Auto Approval

What is Auto Approval?

Auto approval is a system process that runs daily.

Auto approval checks to see if entries:

• Are within the hours on the service authorization; and
• Have completed client signoff.
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Time entries that pass auto approval do not need to be approved by a user.

Entries that fail auto approval will remain in a Pending status until the entry is corrected. These pending entries will appear in the Pending Entries screen. The agency can manage these entries through their Pending Entries Management process.

Pending Entries Management

What is Pending Entries Management?

• The agency uses the term “pend” to refer to entries that have failed or are awaiting auto approval.
• In OR PTC DCI, entries pend until auto approval runs and will stay in the pending status if they fail auto approval.
• Staff will use the Pending Entries screen in OR PTC DCI to manage pending entries.
• Staff should search for pending entries up through yesterday’s date to view a list of entries that failed the auto approval.

Pending Entries Review Icons

You can approve, reject, and edit entries in a Pending status. 

1. Hovering over the red eye icon will reveal the reason the entry failed auto approval.

   Note
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   An entry can fail more than one business rule, so there may be more than one reason listed for why an entry failed.

2. Hovering over the grey question mark icon will reveal information about the pended entry.

   Note
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   Entries showing the reason “Portal Sign Off Pending” do not need action. They will be auto approved.

Filtering Pending Entries

You can use the search fields to filter the pending entries.

1. Entries can be filtered by:
   1. Date
   2. Punch Id
   3. Service Code
   4. Consumer Name
   5. Provider Name
   6. Cost Center
   7. Account Type
   8. Select EVV
   9. Select Review
2. Once you have entered all your filter criteria, click Search.

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Working Pending Entries Overview

To work the Pending Entries Tab follow 4.1.1 Pending Entries Management:

• The staff member views the Pending Entries Tab daily in OR PTC DCI.
• For each pended entry, the staff member identifies why the entry has pended.
  • If the entry is pended due to being over the authorized hours, follow the steps for 12.0 Provider Goes Over Authorized Hours.
  • If the entry is pended due to any reason other than Authorization Remaining Balance Failure, approve the entry.

Working Pending Entries Over Authorized Hours Process Steps

If an entry has pended because the provider is over the authorized hours by MORE than 15 minutes:

1. Staff member checks Oregon Access narration to see if more hours were authorized and checks to see if a 546SF exists.
2. Staff member determines whether the case manager has authorized the additional hours per narration and/or 546SF. (If both were not completed, check with the case manager to have the missing step completed.)
   1. If the case manager did not authorize the hours, proceed to step 3.

   2. If the case manager did authorize the hours, proceed to step 4.
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      Note
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      If the provider knows they will go over hours due to an emergency, they must notify the local office no later than two business days after the emergency.

3. If the staff member determines the case manager has NOT authorized the additional hours per narration and/or 546SF:
   1. The staff member reaches out to the provider to notify them they have gone over their authorized hours and must edit their time.
   2. The provider will then edit their time in OR PTC DCI. See Business Process 2.2.3 Correct Punch Entry Mistake for more information.
   3. The staff member narrates in Oregon Access.
   4. The staff member may also want to add a note to the provider’s profile documenting the contact.
   5. Proceed to the next pending entry.
4. If the staff member determines that the case manager DID authorize the additional hours per narration and/or 546SF: The staff member checks to see if the Mainframe is inaccurate (does not include authorized hours).
   1. If YES, Mainframe is inaccurate, the staff member voids the voucher in Mainframe and creates a new voucher with the updated authorization information on the 546SF. The staff member then updates the voucher number and hours/miles in OR PTC DCI on the authorization(s).
   2. If NO, Mainframe is accurate, the staff member updates the authorization information in OR PTC DCI.
   3. The staff member approves the pending entry, thus removing it from the Pending Entries Tab.
5. The staff member narrates in Oregon Access.

6. The staff member continues working the Pending Entries Tab.

   Note
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   The entry will not go through auto approval, it must be approved manually if the entry is not edited.

After identifying an entry has pended due to being over the authorized hours and if the voucher specialist finds that the provider goes over authorized hours by LESS than 15 minutes, they should follow the below steps.

