The Visit Verification ("VV") workflows in AlayaCare allow organizations to go through a verification process to determine whether any visits are in violation of the VV requirements configured for your organization. If any VV exceptions are found during the verification process, you will need to review the visits that failed verification and, where required, select the correct reasons and resolutions before you can approve the visit to include in claims and payroll.
- Setting criteria and running visit verification
- Reviewing visits that failed verification and resolving exceptions
- Approving visits for billing and payroll
- VV and visit locking
- Reviewing approved and rejected visits
- Additional Sorting
Roles and permissions
The following ACLs offer various permissions to a visit. The ACLs must be selected if you wish to perform the described action for the visit:
- Accounting>Reset visit to not approved: to set a visit back to not approved
- Accounting>Reject visit: to reject a visit.
- Accounting>Override bill quantity: to edit the bill quantity on a visit before it is approved.
- Accounting>Override pay quantity: to edit the pay quantity on a visit before it is approved.
- Accounting>Override bill quantity on locked visit: to edit the bill quantity on an approved visit.
- Accounting>Override pay quantity on locked visit: to edit the pay quantity on an approved visit.
- Scheduling>Adjust Recorded Start Time: to adjust the start time on a visit
- Scheduling>Adjust Recorded End Time: to adjust the end time on a visit
- Scheduling>Adjust Recorded Start Time on a locked visit: to reset the start time on a visit to the value of the work session
- Scheduling>Adjust Recorded End Time on a locked visit: to reset the end time on a visit to the value of the work session
Setting criteria and running visit verification
To verify and approve visits according to the VV requirements in effect for your organization, go to Schedules> Visit Verification.
The tabs unverified, failed verification, and approved & rejected will then be shown.
The number in parentheses for unverified is the number of visits up to the current date and time that have an approval status of not approved.
Vacant and on-hold visits will not be included in the count. Note that in multi-office environments, this number will be filtered by branch.
The number in parentheses for failed verification represents the current number of visits, for which one or more exception to the VV requirements has been found during the verification process, which now have the status in violation. Further action is required before these visits can be approved for billing/claim generation and payroll. Note that in multi-office environments, this number will be filtered by branch.
To begin the verification and approval process, you will first need to filter for a date range to populate a list. Use the Start Date and End Date fields to select a desired range. The default range is set to 30 days from the Visit Verification Default End Time Delay date, but you can select up to 60 days from the visit end date. The system will include all unverified visits up to this date and time. You will not be able to select a time or date in the future, as visits must be in the past before they can be verified and approved.
The additional fields such as more payors, service departments, employee departments, employee groups, client groups, or branches (multi-office environments only) help you filter the unverified visits. You can also choose to filter visits by a single employee or client.
Note that in multi-office environments, you will be able to select payors, departments, groups, employees, and clients that belong to the current branch, parent branch, or child branch, but not sibling branches.
Click run verification once you have selected all criteria you wish to apply. (The + Run Verification button will only be enabled when a valid date range has been entered.)
The verification process will then occur. When the verification process is run on new visits, the number of visits found with exceptions displayed in the failed verifications tab will update accordingly.
Any visits for which no exceptions were found will be automatically approved for the bill and pay quantities, which are determined by the rounding rules set on the bill and pay code for the service. Click on the Approved & Rejected visits tab to review the approved visits or override the bill and pay quantities.
Reviewing visits that failed verification and resolving exceptions
To review the exceptions found during the verification process, click on the Failed Verifications tab. To populate a list, you will first need to filter for a date range. By default, the date filters are set to 30 days from the current date, but you can edit the Start Date and End Date to a range of up to 60 days. Once you have selected a date range, click “Search Visits” to show the results.
(The "Search Visits" button will only be enabled when a valid date range has been entered. If it’s an invalid date range, a temporary message will appear on the top right of the page explaining the problem.)
Each visit will be listed with its visit ID, client (or facility), employee, visit start date, associated payors, number of remaining exceptions, and corresponding branch (multi-office environments only). From here, you can also manually change the status of multiple visits back to not approved, via the select visits to edit button, if they require re-verification.
You can filter the list of visits by date range, client/facility, employee, client groups, employee groups, payors, service departments, exception type or branches (multi-office environments only). Turn on the only resolved visits toggle to filter to visits that still require time approval, but for which all exceptions have been resolved. Filter by exception type to only include or exclude visits with certain exceptions flagged.
Click on Review to have a look at the visit.
The screen below will appear and you will be able to review visit information, resolve exceptions, and approve bill and pay quantities so you can proceed to generate billing/claims and run payroll.
Basic information about the visit will be displayed at the top of the screen. The client, employee, facility (if applicable), visit ID, service, and address will be displayed under visit information. Under scheduled visit details, you will see the scheduled start date, scheduled start time, scheduled end time, the duration of any scheduled breaks, and the total scheduled duration.
To review the next visit in the failed verifications list, click next.
If you have the required permissions, you can edit the status of the visit from in violation, to not approved or rejected, from the edit status dropdown. Once you reject a visit, you will not be able to verify it for exceptions again.
