Betasky

Chapter 13: Go Live Process

Overview

The Go Live Process is how your agency transitions from Sandbox Mode (testing environment with demo data) to Production Mode (live environment for real patient care). This chapter covers:

  • Understanding the difference between Sandbox and Production
  • Requirements for going live
  • Submitting a Go Live request
  • The admin approval workflow
  • Payment and subscription activation
  • Post-Go Live considerations

Who Should Read This Chapter:

  • Agency Administrators
  • Agency owners and executives
  • Sales & Onboarding staff (Betasky)
  • Super Administrators (Betasky)

Prerequisites:

  • Completed all initial setup (Chapters 4-9)
  • Valid CMS Certification Number (CCN)
  • National Provider Identifier (NPI)
  • Decision on subscription tier (Growth, Pro, or Enterprise)

13.1 Understanding Sandbox vs. Production

13.1.1 Sandbox Mode

What Is Sandbox Mode?

  • A testing and training environment separate from live patient care
  • Pre-populated with demo data (sample patients, visits, OASIS, care orders)
  • Free and unlimited access for exploration and staff training
  • Clearly labeled with a blue "Sandbox" banner at the top of every page

Sandbox Mode Features:

  • ✅ Full access to all system features
  • ✅ Unlimited users (no subscription limits)
  • ✅ Pre-seeded demo data for immediate testing
  • ✅ No risk to real patient data or billing
  • ✅ Safe environment for learning workflows

Sandbox Mode Limitations:

  • ❌ Cannot submit real Medicare/Medicaid claims (demo mode only)
  • ❌ Cannot process actual patient care (test data only)
  • ❌ No official regulatory compliance (not for production use)
  • ❌ Data is not backed up long-term (can be reset at any time)

When to Use Sandbox:

  • During initial agency setup and configuration
  • Training new staff members
  • Testing new workflows or features
  • Demonstrating the system to prospective clinicians

13.1.2 Production Mode

What Is Production Mode?

  • The live environment for real patient care
  • Used for actual patient admissions, visits, documentation, and billing
  • Fully compliant with Medicare, Medicaid, and HIPAA regulations
  • Requires a paid subscription and CMS Certification Number (CCN)

Production Mode Features:

  • ✅ Real patient data with full HIPAA protection and encryption
  • ✅ Live claim submission to Medicare, Medicaid, and private payers
  • ✅ Regulatory compliance for CMS certification and state licensing
  • ✅ Data backup and disaster recovery (daily automated backups)
  • ✅ Production-level support with SLA guarantees (Pro/Enterprise)
  • ✅ Audit trail and compliance logging for regulatory inspections

Production Mode Requirements:

  • ✅ Valid CMS Certification Number (CCN) (6-character code)
  • ✅ Valid National Provider Identifier (NPI) (10-digit number)
  • ✅ Paid subscription (Growth, Pro, or Enterprise tier)
  • ✅ Admin approval from Betasky (to verify credentials and setup)

When to Use Production:

  • After initial setup and staff training are complete
  • When you're ready to admit real patients and provide care
  • For live billing, claim submission, and revenue cycle management

13.1.3 Key Differences

FeatureSandbox ModeProduction Mode
PurposeTesting, training, demosReal patient care
DataDemo/sample dataReal patient data
ClaimsCannot submit real claimsLive claim submission
CostFreePaid subscription required
CCN RequiredNoYes (mandatory)
User LimitsUnlimitedBased on subscription tier
SupportStandard supportPriority/SLA support (Pro/Enterprise)
ComplianceNot requiredFull HIPAA, Medicare, state regulations
Data BackupNot guaranteedDaily automated backups

13.2 Requirements for Going Live

Before submitting a Go Live request, ensure you have completed the following:

13.2.1 Mandatory Requirements

1. CMS Certification Number (CCN)

  • What: 6-character alphanumeric code issued by CMS
  • Why: Required for Medicare billing and regulatory compliance
  • Where to Get: Apply through your state survey agency (part of home health licensure process)
  • Format: 12345A (6 characters)