1. The staff member edits the entry in OR PTC DCI, reducing it to be within the authorized amount.
2. A different staff member verifies the entry in OR PTC DCI.
3. Staff member narrates in Oregon Access.
4. Staff member continues working the Pending Entries Tab.

Tips for Working Pending Entries

• Work the Pending Entries Tab daily - being proactive means less workload strain later in the pay period.
• If the pending entry error is an Authorization Remaining Balance Failure or has more than one error including this, more work is needed to research the error. The entry cannot simply be approved or rejected.
• If the pending entry error is anything other than the Authorization Remaining Balance Failure, approve the entry, no further work is needed.
• If an entry pends for being over hours, the entries after that will also pend for being over hours. The error will stay on the entries even if the original entry is fixed. These entries will need to be manually approved if they are no longer over hours.

Entries pending due to being over the authorized hours do require research to do the following:

• Determine if the overage was authorized or not.
• Determine how far over the authorized hours the provider is by using one of the following options:
  • Client Total Hours Per Week Widget: search for the consumer, add the total hours for the provider in question for the two weeks for the pay period, and compare this to the authorized hours.
  • Authorizations Widget: search for the consumer, identify the appropriate authorization based on the service code, and view the Current Available Balance column. If this is negative, that is how far over the authorized hours the provider is. This can only be used for current pay period authorizations.
  • View the authorization in the Authorization tab: calculate available balance as Remaining Balance - Pre-Authorization Holds = Available Balance.

  • Authorization Entries Report: enter the consumer’s name and check the box next to Include Ended Authorizations, then scroll to see the available balance. If this is negative, that is how far over the authorized hours the provider is.

    Note
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    For more information on these methods to determine how far over the authorized hours a provider is see How Far Over Their Authorized Hours is a Provider?.

Pending Entries Tab in OR PTC DCI

Entries that are in a Pending status will need to be approved or rejected. Follow the steps below to complete either of these actions. 

To Approve an Entry

1. Click A at the beginning of the row for the entry you want to approve.
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2. Click Yes on the Alert to confirm.
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Once an entry has been approved, the A will disappear from the entry. If you refresh the webpage, the entry itself will disappear from this list. You will also see an alert at the top of the pending entries table identifying the approved entry.

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To Reject an Entry

1. Click

...

1. R at the beginning of the row for the entry you want to reject.Image Added
2. Click Yes on the Alert to confirm.
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Once an entry has been rejected, the R will disappear from the entry. If you refresh the webpage, the entry itself will disappear from this list. You will also see an alert at the top of the pending entries table identifying the rejected entry.Image Added

How Far Over Their Authorized Hours is a Provider?

Option One: Client Total Hours Per Week Widget

Client Total Hours Per Week widget on the dashboard can be used to determine how far over the authorized hours a provider is. To do so:

1. Search for the consumer by name.
2. Add the Weekly Total for the provider in question for the two-week pay period.
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3. Compare this to the authorized hours.

Option Two: Authorizations Widget

Authorizations widget on the dashboard can be used for authorizations for the current pay period only.

1. Search for the consumer by name.
2. Identify the service code associated with the provider in question to find the correct authorization.
3. View the Current Available Balance column. If this is negative, that is how far over the authorized hours the Provider is. If it is positive, they are not over their authorized hours.
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Option Three: Authorization Tab

You can also use the authorization tab if you have the Authorization Permission. On this tab, you can calculate the available balance, which will tell you how far over the authorized hours they are. If this number is negative, they are over by that amount. If the number is positive, they are not over their authorized hours. You can calculate available balance as Remaining Balance minus Pre-Authorization Holds.

