Claim Attestation Forms

Executive Summary

Claim Attestation Forms produces the monthly claim attestation forms that are completed for Medicaid clients, one form per client and funder, for a billing cycle period and branch. Staff start a period by choosing the branch, billing cycle, year, period and a template. The system reads the approved visits, Medicaid claims, cancelled visits and completed interventions from AlayaCare and builds a form for each client, flagging any form that has problems. Staff then open the period to review the forms, fix and recreate problem forms, submit the forms that are ready (which signs the PDF with the template signature and submission date), print or download them, export the list to Excel, and upload the submitted PDFs back to the clients' files in AlayaCare.

Key Features

Start a period for a branch, billing cycle, year, period and template; the forms are built straight away
Counts of Cancelled, Errors, Waiting For Submission, Submitted and Pending forms for every period
Check for new forms, start a form for one client, or refresh the whole period
Recreate a single form, all Pending forms, or all Waiting For Submission forms
Submit one form or all forms that are waiting for submission, with a submit date
View, download, zip, or print the form PDFs; export the form list to Excel
Review each form's claims, visits, cancelled visits, interventions and messages
Upload submitted forms to the client's files in AlayaCare
Open the client in AlayaCare from a form, and review the history of every action on the period

Typical Workflow

Select the Branch at the top of the page (all branches can only be chosen with the All Branches permission).
Click Start A New Period, choose the branch, billing cycle, year, billing cycle period and template, then click Ok. The forms are built while the progress panel runs.
Open the period with the Edit icon (or right-click the row and choose Edit).
On the All Forms tab, check each form's Status and Messages. Forms with Errors or Pending need attention: correct the data in AlayaCare, then use Recreate Form (right-click) or Recreate Pending Forms.
When the forms are ready, click Submit All Forms (or right-click one form and choose Submit), choose the submit date and click Ok.
Use Download Selected Forms, Print Selected Forms or Export Selected Forms as needed.
Click Upload Submitted Forms to attach the submitted PDFs to the clients in AlayaCare.

Report Output

Each form is a PDF generated from the claim attestation form layout. The PDF is first built when the form reaches Waiting For Submission, and it is built again with the submit date, signature and signature name when the form is submitted. A second page is added when the client has complex care tasks. The file name pattern is Invoice{client last name}{client first name}{period number as 2 digits}{year as 2 digits}.pdf with spaces removed. The PDF is retrieved in these ways:

View (right-click) opens the PDF in a viewer.
Download PDF (row icon) or Download Form (right-click) saves one form.
Download Selected Forms saves a zip file named ClaimAttestationForms_{date}.zip.
Print Selected Forms saves one combined PDF named ClaimAttestationForm_{date}_From_{n}_To_{n}.pdf; lists of more than 400 forms are split into files of 400 forms.
Export Selected Forms saves an Excel list of the forms (see Actions).

Report Contents

Content	How it is determined
Form ID	The form number.
Agency name, phone number, provider number, contact person	Values entered on the template when the form was built.
Submitted date	The submit date chosen when the form is submitted, shown as MM/dd/yyyy. Blank before submission.
Client name	The client's first and last name from AlayaCare.
Medicaid number	The member number on the client's Medicaid claim.
Billing period	Period number and year, shown as MM/yyyy.
Bill to	Client form context field selected on the template for Bill To. The form gets an error when it is empty.
Adult services worker / Attention	The enabled contact of the client whose form context field selected on the template for adult services worker is True. A form gets an error when there is no such contact, or more than one.
Hourly rate	Hourly rate entered on the template, shown as a dollar amount.
Certify initials	The agency name.
Service verification, by day of the month	For each day, a check mark for every personal care task completed on that day's visits (Bathing, Dressing, Eating, Grooming, Mobility, Toileting, Transferring, Housework, Laundry, Travel Time For Laundry, Medication, Meal Preparation, Shopping, Travel Time For Shopping, Hospital/Nursing Facility Stay). A completed intervention is matched to a task using the template's task and intervention list. A cancelled visit marks Hospital/Nursing Facility Stay on its day when its cancel code is set up for that.
Complex task verification, by day	For each day, the count of complex care tasks completed (Bowel Program, Catheters For Leg Bags, Colostomy Care, Eating Or Feeding Assistance, Peritoneal Dialysis, Range Of Motion Exercises, Specialized Skin Care, Suctioning, Wound Care). The second page of the form is only printed when there is at least one.
Minutes for each complex task	Numbers taken from the client's form context fields selected on the template for each complex task. A form gets an error such as "Wound Care cannot be calculated" when the task was done but its number is zero.
Total time for complex care tasks	Number of times each complex task was done multiplied by its minutes, shown as hours:minutes.
Total time for services	Total scheduled visit time minus the complex care task time, as hours:minutes.
Total time for billing period	Total scheduled visit time of the visits on the claims, as hours:minutes. A cancelled visit counts only when its cancel code is set to process completed interventions.
Signature and signature name	The signature image and name set on the template, added when the form is submitted.

