Visit Verification is a process that automates most of the visit approval workflow, which determines which visits qualify for billing and payroll. The process compares completed visits against a set of configurable rules, flagging any issues that require review or further investigation. These issues can include visits that do not meet requirements configured for your organization. You can review these visits in detail and document the actions to validate compliance.
Within the US market, Visit Verification helps organizations electronically verify information related to home health care visits covered by Medicaid. Visit Verification ensures that clients are receiving care accordingly and reduces the number of fraudulent care claims submitted.
The Visit Verification workflows in AlayaCare allow organizations to determine whether any visits are in violation of the Visit Verification requirements configured for your organization. If any Visit Verification exceptions are found during the verification process, you will need to review the visits that have failed verification.
Where required, you will select the correct reason and resolution codes before you can approve the bill, pay quantities for the visit, and proceed to billing/claim generation and payroll.
When required, the visit verification information is then exported and sent to a third-party aggregator.
Before you begin
- Visit Verification is available by request for your organization.
- You must have required permissions prior to using Visit Verification.
Please refer to the attached Visit Verification configuration guide for more information.
Configure Visit Verification settings
You must first configure your Visit Verification accounting settings before using Visit Verification to identify visits that are in violation of related requirements:
- Set up rounding rules to calculate approved time for visits during visit verification.
- Create the reasons, resolutions and associations that will be used to resolve exceptions found during visit verification.
- Set your desired unit for distance thresholds in Settings>Locale>Unit of distance
- Create rule sets with different rule types and attach them to service codes, payors and branches.
Transitioning over from the legacy workflow
If you are transitioning over from the legacy workflow, make sure to clean up past visits by rejecting them, so that they aren't considered by verification.
Verifying and approving visits
To complete visit verification and approval processes for visits, go to Schedules>Visit Verification.
To verify recently completed visits, set your verification criteria and select Verify All from the unverified tab.
You can now review visits with exceptions from the failed verification tab. When all exceptions on a visit are resolved, you can approve the bill, pay quantities, and have the visit approved for billing and payroll.
More information: How do I verify and approve visits using Visit Verification?
Other implications
The latest Visit Verification workflow brings these additional changes to the visit approval process:
- You can no longer edit the clock-in and clock-out times of a work session.
- All time approval fields in the visit dialogue are disabled for visits.
- Visits will be locked upon Approval
- Legacy visit approval page remains accessible, but all approval actions are removed.
For more information on Visit Verification, please see the attached user guides.
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