The new Before submitting visits to Highmark, Netsmart must submit the visit data to Sandata and get approval. If those visits are rejected by Sandata, providers must correct the errors and resubmit. Currently, providers don’t have a way to search for rejected visits by Sandata. The Status search on the Worklist is for the Claim Invoice status, not the EVV status that is associated with the visit submission to Sandata. If the user searches for Rejected in the Status field, it will bring back 837 claim rejections.
In the upcoming release 23.24, which will be in Production on December 6, providers will have a way to identify visits rejected by Sandata, so that errors can be corrected and re-released.
The Payer Approval Status field on the Worklist can be used to filter search results based on a claim invoice status the status received by Sandata of Accepted or Rejected. When a value is selected in Payer Approval Status field and Search is selected, the system will return all visits that have a Visit status from the aggregator that matches the selected value. Clicking the Help icon will open a pop-up that displays any rejection reasons that apply. This update improves the workflow used by providers to identify visits rejected by Sandata, which need to have errors corrected so the visits can be re-released
Payer Approval Status will be visible in the Search Results list to the right of the Status column.
If Sandata rejects the visit, the claim invoice will be placed in 'Unmatched' status and Payer Approval Status will be Rejected.