Available Permissions

The following permissions are available to be assigned to AlayaCare Roles:

Attribute	What It Controls
View	Open the page
Settings View	Open View Settings
Settings Edit	Open Edit Settings
All Branches	Choose All Branches in the branch selector instead of being limited to your own branch

Main Grid

The grid lists the claim attestation periods for the selected branch, newest first (14 rows per page).

Column	Description
Cycle	Billing cycle.
Year	Billing year.
Period	Billing cycle period number.
Branch	Branch of the period.
From	Period start date.
To	Period end date.
Cancelled	Number of cancelled forms.
Errors	Number of forms with errors.
Waiting For Submission	Number of forms ready to submit.
Submitted	Number of submitted forms.
Pending	Number of pending forms.
Added	Date and time the period was started, in the tenant time zone.
Added By	User who started the period.
Processing Start / Processing End	When the forms were being built.
Duration	Elapsed processing time.
Manage Records	Edit icon that opens the period.

Main Grid Filters

Filter	Purpose
Branch	Lists only the periods of the chosen branch. Changing the branch refreshes the grid.

Actions

Button	Description
Start A New Period	Opens the Start A New Report dialog.
View Settings / Edit Settings	Opens the page settings dialog. Shown only with the Settings View or Settings Edit permission. The dialog currently shows no options to change.
Reset For Testing	Shown only on staging and UAT environments. After confirmation, deletes every period and all of their forms.
Edit (row icon, or right-click a row)	Opens the period (detail page).

Dialog Components

Start A New Report

Opens from Start A New Period. Fill in every field and click Ok.

Field	Purpose
Branch	Branch the period is for.
Select A Billing Cycle	Billing cycle for the period.
Year	Billing year. Defaults to the current year; the previous year is also offered in January and February.
Select An Billing Cycle Period	Period within the cycle and year, shown with its dates.
Select A Template	Claim attestation template used to build the forms.

A warning appears if the cycle or period is missing, or "This period has already been processed" when a period already exists for that branch, cycle, year and period.

Claim Attestation Forms (period detail page)

Opens from the Edit icon on a period. The arrow beside the title returns to the period list. The top of the page shows the Billing Cycle, Year, Period, Branch and the counts Errors, Waiting For Submission, Submitted and Pending. While a period has no processing end time, Last Form Added and a Refresh button also appear.

Buttons at the top of the page:

Button	Description
Start A New Form	Opens Start A New Form to build a form for one client.
Check For New Forms	Builds forms for clients that have claims in the period and do not yet have an active form. Reports how many forms were created, or "No forms to create".
Refresh Period	After confirmation, deletes the forms that are Pending or Waiting For Submission and rebuilds them from the latest AlayaCare data, together with any new clients. Submitted, error and cancelled forms are left as they are.

Tabs

Tab	Purpose
All Forms	The forms of the period and the buttons to submit, download, print, upload, recreate and export them.
History	A log of the actions taken on the period.

All Forms — Grid

Column	Description
ID	Form number.
Client Name	Client name.
Status	Errors, Cancelled, Pending, Waiting For Submission or Submitted.
Messages	Messages recorded for the form (see below).
Services	Service time (total visit time minus complex tasks), as hours:minutes.
Complex Tasks	Time for complex care tasks.
Total Time	Total time for the billing period.
Submitted	Date and time the form was submitted.
Upload Status	Success or Failed after an upload to AlayaCare.
Uploaded On	Date and time of the upload.
Actions	Edit icon, and a Download PDF icon when the form has a PDF (statuses Waiting For Submission and Submitted).

The list is sorted by client last name, then first name (12 rows per page).