Without a CCN:

  • You cannot go live in production
  • Medicare claims will be rejected
  • Your agency is not certified for home health services

How to Enter CCN:

  1. Go to Agency Settings (Chapter 4)
  2. Enter your CCN in the CMS Certification Number field
  3. Save changes

2. National Provider Identifier (NPI)

  • What: 10-digit unique identifier for healthcare providers
  • Why: Required for all claims (Medicare, Medicaid, private insurance)
  • Where to Get: NPPES NPI Registry
  • Format: 1234567890 (10 digits)

How to Enter NPI:

  1. Go to Agency Settings (Chapter 4)
  2. Enter your NPI in the National Provider Identifier field
  3. Save changes

3. Paid Subscription Tier

  • Options: Growth, Pro, or Enterprise
  • Pricing: Contact Betasky Sales (sales@betaskyhealth.com)
  • Payment Methods:
    • Stripe (Credit Card) - Automated recurring billing
    • Manual Payment - Check, Wire, or ACH (for first payment, then Stripe)

Subscription Tiers:

TierUser LimitMonthly CostBest For
Growth20 usersContact SalesSmall agencies, single location
Pro50 usersContact SalesMid-sized agencies, Custom Role Builder
EnterpriseUnlimited usersContact SalesLarge multi-branch agencies, SLA support

13.2.2 Recommended (But Not Mandatory)

Before going live, it's highly recommended to complete:

Agency Setup

  • ✅ Agency information (name, address, contact) entered (Chapter 4)
  • ✅ Branches configured (if multi-branch agency) (Chapter 5)
  • ✅ Payers added (Medicare, Medicaid, private insurance) (Chapter 6)
  • ✅ Pharmacies added (Chapter 7)

Staff Setup

  • ✅ Users added with appropriate roles (Chapter 8)
  • ✅ Physicians and referral sources entered (Chapter 9)

Configuration

  • ✅ Clinical settings configured (Chapter 10)
  • ✅ Visit types set up (Chapter 11)
  • ✅ Fee schedules configured (Chapter 12)

Why This Matters:

  • Going live without setup means your staff cannot immediately start working
  • You'll need to configure these items in production, delaying patient care

13.3 Submitting a Go Live Request

Once you've met the requirements, you can submit a Go Live request from within the Sandbox environment.

13.3.1 Access the Go Live Option

From the Sandbox Banner:

  1. At the top of any page in Sandbox mode, you'll see a blue banner that says:

    • "Sandbox Mode - You are in a testing environment"
    • Two buttons: "Go Live" and "View Go Live Status"

  2. Click the "Go Live" button

Alternative Path:

  • Go to Settings → Agency Settings → Go Live tab

13.3.2 Complete the Go Live Request Form

A modal or page will open with the following fields:

Requested Subscription Tier

  • Purpose: Choose the subscription plan you want to activate
  • Options:
    • Growth (20 users)
    • Pro (50 users, includes Custom Role Builder)
    • Enterprise (Unlimited users, SLA support)
  • Note: Your selection determines pricing and features

Confirm Agency Information

The system will display your current agency settings:

  • Agency Name
  • NPI (must be entered)
  • CCN (must be entered)
  • Tax ID
  • Address
  • Contact Information

Review Carefully:

  • Ensure all information is accurate (this will be verified by Betasky staff)
  • If anything is incorrect, click Cancel, update your agency settings, and resubmit

Acknowledgment and Certification

You must acknowledge:

  • ✅ I confirm that the information provided is accurate and up-to-date
  • ✅ I understand that my CCN and NPI will be verified by Betasky staff
  • ✅ I understand that a paid subscription is required to go live
  • ✅ I agree to the Betasky Terms of Service and Subscription Agreement

13.3.3 Submit the Request

  1. Review all information
  2. Click Submit Go Live Request
  3. A Success notification appears: "Your Go Live request has been submitted. You will receive an email when it's reviewed."