Remaining Balance - Pre Authorization Holds = Available Balance

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Option Four: Authorization Entries Report

The Authorization Entries Report will show you the Available Balance, similar to Option 2, but it shows this for every pay period. To find and read the Authorization Entries Report:

1. Click the Reports tab.
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2. Hover over Authorization Reports, then click Authorization Entries Report.
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3. Enter the consumer’s name.
4. Check Include Ended Authorizations.
5. Click Search.
6. On the report, identify the authorization in question (identified by the Authorization ID Reference, Authorization ID Reference 1, and start and end dates). Once you identify the appropriate row, scroll over to find the Available column. If the available balance is negative, that is how far over their authorized hours the provider is.
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Converting Decimal Hours to Minutes

Use this chart to convert hours to minutes. To view the chart online, go to https://dciconfluenceprod.dcisoftware.com/display/DCI/Time+Conversion+Chart+-+Minutes+to+Decimal+Hours.
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Correcting a Punch Entry Mistake

• When it is identified that a mistake has been made on a punch entry, or if a consumer or consumer employer representative disputes a punch, it should be corrected by the provider.
• If the entry is already in approved or processed status, it will be canceled by a staff member with the Supervisor Role in order for the provider to create a new historical entry.

The path to correcting the error can go a variety of ways depending on the situation. We will look at each path and what a staff member’s role will be within the process.

Correcting Paid Versus Unpaid Entries

If an entry has been paid, you will need to follow the 4.4.0 Over/Underpayment, which includes making an adjustment to the entry in OR PTC DCI.

• Time entry adjustments in OR PTC DCI are covered in Adjustments.
• The paperwork and payment adjustment process in Mainframe will remain the same.

If an entry has not been paid, there are several ways the entry can be corrected. See 2.2.3 Correct Punch Entry Mistake for more information.

Process for Editing an Entry

Follow the appropriate path below based on the current status of the entry and whether the entry was made using the landline method.
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How to Verify an Entry

If a staff member edits or creates an entry, the entry will be created in an unverified status. The staff member must then notify someone else, someone with a Supervisor Role over the consumer’s cost center, so the other staff can verify this entry. The system will not notify another staff member to do this. Entries created or edited by staff must be verified. Entries that remain in an unverified status will not be pulled into a batch and paid. The same staff member who created/edited the entry cannot verify it.

1. On the Punch Details screen for the specific entry in question, scroll to Status.
2. You will see that it says Unverified in red. Click Verify.
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Entry Edits

Staff can also edit entries in a pending status.  To do so from the Pending Entries Tab:

1. Click on the entry to see the Punch Details screen. Be sure NOT to select the blue hyperlinks on the entry.
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2. From the Punch Detail screen, Click Actions.
3. Click Edit Entry.
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4. Make the necessary changes.
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5. Click the blue plus sign next to Reason. After clicking, it will change to a minus sign and the Add Reason Codes field will appear.
6. Select Reason Code: State-Other from the drop-down. Staff must select this reason.

7. Add Note to explain the reason for the edit.

   Note
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   When making edits, it is important to add a note that explains why you are making the edit and that you have validated the information with the provider.

8. Click the larger blue plus sign to add the Reason Code and note to the entry.
9. Added Reason Codes shows the reason and note. If you need to remove a Reason Code, click the minus sign next to it. If you don’t see a Reason Code here, you did not successfully add one.
10. From the Statements field, select the check box next to the attestation, thus specifying that the time is correct to the best of your knowledge.
11. Click Save.
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12. When the Alert appears, click Yes.
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The original entry will be rejected, and a new entry will be added.

The new entry will be in an unverified status until verified by a separate staff member or the provider. 

If you are not beginning from the Pending Entries Tab, you can find the entry in question on the provider or consumer’s profile under Entries. Once you have opened the entry in question, follow the above steps, beginning with step 2.

Adjustments

The Agency uses the term adjustment to refer to modifications and cancellations to entries after they have already been paid through Mainframe (DHR). In OR PTC DCI, the term adjustment will refer to any modifications or cancellations on entries in an approved or processed status.

Who can adjust entries in an approved status?

• Staff users with a Supervisor role.
  • You will only be able to adjust entries that are under your Cost Center. For example, if Suzy has the Supervisor role over Cost Center A, Suzy will only be able to adjust entries in Cost Center A.

