Sandata Billing Reports

This report displays all visits within the selected date range and shows the last time each visit was returned to the payer for validation. Use this report to track the status of visits relative to claims validation. It can be used to review when a particular visit was returned to the adjudicating system.

Use the following fields to limit the report output:

Field	Description
Payer	Visits for the selected payer(s)
Program	Visits for the selected program(s)
Service	Visits for the selected service(s)
Client Medicaid ID	Visits for the client's Medicaid ID
Supervisor	Visits for the selected supervisor at the provider agency
Visit Status	Visits for the selected visit status

Reports are grouped by the following fields. Each change in these fields results in a page break.

Field	Description
Account:	The selected provider
Provider Medicaid ID:	The provider's Medicaid ID and/or Alternate Medicaid ID

Each column of the report displays:

Columns	Description
PayerT	The payer for the related visit
Program	The program(s) fir the visit
Service	The service performed for the visit
HCPCS	The HCPCS code used for billing
Client Name	The client name Blank if unknown
Medicaid ID	The client’s Medicaid ID and/or Alternate Medicaid ID If not available, Payer ID. If newborn support is enabled and the client is flagged as a newborn, is shown as “N”.
Visit Date/Start/End	The date, start time and end time of the visit
Group Visit Code	The group visit code associated with the visit, if applicable
Status	The status of the visit
Batch ID	Currently Unavailable
Transaction ID	Currently Unavailable
Visit Verified Date	Currently Unavailable

Sample Report

Claims Rejections by Submission Date - Single Day Closed

This report shows all claims validation requests that were returned unsuccessfully by the Sandata’s Claims Validation system. The report shows the request including the error message returned. Use this report to quickly identify claims where matching EVV information was not found. This can assist in identifying visits that require action so they can be resubmitted to the claims validation system.

Use the following fields to limit the report output:

Field	Description
Payer	Visits for the selected payer(s)
Program	Visits for the selected program(s)
Service	Visits for the selected service(s)

Reports are grouped by the following fields. Each change in these fields results in a page break.

Field	Description
Account	The provider agency’s Sandata EVV account number
Provider	The state assigned identifier for the prover (e.g Provider Medicaid ID)

Each column of the report lists the following information:

Columns	Description
Received	The date the claim was received by Sandata Claims Validation
Batch ID	The batch ID number for the claims validation request
Trans ID	The transaction ID number for the claims validation request
Invoice Control NO	The invoice control number for the claims validation request
Line NO	The line number within the invoice
Client ID	The Sandata client ID
Visit Range	The date range for the claim where the visits were reviewed
Payer	The payer for the claim line
Program	The program for the claim line
Service	The service for the claim line
Bill Unit	The billable units for the claim line. This reflects the total billing requested for the date range
Exception	The information returned for the failed claims request
Provider Medicaid ID	The client's Medicaid ID and/or Alternate Medicaid ID If not available, Payer ID. If newborn support is enabled and the client is flagged as a newborn, is shown as "N".
Client Name	The client's name. Blank if unknown.
Units Found	The total billable units for all visits found matching the request criteria
Visits	The number of visits found which were reviewed for the claims request

Sample Report

Claims Rejections by Visit Date - Max 31 Days Closed

What does this report show?

The Claims Rejections by Visit Date - Max 31 Days Report helps you identify claims that were rejected because they could not be matched to an Electronic Visit Verification (EVV) visit. This report displays claims based on the visit date of service, allowing you to review rejected claims for visits that occurred during a selected date range of up to 31 days. Use this report to investigate claim rejections, identify mismatched information between claims and visits, and determine what needs to be corrected before resubmitting a claim.

Before You Begin

Keep these points in mind before running the report.

For the best results:

Run the report for a maximum of 31 days at a time.
Run the report separately for each Sandata account.
Use this report with your other Sandata reports to gain a complete picture of your claims and visits.

When reviewing your results, remember:

Claims that cannot be matched to a visit are not associated with a specific Sandata account because Sandata cannot determine which account the missing visit belongs to.
Because this report is based on visit dates, claims without a matching visit date are not included in the report results.

When should I use this report?

Use this report when you need to:

Review rejected claims for services provided during a specific date range.
Investigate why a claim did not match an EVV visit.
Identify claim or visit information that needs to be corrected.
Verify that visits were recorded and verified before claims were submitted.

Which Claims Rejections report should I use?

There are two Claims Rejections reports. Both identify claims that failed to match an EVV visit, but each uses a different date to retrieve results.

If you want to...	Use this report
Review claims based on the date services were provided	Claims Rejections by Visit Date - Max 31 Days
Review claims based on the date claims were submitted	Claims Rejections by Submission Date - Max 31 Days

How do I use this report?