Common status messages:

Message	Meaning
Pending Claim Present / Draft Claim Present	A claim for the client is still Pending or Draft in AlayaCare. The form is Pending.
Unapproved Visits Present	A visit in the period is not approved. The form is Pending.
Visits Without Claim Present	A visit in the period has no claim. The form is Pending.
Bill To is missing	The Bill To field is empty on the client. The form has Errors.
No Adult Services Worker found for client / More than 1 Adult Services Worker found for client	The contact set-up is incomplete. The form has Errors.
Task cannot be calculated	A complex task was done but its minutes value is zero. The form has Errors.
Intervention not found in local table	A completed intervention is not in the template's task list. The form has Errors.
Intervention task not mapped in visit	A warning that an intervention could not be matched to a task category. It does not stop the form.
Visit details not found for visit	AlayaCare did not return a visit. The form has Errors.

All Forms — Grid Filters

Filter	Purpose
Filter First Name / Filter Last Name	Shows forms whose client name contains the text.
Filter ID Includes	Shows forms whose number contains the text.
Filter Status	Multi-select of Errors, Cancelled, Pending, Submitted and Waiting For Submission.

Click Apply Filter to refresh the list and Clear Filter to reset the filters. Download, print and export use the filtered list.

All Forms — Grid Actions

Button	Description
Submit All Forms	Opens Submit Form(s) to submit every form that is Waiting For Submission.
Download Selected Forms	Opens Download Selected Forms to zip the filtered forms.
Print Selected Forms	Combines the PDFs of the filtered forms into one PDF.
Upload Submitted Forms	After confirmation, uploads every submitted form that has not yet been uploaded.
Recreate Pending Forms	After confirmation, rebuilds every form that is Pending.
Recreate Waiting For Submission Forms	After confirmation, rebuilds every form that is Waiting For Submission.
Export Selected Forms	Saves an Excel list of the filtered forms: ID, Client AC Id, Client Name, Medicaid Number, Bill To, Attention, Email Address, Status, Messages, Services, Complex Tasks, Total Time, Submitted, Upload Status and Uploaded On.
Edit (row icon, or right-click Edit)	Opens the Form dialog.
Right-click View	Opens the PDF (forms that are Waiting For Submission or Submitted).
Right-click Recreate Form	Rebuilds the form. Not shown for cancelled forms. A submitted form is kept but marked Cancelled; any other form is replaced.
Right-click Submit	Opens Submit Form(s) for this form. Shown only when it is Waiting For Submission.
Right-click Upload Submitted Form	After confirmation, uploads this form to AlayaCare. Shown only when it is Submitted.
Right-click Download Form	Saves the PDF. Shown for Waiting For Submission and Submitted forms.

History — Grid

Column	Description
Action	What was done, such as Run Job, Check For New Forms, Create Form For Client, Recreate Form For Client or Refresh Period.
Client ID / Client Last Name	Client involved, for single-client actions.
Added / Added By	When and by whom the action was started.
Processing Start / Processing End	When the action ran.
Duration	How long it took.

Start A New Form

Opens from Start A New Form. Search for the Client (type at least three characters) and click Ok. A warning appears if no client is chosen or "Client already has a form". The form is built from the client's claims in the period.

Submit Form(s)

Opens from Submit All Forms or the right-click Submit. Choose the Submit Date and click Ok. Each form that is Waiting For Submission is signed, stamped with that date and set to Submitted.

Download Selected Forms

Opens from Download Selected Forms. Enter Submitted At Or After (required) and click Ok. The zip contains the filtered, non-cancelled forms that were submitted on or after that date.

Form

Opens from the Edit icon or Edit on a form. It shows the Client, a button Open Client In AlayaCare, and these tabs. Ok and Cancel close the dialog without changing anything.

Tabs

Tab	Purpose
Claims	The claims included in the form.
Visits	The visits on those claims.
Cancelled Visits	Cancelled visits that count towards the form.
Interventions	The completed interventions matched to a task category.
Messages	The errors and warnings recorded when the form was built.

Claims — Grid

Column	Description
Claim Number	Claim number and version.
Service Range From / Service Range To	Service dates of the claim.
Member Number	Medicaid member number.
Place Of Service	Location indicator of the claim.