To make an adjustment (meaning it is in an approved or processed status) to a provider’s time entry:

1. Click on the Employees tab.
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2. Enter the provider’s name and/or Uni ID into the search criteria.
3. Click Search.
4. Click on the correct provider from the results to go to their Employee Details page.
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5. Click Entries Tab located after provider demographics.
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6. Enter search criteria to find the entry you need to edit. For example: enter a start and end date, select Approved or Processed in the status filter (whichever status the entry needing adjusting is in), or enter a client name.
7. Click Search to display entries matching your search criteria.
8. Click on the entry that needs to be adjusted.
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9. From the Punch Detail page, click Actions.
10. Click Edit Entry.
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11. Make the necessary adjustment(s).
12. Click the blue plus sign next to Reason.
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13. Select State-Other – StateO from the Add Reason Codes drop-down.
14. In the Add Note field, explain why you are adjusting the entry.
15. Click the larger blue plus sign to add the reason code.
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16. The Reason Code will show in the Added Reason Codes section. If you need to remove a Reason Code, click the minus sign next to it. If you don’t see a Reason Code here, you did not successfully add one.
17. Click Save.
18. When the Alert appears, click Yes.
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19. The original entry will be flagged as Compensated.
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20. An entry for the negative amount of the original will be created and automatically approved. This negative entry is called a Compensating entry.
21. A new entry will be created; this new entry will reflect the adjustments made. The new entry will have a status of Pending.
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Handling Over and Under Payments

Identifying Over and Under Payments Caused by Staff

Once it has been determined there was a staff entry error:

1. The voucher specialist updates OR PTC DCI with the correct hours and an explanation as to why an update is made and if OR PTC DCI is inaccurate.
2. Another staff member verifies the punch entry if OR PTC DCI was updated.

3. The voucher specialist adjusts, deletes, or adds shift(s) in the Mainframe to correct the time.

Identifying Provider/Consumer Over and Under Payments

Once it has been determined there was a provider/consumer entry error:

• If it is an Overpayment:
  • The voucher specialist updates the approved punch entry with the correct hours and includes an explanation for why the update was made.
  • The voucher specialist adjusts STIM data entries and deletes or adds shift(s) in the Mainframe to correct the time.
• If it is an Underpayment:
  • The provider creates a historic punch entry for the unpaid time.
  • The voucher specialist adjusts STIM data entries and deletes or adds shift(s) in the Mainframe to correct the time.

Historical Entries

Entries that are entered via the web portal without a valid fob code or landline entries which are called in for previous days and times are called historical entries. These entries are not EVV compliant.

Historical entries may be needed if a provider forgot to clock-in/out or could not clock-in/out for a variety of reasons.

Who can enter historical entries?

• Staff with the Supervisor role
  • Note that staff will only be able to add historical entries for consumers in cost centers they have a role over. For example, if Suzy has the Supervisor role over Cost Center A, Suzy will be able to create historical entries in Cost Center A.
• Providers can retroactively make entries for themselves.

How to Add a Historical Entry

As a staff member, to add a historical entry:

1. Click the Employees tab.
2. Enter the provider’s name and/or Uni ID in the search criteria.
3. Click Search.
4. Click on the provider in the search results you want to add an entry for.
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5. From the Employee Details page, click Actions.
6. Select New Entry from the drop-down menu.
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7. Select Account Type as Hourly or Client Transportation.
8. Enter the consumer’s name in the Client field.
9. Select the proper Service Code. There will likely only be one option. There may be more than one option if this provider/consumer pairing worked together under a different program previously.
10. Enter the Service Date.
11. Enter Check In as the time the provider started working.
12. Enter Check Out as the time the provider stopped working.
13. Select Portal Signoff as the EVV Method.
14. Click the blue plus sign next to Reason.
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15. Select the Reason Code State-Other - StateO from the drop-down.
16. Add a note in the Add Note field to explain why you are creating the entry.
17. Click the blue plus sign to add the reason code.
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18. The Added Reason Codes field shows the reason and note. If it does not appear here, return to step 15. If you need to change it, click the blue minus sign next to the reason code and then return to step 15.
19. From the Statements field, select the checkbox next to the attestation statement confirming the time is correct.
20. Click Save.
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21. When the Alert appears, click Yes.
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The new entry will be in an unverified status until verified by the staff or the provider. 

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