Sandata Agency Management Aggregator Data Requirements - Internal

This article will help you to:

• Understand the vendor solutions data requirements for Sandata Agency Management

 

Data Requirements - V1.2

Saturday, January 15, 2022

1:28 AM

SAM Data Requirement Guide

Introduction

Below is a list of data points that are required in SAM that will allow a record qualify to be sent from SAM to Sandata's Aggregator, eMedNY, and Tellus. The requirements are based on the SAM Stored Procedure uspGetScheduleToUploadAltEVV that is current as of 1/15/2022 SAM 6.10.19

Client Data Requirements

• Client must have at least one address record
• Client must have an address entry that has the 'Address' field on the 'Personal' page with some value that is not blank
• Client's admission must have the 'Santrax Enabled' checkbox checked on the admission 'General' page
• Client's admission must have a rank 1 payer record that is Aggregator enabled
• Client's admission must have a rank 1 payer assigned that is tied to a payer that has a 'Number' value entered in the "Provider Numbers" section for the specific location that the client's admission is associated with. This 'Number' value must match the Aggregator setup for this customer.
• Client's admission must have an authorization (requirement for Ohio)
• Client's authorization must align with billing rate with matching service and event code configured on the client's associated rate plan (requirement for Ohio)
• Client's admission must have a rank 1 payer with a customer number value entered that is not blank

• Client's admission must have a rank 1 payer that has the payer setting 'Hold Visit Verification with no Customer Number' (found on EDI Settings tab) not enabled  Client's admission must have a rank 1 payer with a 'Medicaid ID' value that is greater than or equal to 5 characters in length
• Client's admission has to have an attribute that has the Newborn flag set (requirement for Ohio)

• Client admission must have an entry in the stxClientUploadDetails table (Tier 3 or Dev has to verify)
• Client must have Services which correctly correlate to the AltServiceCodes between SAM/Agg (requirement if MMT's ProcedureCode is set to AltServiceCode) 
• Client must have schedule in '02-Confirmed', '03-In-Process', or '04-Closed' status OR an Admission Service record that is not ended with a date prior to the current date.

Staff Data Requirements

• Staff must have a SSN value that is not blank
• Staff must have an 'Agency ID' value that is not blank
• Staff must have a schedule that meets the "Visit Data Requirements"
• Staff must have a record in the SQL view called 'viewStaff' (Tier 3 or Dev has to verify)
• Staff must have an entry in the stxStaffUploadDetails table

Visit Data Requirements

• Schedule must have a client assigned
• Schedule must have a service assigned (unscheduled events are disqualified)
• Schedule must have a client participant item
• Schedule must have a client participant item associated to a billing rate

• If MMT is configured for AltServiceCode, this value must be configured on the billing rate

• Schedule must have a client that has a location assigned
• Schedule must have a client that has a 'Other ID' populated (requirement for Ohio)
• Schedule must have a client that has a rank 1 payer record
• Schedule must have a client whose rank 1 payer has a location entry on the payer 'General' tab with a 'Number' value
• Schedule must have a client that has a rank 1 payer record that is Aggregator enabled
• Schedule must have a client that is Santrax enabled (found on client general page)
• Schedule must have a client where the rank 1 payer is Santrax enabled (found on payor santrax settings page)
• Schedule must have a staff assigned
• Schedule must have a staff participant item
• Schedule must have a staff that has an 'Agency ID' value that is not blank
• Schedule must have a staff that has a 'Santrax ID' value that is not blank or zero
• Schedule must have a schedule date that is greater than or equal to the 'Aggregator Effective Date'
• Schedule must have an entry in the SantraxScheduleUploadDetails table (Tier 3 or Dev has to verify)
• Schedule must have a service that does not have the 'Do not Send Alert' enabled

 

Visit Task Requirements

• Schedule that meets the "Visit Data Requirements" has to have a task entered that aligns with a task previously sent from EVV Account Manager setup

 

Definitions

• Contract - A single value that is entered on the payer record on the tab called 'Santrax Settings' in the field called 'Contract Identifier'
• Program - A single value that is entered on the admit type record on the tab called 'General' in the field called 'Third Party Payer Program'

Last Updated: January 2022, JLO  Last Reviewed: January 2022, JLO