Caregivers who need to submit a 485 on behalf of their clients can generate the form directly in AlayaCare. When creating the 485, data from the client's profile will automatically populate the form to avoid having to reenter information.
Roles and Permissions
Note that you will need the "View 485" and "Manage 485" ACL (permissions) enabled for your role before you can perform the following steps. These ACLs are accessible from Settings > Roles and Permissions, and are available under the Clinical folder.
The following sections of a client's profile are linked to the 485:
- Demographics
- Coordination
- Medical History
- Medication
- Care Plan
- Risk Assessment
- Equipment and Supplies
- Care Item Descriptions
The 485 itself can be added and approved from Document Approval in the Care Documentation tab on the client's profile:
- Add the 485 in Document Approval
- Sign the Form and Mark as Sent
- Approve the Form
- Status Change within the Document Approval Process
- Office Identification Sets within 485
Please note that the sample images for the 485 below are NOT an exact match to the steps shown within the mock-up AlayaCare environment - our aim is to show you how and where the corresponding text should appear on your 485.
Enter the Client's Demographics
The Salutation, First and Last Name, Address, Phone Number, Sex, and Date of Birth entered in the Demographics tab on the client's profile appears in the Patient's Name and Address, Date of Birth, and Sex sections (6,8, and 9) of the 485.
Enter the Client's Physician as a Contact in the Coordination Tab
To have the contact information of the client's physician appear on the 485, you must first enter the physician as a client contact in the Contacts tab of the Client's profile. Locate your client, then go to Client Info > Contacts, and click on + Contact.
Enter the physician's name, address, and phone number and then save the contact. You will now be able to select the client's physician from the Physician dropdown when adding a 485. The contact information for the physician will appear on the 485 in the Physician's Name and Address section (24).
Learn more about adding client contacts.
Complete the Client's Medical History
Information about a client's Diagnoses, Surgeries, Nutritional Requirements, Functional Limitations, Activities Permitted, Mental Status, or Prognosis entered in Care Documentation>Medical History on the client's profile will be automatically added to a 485 created for the client.
The diagnosis marked as the client's Primary Diagnosis will appear as the Client's Principal Diagnosis on the 485 (section 11). The rest of the Diagnoses entered in the Client's Medical History will appear in the Other Pertinent Diagnoses section (13) of the 485.
Surgeries entered in the Client's Medical History will appear in the Surgical Procedures section (12) of the 485.
You will find the Medical History tab under Client Info as well.
On 485:
Any Nutritional Requirements, Functional Limitations, Activities Permitted, Mental Status options, or Prognosis options checked in the client's Medical History will appear in the corresponding sections (16, 18.A, 18.B, 19, and 20) of the 485.
In Medical History:
On the 485:
Learn more about completing a client's medical history.
Enter the Client's Medications
Active Medications that have been entered in Care Delivery > Medications on the client's profile will appear in the Medications section (10) of the 485. The Medication Name, Dose and Dose Type, Time Instruction, and Route will be included for each medication.
This is how your Medications tab will appear on your environment:
On the 485:
If a medication has been added since the last 485 was generated for the client, it will be marked N for new on the 485. If a medication has been modified since the last 485, it will be marked C for changed. If it is the first 485 added for the client, all medications on the form will be marked as new.
Fill Out the Client's Care Plan
If your organization is using Care Plan 2.0, active diagnoses, interventions, and goals on the client's current active care plan will flow through to the 485. You will find the below tab under Care Management > Care Plans.
Active diagnoses and interventions will appear in the Orders for Discipline and Treatments section (21) of the 485. If an intervention is linked to a diagnosis on the care plan, it will appear under that diagnosis. Diagnoses and their linked interventions will appear in the order the diagnoses appear on the care plan.
In the care plan:
In the 485:
All diagnoses will flow through to the the 485, unless they have been archived or resolved.
You can control which interventions appear in the 485 by using the Include in 485 checkbox when adding or editing an intervention. When adding an intervention, the Include in 485 checkbox will be selected by default. If you do not want that item to pull through to the 485, uncheck the box.
Interventions that will be included in the 485 will have the 485 icon next to them in the client's care plan.
The client's active goals from the care plan will appear in the Goals/Rehabilitation/Potential Discharge Plans section (22) of the 485. Goals will be listed in the order in which the diagnoses they are linked to appear in the care plan.
In the care plan:
In the 485:
Learn more about adding and editing diagnoses, interventions, and goals.
