PA - Sandata

The state of Pennsylvania is an Open Vendor Hybrid Model, which means agencies providing Medicaid services can use any EVV vendor of their choosing as long as the vendor can send important data elements to the state chosen EVV aggregator. Pennsylvania uses Sandata for EVV aggregation. Rosemark has a direct integration with Sandata in the state of Pennsylvania for participating Medicaid agencies. 

 

Why do Pennsylvania Agencies need an integration?

The goal of the integration is for Rosemark agencies to continue managing ALL of their data in Rosemark and have that data be transmitted to the state of Pennsylvania (through Sandata) to maintain compliance with the 21st Century Cures Act. In order for the integration to be successful, each agency must set up their particular data in Rosemark a certain way so that it conforms to expected standards set by the state. These rules must be followed by ALL agencies regardless of what software they use to run their agency.

 

How to Set up the initial integration

Review a list of Sandata Syncable Services here.

It is critical that you know the payer, program and procedure codes for the services your agency provides as these are the key data points needed for the integration. 

 

Agency Configuration

In order to sync your agency details correctly with Sandata we will need your Medicaid provider ID. This is supplied to you by the state when you are approved to provide Medicaid services.

First go to the main Rosemark File Menu > Configuration > Medicaid.

Fill out your Medicaid Provider ID, and set your ICD code number to 10. Move on to identifying Medicaid service types.

 

Identifying Medicaid service types

Each Medicaid program you are registered under and each procedure code you provide services for (and bill for) will need to be set up in Rosemark.

Go to File > Configuration > Service Types and Rates.

Here you'll need to set up service types codes that show three pieces of information:

1. Payer

Example: PAOLTL, PAODP, PAOMAP.

1. Program 

Example: ODP, OMAP

1. Procedure Code 

 Example: S5150, W1725, S9122

Here is an example of a complete service type that is ready to sync to Sandata:

                                        PAOLTL- OLTL - S5150

 

In the description field of the service type code put in the procedure code as well as modifier, if appropriate. Keep in mind that each procedure code you bill under needs to have its own matching service type in Rosemark.  For instance, if you bill under T1019 and T1019:TF then you should have 2 service types in Rosemark. Once you have set up the appropriate service types move on to Client and Caregiver data entry.

 

Client Data

Each Medicaid client profile in Rosemark must contain the following data:

• First and Last Name (Info Tab)
• Medicaid Number (Inquiry Tab)
• Birthdate (Condition Tab)
• Primary ICD 10 Diagnosis Code (must be the first thing in the Diagnosis field on the Condition Tab)
• If the client has one or more of the following services, they MUST have a care plan set up in order to send task data to the state:
  • S5120 - Chore
  • S5130 - Homemaker 
  • T1019:U2 DSDS -CDS Personal Care 
  • T1019 DSDS - Personal Care
  • T1019:TF DSDS - Advanced Personal Care

 

Caregiver Data

Each Medicaid caregiver profile in Rosemark must contain the following data:

• First name and last name (Info Tab)
• Birth Date (HR Tab)
• Social Security Number (HR Tab)
• Email address (Info Tab)
• Caregiver ID # (Communication Tab)

Once you have completed the Initial Set up instructions as listed in this guide, please email Support@shoshana.com to schedule a call with Customer Care to review your data and complete the integration.