After running the report, work through each rejected claim using the following process.

Review the rejected claim and note the reported error.
Compare the information on the claim with the associated EVV visit.

Check these items first:
- Provider ID - Does the Provider ID on the claim match the Provider ID in Sandata?
- Client ID - Does the claim match the correct client?
- Visit Date - Does the service date on the claim match the visit date?
- Payer ID - Does the payer match on both the claim and the visit?
- Procedure Code - Does the procedure code match? Some states require modifiers to match exactly. Follow your state's requirements.
- Units - Are the billed units equal to or less than the verified visit units? Follow your state's unit rounding requirements.
- Submission Timing - Was the visit entered and verified in Sandata before the claim was submitted?
Determine whether the problem exists on the claim or the visit and correct the issue.

Why didn't my claim match a visit?

Several issues can prevent a claim from matching an EVV visit. Review the common issues below to identify what needs to be corrected.

The visit wasn't verified

Only visits in Verified status (Auto Verified or Manual Verified) are eligible for claims matching. Visits in Incomplete or Omit status cannot be matched.

Check that:

The visit is in Verified status.
All required visit information has been entered.
Any exceptions have been resolved.

The visit wasn't available when the claim was processed

A claim can only be matched to an EVV visit that has already been received and verified by the Sandata EVV Aggregator.

Check that:

The visit was received by Sandata before the payer processed the claim.
The visit was already in Verified status when the claim was submitted.

Note: If the visit is received after the claim has been processed, the claim will not automatically be matched. You'll need to correct the issue and resubmit the claim.

The service codes don't match

The procedure code on the claim must match the procedure code on the verified EVV visit.

Check that:

The procedure code on the claim matches the procedure code on the verified EVV visit.
Any required procedure code modifiers also match, if applicable.

The billed units don't match

The units billed on the claim must be less than or equal to the verified visit units.

Check that:

The number of units billed on the claim does not exceed the verified visit units.
The units on the claim and the verified visit were calculated using your payer's or state's unit rounding requirements.

What should I do if a claim doesn't match a visit?

After identifying the issue, either:

Correct the claim and resubmit it.
Correct the visit, verify it if necessary, and then resubmit the claim.

Before resubmitting, confirm that all claim and visit information matches.

Available Filters

Use filters to narrow your report results.

Filter	Description
Date Range	Limits results to the selected visit date range (up to 31 days).
Payer	Displays claims for a specific payer.
Program	Displays claims for a specific program.

Field Definitions

Field	Definition
Account	Provider name and Sandata account number.
Provider	Provider Identifier on the claim.
Error	The reason the claim did not match a visit.
Total	Total number of claims for the error shown.
Received	Date the claim was received by the Sandata system.
Batch ID	Batch ID assigned to the claim.
Transaction ID	Transaction ID associated with the claim. This field is not used in all states.
Invoice Control Number (ICN)	Unique identifier assigned by the payer to track the claim.
Line No.	Service line number on the claim.
Client ID	Client identifier on the claim.
Visit Range	Start and end dates of the visit on the claim.
Payer	Payer identifier on the claim.
Program	Program associated with a potential matching visit. This field populates only for Unmatched Units errors.
Service	Procedure code on the claim.
Bill Units	Units billed on the claim.
Provider Medicaid ID	Provider Medicaid ID on the claim.
Client Medicaid ID	Client Medicaid ID on the claim.
Client Name	Client name from the potential matching visit. This field populates only for Unmatched Units errors.
Units Found	Number of units found on the potential matching visit. This field populates only for Unmatched Units errors.
Visits	Number of visits that matched the claim.
Error Reason	Additional information about the matching error. This may include information from the claim response file's Note Detail field.

Note: Providers are responsible for ensuring that visits accurately reflect the services delivered and that claims are submitted only for services that were actually provided. Submitting inaccurate or unsupported claims may raise concerns related to fraud, waste, and abuse.

Sample Report

Claims Rejections by Submission Date - Max 31 Days Closed

What does this report show?

The Claims Rejections by Submission Date - Max 31 Days Report helps you identify claims that were rejected because they could not be matched to an Electronic Visit Verification (EVV) visit. This report displays claims based on the claim submission date, allowing you to review rejected claims submitted during a selected date range of up to 31 days. Use this report to investigate claim rejections, identify mismatched information between claims and visits, and determine what needs to be corrected before resubmitting a claim.

Before You Begin

Keep these points in mind before running the report.

For the best results:

Run the report for a maximum of 31 days at a time.
Run the report separately for each Sandata account.
Use this report with your other Sandata reports to gain a complete picture of your claims and visits.