Visits — Grid

Column	Description
Claim#	Claim the visit belongs to.
Visit AC ID	AlayaCare visit number.
From / To	Visit start and end.
Employee AC ID / Employee Name	Employee on the visit.
Service Code	Service code of the visit.

Cancelled Visits — Grid

Column	Description
Visit AC ID, From, To, Employee AC ID, Employee Name, Service Code	As for visits.
Cancel Code	Cancel code of the visit.

Interventions — Grid

Column	Description
Intervention AC ID	AlayaCare intervention number.
Intervention	Intervention name.
Category	Task category it is counted under on the form. Blank when it could not be matched.

Messages — Grid

Column	Description
Type	Error or Warning.
Message	The message text.

Dependencies

The following tables must be configured for lookups on this view to work:

Table	Description
Billing Cycles	Billing cycles offered in the dialog. Also covers its billing cycle periods: periods offered in the Start A New Report dialog.
Branches	Branches offered in the branch selector, and the branch of each user.
Cancel Codes	Decide whether a cancelled visit appears on the form and whether it is counted or marks a hospital or nursing facility stay.
Claim Attestation Templates	Templates offered in the dialog (agency details, hourly rate, form context fields, signature, upload folder, task and intervention list).
Form Context Fields	Client and contact fields chosen on the template.
Funders	The funders billed in the period; forms are built per funder.

Processing Overviews

This section describes what happens after you confirm a processing action.

Start A New Report

Checks that a cycle and period are selected and that no period exists for the same branch, cycle, year and period.
Creates the period and then builds the forms straight away, using the same steps as Check For New Forms. The period is marked finished with an end time and duration when processing ends.

Check For New Forms / Start A New Form

Logs in to AlayaCare and loads the billing cycle period and the template. A warning stops the run if the login fails or the period or template is missing.
Downloads the period's cancelled visits from AlayaCare and keeps those whose cancel code is set to be used on claim attestation forms (and the period's branch).
For each funder billed in the period, downloads the visit verification records for the period, drops cancelled visits that are not kept, and limits them to the period's branch (and to the chosen client for Start A New Form).
Skips every client who already has an active form for that funder. For each other client, looks up each visit's Medicaid claim (ignoring void claims) and the claim details. Clients with no claim are skipped. It also notes visits that are unapproved or have no claim.
Loads the client details and each visit's details. A few clients are loaded at the same time.
For each client, creates the form with the agency details from the template, the Medicaid number, Bill To, adult services worker and the complex-task minutes from the client's fields. Saves the claims, visits and cancelled visits. For each visit that counts, loads the completed interventions and maps them to the task categories in the template.
Works out the form time totals and sets the status: Errors when any error was found; otherwise Pending when a claim is Pending or Draft, a visit is unapproved, or a visit has no claim; otherwise Waiting For Submission. Errors and warnings are saved as messages.
Creates the PDF for forms that are Waiting For Submission. Adds a history line and reports how many forms were created.

Refresh Period

After confirmation, deletes every form that is Pending or Waiting For Submission.
Runs the same steps as Check For New Forms for the whole period, so those clients get new forms from current AlayaCare data. Forms that are Errors, Submitted or Cancelled are untouched and their clients are not rebuilt.

Recreate Form / Recreate Pending Forms / Recreate Waiting For Submission Forms

A single form can be recreated when it is Errors, Submitted, Waiting For Submission or Pending. The bulk buttons take every form in the chosen status.
A Submitted form is marked Cancelled and kept; the others are deleted.
Builds the form again for that client and funder using the steps of Check For New Forms, and adds a history line.

Submit

Only forms that are Waiting For Submission are submitted. For Submit All Forms, the forms are submitted one by one and a warning shows any that fail.
Records the submit date as both the submitted and signed date, rebuilds the PDF with the signature image and name from the template, and sets the status to Submitted.

Upload Submitted Forms

After confirmation, selects forms that are Submitted and have no upload date.
Uploads each PDF to the client's files in AlayaCare in the upload folder set on the template.
Records the Upload Status as Success (with the uploaded date) or Failed with the response code.

Download Selected Forms and Print Selected Forms

Download Selected Forms takes the filtered forms that are not cancelled and were submitted on or after the chosen date, adds each stored PDF to a zip file and downloads it.
Print Selected Forms merges the stored PDFs of the filtered forms into one PDF (in sets of 400 forms) and downloads it. A form that cannot be read is skipped with a warning.