Add Risks to a Client's Risk Assessment
Any Allergies added as Risks to Risk Assessment of the Client's profile will appear in the Allergies section (17) of the 485. Any Risks in the General, Environmental, or Infectious Diseases categories added for the Client will appear in the Safety Measures section of the 485. Note that Risk Assessment can be found directly within the Overview tab, therefore Client > Overview > Risk Assessment.
In Risk Assessment:
On the 485:
Learn more about adding risks for a client.
Add a Provider Requisition to the Client's Equipment & Supplies
Equipment and Supplies added to a client's profile will appear in the DME and Supplies section (14) of the 485. To have items appear in this section of the 485, you must first add and approve a Provider Requisition for one of the client's services.
To do so, within your client's profile, go to Care Management > Services. Then, select a service by clicking the service name, and go to the Equipment & Supplies tab. From here, click +New Requisition.
After creating the Provider Requisition, start adding items by clicking +Add Item.
In the Item Name field, you will see that the system will prompt you to "start typing". Depending on your environment, you may start typing and be able to select an item from the list of Supplies available.
Be sure to also enter Quantity Requested and any Additional Information, and then click Save.
You must approve the Provider Requisition for the added items to appear on a 485. Click the Approve button on the Requisition to change the status from Draft to Approved.
On the 485:
Please note that we are currently working on updating documentation related to Equipment and Supplies.
Displaying Descriptions to Care Item Fields in the 485
Agencies that have multilingual caregivers have been recommended to put translated material into the description field of the "goal", "diagnosis" or "intervention", as translation for this particular field is not currently supported by our localized Spanish or French versions.
Users can now navigate to System Settings and choose to turn the descriptions to these care items ON or OFF within the 485. Settings can be toggled like the sample shown below.
Add the 485 in Document Approval
When you are sure that the relevant information in the client's profile is correct and up to date, you can go ahead and generate the 485 for the client by going to their profile, then Care Management > Document Approvals and clicking Add Document. Be sure to select "485" as your document type.
In the resulting dialogue box, enter the Client's HI Claim No., Provider No., Certification Start Date, Certification End Date, and Start of Care Date. In the Physician dropdown, select the Client's Physician from their list of contacts. This information will appear directly on the 485. When you have finished, click Save.
The document will appear as a Draft in the Document Approval screen. Note that the information in the Provider's Name, Address and Telephone Number section (7) is pulled from Settings > Agency Information.
Sign the Form and Mark as Sent
After reviewing the generated form, click Send to mark the 485 as sent.
In the dialogue box, enter the Date of Verbal SOC (if applicable) and use your cursor to sign your name electronically in the Signature field. When you have finished, click Mark As Sent.
Your electronic signature will appear in the Nurse's Signature and Date of Verbal SOC Where Applicable field (23).
If you discover an error in the form, select Reject. After marking the form as Rejected, you can correct the errors and add a new 485 for the client.
Approve the Form
Once the 485 Form has been signed by the client's physician, you can upload the signed form and mark it as Approved. To begin, click Approve on the 485 Form.
Click Upload file here to attach a scan of the signed 485 Form. After attaching the document, click Mark as Approved.
The Status of the 485 Form will then change to Approved.
Status Change within the Document Approval Process
If the user has the right ACL (permissions) enabled, they will be able to change the status of approved documents within the document approval workflow. Specifically, from Settings > Roles and Permissions, then under the Clinical folder, you will find the following ACLs:
This is self-explanatory: the ACLs listed above offers the user with the ability to delete 485 document drafts; to revert the 485 status from Sent to Draft; to revert the 485 status from Approved to Sent; and to revert the 485 status from Rejected to Sent.
Office Identification Sets within 485
Office sets are used by agencies who have multiple offices in one branch, and need a way to configure name, location, billing and communication information for each office in the branch. Currently, the 485 document approval workflow pulls information from the branch's system settings. When there are multiple configured offices sets for the same group, or where there are none, there is a need to fall back to the organization's main system settings.
As part of a recent improvement in 2024, we introduced new fields in the Office ID sets. This means the system will automatically populate address information from the office set to the 485 forms, when linked to a group, provided that the selected client in that group has a 485 form. Additionally, the 485 forms now support agencies using multiple fax numbers per branch.
Additionally, 485 forms now lets users select a "from" fax number. If multiple fax numbers are configured for a branch, users can now select a "from" fax number from the provided list. If the fax number is configured in the Office ID set, it will populate by default.
To set this up for your organization, navigate to the "Office ID set" section. Enter the address information in the new fields provided, and link the Office ID set to the appropriate group.
For more on Office Identification Sets, refer to this article.
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