In the work session information section, you will see information about the total duration of the visit based on the clock-in and clock-out times, as well as information about the location of the visit.
The total duration displays the actual duration of the visit based on the recorded clock-in and clock-out times. The coverage % represents the percentage of the scheduled time that the actual visit lasted (total duration/scheduled duration). Start time represents the first clock-in (if available), while end time represents the last clock-out (if available). A visit with an open work session would not have an end time displayed. Start time and end time value can be respectively adjusted via adjust start time and adjust end time buttons.
Once start time or end time value has been adjusted, a visual indicator is shown, to indicate that this value was entered by a user and is not from the work session. They can be reset to the work session values via the reset start time and reset end time buttons shown when a value has been adjusted.
Under work sessions, you will see the times at which the employee clocked in and clocked out of the visit. An icon will indicate whether the clock-in and clock-out occurred via the web application, mobile application, or the interactive voice recognition (IVR) system. Scroll down to review more information if you have multiple clock-ins and clock-outs.
Mobile application: IVR application:
If the clock-in or clock-out occurred from the mobile application, the distance from the client’s address that the clock-in or clock-out occurred will be displayed. It will be shown below the clock-in/clock-out time in the units configured by your organization under settings>system settings> locale>unit of distance.
If the clock-in and clock-out occurred via IVR, the phone number that the employee used to clock in or clock out will also be displayed. If the phone number matches the client’s phone number, it will be displayed in green. If the phone number they used does not match the phone number on the client’s profile, it will be displayed in red.
If the employee clocked in or out from the mobile application, the GPS coordinates of the location at which they clocked in (shown in green) and out (shown in red) will be displayed on the map, as well as the location at which the visit was scheduled to occur (shown in blue).
If the employee clocked in and out via the web application or IVR, the clock-in and clock-out coordinates will not be captured. Only the service location will be displayed on the map.
If your organization uses visit notes, click on visit notes section to review any notes written by care providers during the visit before you approve the visit and resolve exceptions. Please note that the Visit Notes section has moved under the time approval section in the details page to allow for better visibility during the verification process.
Note that you must be in a role with the view visit notes ACL to view this section.
The exception list section will display the exceptions to the VV requirements identified for the visit. For details about the various exception types, please see the user guide for more information on the rule types.
For each exception, select from the dropdown in the reasons column to resolve it. If required, enter comments in the comment(s) field and click save. The status of the exceptions will then change to resolved.
For each exception, you must select from the same dropdown menu resolve the exception. If you only need to acknowledge the exception to verify the visit, select acknowledge.
If you are required to select a reason and matching resolution, select a reason from the same dropdown menu and then select the corresponding resolution. Note that only resolutions that have an association created in your branch with the reason you selected will be available to you.
If required, enter comments in the comment(s) field.
Click save to save your changes to the exception list.
The status of the exceptions will change to resolved.
If a comment was not entered for an exception or resolution that requires a comment, you will be prevented from saving and receive the following error:
Approving visits for billing and payroll
Once all exceptions within the visit have been resolved, you can review the bill and pay quantities, as well as approve the visit so it can be included when running billing and payroll. Please note that you have must have the required ACLs to complete this action.
Adjust the bill and pay quantities for the visit if necessary. Next, click approve.
The visit's status will then be changed to approved.
VV and visit locking
A visit gets locked when its status changes to approved or rejected. The visit will become unlocked again if its status is changed to not approved.
Note that this locking applies to the reject all batch action on the vacant visits page.
Reviewing approved and rejected visits
To see a list of previously approved or rejected visits, click on the Approved & Rejected Visits tab. To populate a list, you will first need to filter for a date range. By default, the date filters are set to seven days from the current date, but you can edit the Start Date and End Date to a range of up to 60 days. Once you have selected a date range, click “Search Visits” to show the results.
(The “Search Visits” button will only be enabled when a valid date range has been entered. If it’s an invalid date range, a temporary message will appear on the top right of the page explaining the problem.)
To review details of a previously approved or rejected visit, select Review.
You can manually change the status of an approved visit to rejected or not approved. You can also set a rejected visit back to not approved status.
Edit the selected reasons and resolutions for the exceptions within the approved visit's exception list. Click save to save your changes.
If you wish to override approved bill and pay quantities calculated during visit verification for an approved visit, you must adjust the values in the bill quantity or pay quantity field and select override in the time approval section. Note that you must have the required permissions to override bill and pay quantities for an approved visit.
If you wish to override approved bill and pay quantities, you must adjust the values in the bill quantity or pay quantity field and select override in the time approval section. Note that you must have the required permissions to override bill and pay quantities for an approved visit.
You will not be able to edit the exception list or time approval sections on a rejected visit.
Within the "In Violation and Approved & Rejected" grids, users can also perform additional sorting with the below prompts:
- Visit ID: sorts numerically in ascending order
- Client: sorts by first and then last name from A to Z while grouping client visits; with a tertiary sort on visit start date and time
- Employee: sorts by First and then Last name, while grouping employee visits, with a tertiary sort by Visit start date and time. Vacant visits will appear first.
For more assistance, contact your customer relations representative or refer to the user guides on the Feature Overview page.