Visits need to be in Sandata before the payer will pay and the correct billing code and amount of hours are necesary. If you get a claim denial you should first examine these steps.

The first thing that needs to be done is to login to the Sandata portal to determine if the visit is there. Keep in mind timing of approval and sending in billing needs to be done correctly. Just because you see it synchronized (today) in SpokeChoice does not mean it was in time when the payer checked for it.

Log into Sandata. If you do not know your credentials please do not ask us, we will not know them.

Once logged in, go to the following screen.

Enter in the members AHCCCS ID (note it should start with an 'A').

Enter in the date of the  denial

Change the search field from All Exceptions to All visits <-(this is VERY important)

Then hit search.

You are looking for some vital data.

You want to take note of the Visit date, the bill Hours and the service code. These will be the items that the Payer is going to ask for when approving your billing claims. If they don't see it they will deny payment(s)

Notice the call in and Adjusted in Numbers. In this example the provider clocked in at 12:00 am but later adjusted the time to 1:30 am. Also, notice that the visit is "verified". This means that according to everything given the claim will pay. Even though the provider adjusted time the reason code was given and clears the exception to be verified

If the service code is wrong it could be that a change record was not sent to Sandata. If so edit the claim to some other service code, update it, then change it back to what you believe it should be and update. This will add a change record to the visit so on next Sandata upload (1 am the next morning) it will change the visit to the correct service code.

Also, please check the claim history and look when the 837 was submitted against the approved date. If they are not at least 2 days a apart this could likely be the reason for denial. Note: As of 2/18/23 SpokeChoice no longer allows you to output the claims that are not synchronized that need to be synchronized.

If you do not see a visit in the Sandata Portal and yet it is Synchronized in SpokeChoice please send an email to support with the details. We typically need the client, provider ,pay period ,service date , service code, time in and time out.

If you are having problem with visits and claims not synced or synchronizing to sandata and it has been a number of days you should be checking reports system status. It is possible you have something missing. The most likely candidate would be the SSN (social security number) is missing. Also, using a qualified Payroll company that is interfaced withe SpokeChoice will help this because once in the payroll companies database the SSN is automatically updated in SpokeChoice eliminating this frustration. If you are wondering why your visits, claims or sandata data is is not syncing then go to reports-system and see if there are issues.

Visits show up in Sandata within 24 hours from the time they are approved in SpokeChoice. The timecard must be approved by the admin after, of course, the guardian has approved timecard. Depending on Sandata's system there is a chance it could take longer than 24 hours. This is due to the fact that sandata has a difficult time receiving new clients and the timing from when AHCCCS sends over the information varies.