AHCA BA Provider Alert: Provider Claims in the Tellus Dashboard in “Accepted” Status for Extended Period of Time

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AHCA BA Provider Alert: Provider Claims in the Tellus Dashboard in “Accepted” Status for Extended Period of Time

 

Provider Claims in the Tellus Dashboard in “Accepted” Status for Extended Period of Time

 

This message is targeted to all AHCA BA providers in Regions 9, 10 and 11.

 

Netsmart has been receiving inquiries from providers about claims that remain in “Accepted” status in the Tellus EVV System for an extended period of time.

 

Please note that the complete source of final adjudication status for claims is FMMIS. Providers may review (and even download) their weekly Remittance Advice (RA) Report from FMMIS for a full listing of that week’s claims and whether they paid, denied, or suspended (EOB Code 9998). Alternatively, providers may check the status of an individual claim on the FMMIS Portal the day after its submission to Tellus.

 

If your claim has been in “Accepted” status in the Tellus system for over 10 days since the claim was submitted and the claim is suspended in FMMIS (EOB 9998), please take the following actions:

  • Call the AHCA (Gainwell) EDI Unit 1-866-586-0961, (Monday – Friday, 8 am to 5 pm EST).
  • Ask the representative to research the reason your claim is suspended. It could be because the provider demographic information needs to be updated or mail sent to the address on file has been returned as undeliverable. If so, you will need to update your provider information in the Florida Medicaid Web Portal. After logging in, select Providers, then Demographic Maintenance.
  • As always, obtain the ITRS Ticket Number from the representative for tracking purposes.

 

Important Note:

  • If your claims status is in suspended status (EOB 9998), once the reason for the suspension is cleared, FLMMIS will automatically re-process the claim.

 

FLMMIS Training Resources:

We encourage you to access the following resources for AHCA BA providers:

  1. On the FLMMIS public portal: FLMMIS Portal Web Training:Home > Provider > services > Training > Web Based Trainings > Under the section Web portal Menu Functionality Lessons, select Lesson 7. This walks users through accessing the RA on the secure web Portal.Group linking and delinking instructions: click here to view

On the AHCA website: Adopted Rules – Reimbursement Policies (myflorida.com)

Adopted Rules > Medicaid Providers Who Bill on the CMS-1500. Chapter 2 on page 2-6 (PDF page 66) How to read the Remittance Advice.

 

Additional Information:
To view additional training materials please go to https://mobilecaregiverplus.com/ahca-ba and select the Training & Resources tab. If you have questions regarding training or system registration you may contact TELLUS at: 1.833.622.2422.

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