performance metrics that may be used to incentivize provider performance through vehicles such as value-based purchasing arrangements, Differential Adjusted Payment initiatives, or quality monitoring reviews. AHCCCS anticipates the baseline period to start after the claim enforcement period (January 1, 2023). AHCCCS does not anticipate having performance metrics at the member level, but will monitor overall provider compliance to determine whether or not a provider agency may fall within or outside the normal threshold for exceptions."

The choice is yours as a business decision but keep in mind it is your responsibility to comply to policy using the features Spokechoice offers.

Upon clocking in, providers are informed of the potential duration of the visit, which could be restricted by:

1. The maximum allowable hours they can work per day.
2. The remaining authorizations for the visit service.
3. The client's ISP definition.

Providers must take note of the latest permissible clock-out time and ensure they clock out by that time or earlier. Failure to do so will result in the visit length being automatically adjusted to the maximum clock-out time. In such instances, the clock-out part of the visit is treated as a manual adjustment. AHCCCS & Sandata consider any manual adjustments to visits as exceptions to the EVV rule, requiring an explanation and reason to clear the exception.