When reviewing your results, remember claims that cannot be matched to a visit are not associated with a specific Sandata account because Sandata cannot determine which account the missing visit belongs to.

When should I use this report?

Use this report when you need to:

Review claims submitted during a specific date range.
Investigate recently rejected claims.
Identify claim or visit information that needs to be corrected.
Monitor claim submission activity and identify claims that need to be resubmitted.

Which Claims Rejections report should I use?

There are two Claims Rejections reports. Both identify claims that failed to match an EVV visit, but each uses a different date to retrieve results.

If you want to...	Use this report
Review claims based on the date services were provided	Claims Rejections by Visit Date - Max 31 Days
Review claims based on the date claims were submitted	Claims Rejections by Submission Date - Max 31 Days

How do I use this report?

After running the report, work through each rejected claim using the following process.

Review the rejected claim and note the reported error.
Compare the information on the claim with the associated EVV visit.

Check these items first:
- Provider ID - Does the Provider ID on the claim match the Provider ID in Sandata?
- Client ID - Does the claim match the correct client?
- Visit Date - Does the service date on the claim match the visit date?
- Payer ID - Does the payer match on both the claim and the visit?
- Procedure Code - Does the procedure code match? Some states require modifiers to match exactly. Follow your state's requirements.
- Units - Are the billed units equal to or less than the verified visit units? Follow your state's unit rounding requirements.
- Submission Timing - Was the visit entered and verified in Sandata before the claim was submitted?
Determine whether the problem exists on the claim or the visit and correct the issue.

Why didn't my claim match a visit?

Several issues can prevent a claim from matching an EVV visit. Review the common issues below to identify what needs to be corrected.

The visit wasn't verified

Only visits in Verified status (Auto Verified or Manual Verified) are eligible for claims matching. Visits in Incomplete or Omit status cannot be matched.

Check that:

The visit is in Verified status.
All required visit information has been entered.
Any exceptions have been resolved.

The visit wasn't available when the claim was processed

A claim can only be matched to an EVV visit that has already been received and verified by the Sandata EVV Aggregator.

Check that:

The visit was received by Sandata before the payer processed the claim.
The visit was already in Verified status when the claim was submitted.

Note: If the visit is received after the claim has been processed, the claim will not automatically be matched. You'll need to correct the issue and resubmit the claim.

The service codes don't match

The procedure code on the claim must match the procedure code on the verified EVV visit.

Check that:

The procedure code on the claim matches the procedure code on the verified EVV visit.
Any required procedure code modifiers also match, if applicable.

The billed units don't match

The units billed on the claim must be less than or equal to the verified visit units.

Check that:

The number of units billed on the claim does not exceed the verified visit units.
The units on the claim and the verified visit were calculated using your payer's or state's unit rounding requirements.

What should I do if a claim doesn't match a visit?

After identifying the issue, either:

Correct the claim and resubmit it.
Correct the visit, verify it if necessary, and then resubmit the claim.

Before resubmitting, confirm that all claim and visit information matches.

Available Filters

Use filters to narrow your report results.

Filter	Description
Date Range	Limits results to the selected submission date range (up to 31 days).
Payer	Displays claims for a specific payer.
Program	Displays claims for a specific program.

Field Definitions

Field	Definition
Account	Provider name and Sandata account number.
Provider	Provider Identifier on the claim.
Error	The reason the claim did not match a visit.
Total	Total number of claims for the error shown.
Received	Date the claim was received by the Sandata system.
Batch ID	Batch ID assigned to the claim.
Transaction ID	Transaction ID associated with the claim. This field is not used in all states.
Invoice Control Number (ICN)	Unique identifier assigned by the payer to track the claim.
Line No.	Service line number on the claim.
Client ID	Client identifier on the claim.
Visit Range	Start and end dates of the visit on the claim.
Payer	Payer identifier on the claim.
Program	Program associated with a potential matching visit. This field populates only for Unmatched Units errors.
Service	Procedure code on the claim.
Bill Units	Units billed on the claim.
Provider Medicaid ID	Provider Medicaid ID on the claim.
Client Medicaid ID	Client Medicaid ID on the claim.
Client Name	Client name from the potential matching visit. This field populates only for Unmatched Units errors.
Units Found	Number of units found on the potential matching visit. This field populates only for Unmatched Units errors.
Visits	Number of visits that matched the claim.
Error Reason	Additional information about the matching error. This may include information from the claim response file's Note Detail field.

Note: Providers are responsible for ensuring that visits accurately reflect the services delivered and that claims are submitted only for services that were actually provided. Submitting inaccurate or unsupported claims may raise concerns related to fraud, waste, and abuse.