What Happens Next:

  • Your request enters PENDING_APPROVAL status
  • Betasky staff will review your request within 1-2 business days
  • You will receive an email notification with the outcome (approved or additional information needed)

13.4 The Admin Approval Workflow

After submission, your Go Live request goes through a multi-stage approval process managed by Betasky staff.

13.4.1 Stage 1: Pending Approval

Status: PENDING_APPROVAL

What's Happening:

  • Betasky Sales or Onboarding staff review your request
  • They verify:
    • ✅ CCN is valid (checked against CMS records)
    • ✅ NPI is valid (checked against NPPES registry)
    • ✅ Agency information is complete and accurate
    • ✅ Subscription tier selection is appropriate for your agency size

Timeline: Typically 1-2 business days (faster for urgent requests)

Possible Outcomes:

  1. Approved → Moves to Stage 2 (Payment)
  2. Additional Information Needed → You receive an email with clarifications or corrections needed
  3. Rejected → Rare; typically due to missing CCN or invalid credentials

13.4.2 Stage 2: Pending Payment

Status: PENDING_PAYMENT

What's Happening:

  • Your request has been approved
  • Betasky staff send you a payment link or invoice
  • You choose your payment method:
    • Option A: Stripe (Credit Card) - Instant activation upon payment
    • Option B: Manual Payment (Check/Wire/ACH) - First payment processed manually, then recurring billing via Stripe

Payment Method A: Stripe (Credit Card)

  1. You receive an email with a secure payment link (Stripe-hosted)
  2. Click the link and enter your credit card information
  3. Payment is processed immediately
  4. Upon successful payment, your request is marked APPROVED
  5. Your agency is converted to Production mode within minutes

Payment Method B: Manual First Payment (Check, Wire, ACH)

  1. Betasky staff coordinate with you for first payment (via phone or email)
  2. You send payment via:
    • Check: Mailed to Betasky office
    • Wire Transfer: Bank wire to Betasky account
    • ACH: Electronic bank transfer
  3. Betasky staff confirm receipt and mark your request APPROVED
  4. Your agency is converted to Production mode
  5. Future billing: You'll be sent a Stripe link for recurring monthly payments

Timeline:

  • Stripe: Instant activation after payment
  • Manual: 1-3 business days (depending on payment method and confirmation)

13.4.3 Stage 3: Approved (Go Live Complete)

Status: APPROVED

What's Happening:

  • Payment has been received and confirmed
  • Your agency is converted from Sandbox to Production mode
  • You receive a confirmation email: "Congratulations! Your agency is now live."

What Changes Immediately:

  • ✅ The blue Sandbox banner is removed
  • ✅ Your subscription tier is activated (user limits, features enabled)
  • ✅ You can now admit real patients and provide live care
  • ✅ Claims can be submitted to real payers (Medicare, Medicaid, insurance)
  • ✅ Data is now production-level protected with daily backups

13.4.4 Rejection Scenarios (Rare)

Status: REJECTED

Why a Request Might Be Rejected:

  • ❌ Invalid or expired CCN (not found in CMS records)
  • ❌ NPI does not match agency name or credentials
  • ❌ Incomplete agency information
  • ❌ Outstanding issues from prior sandbox testing (e.g., Terms of Service violations)

What Happens:

  • You receive an email explaining the rejection reason
  • You can correct the issues and resubmit a new Go Live request
  • Contact Betasky Support (support@betaskyhealth.com) if you need clarification

13.5 Viewing Your Go Live Request Status

13.5.1 Check Request Status

At any time, you can check the status of your Go Live request:

From the Sandbox Banner:

  1. Click the "View Go Live Status" button
  2. A modal displays:
    • Request Status: PENDING_APPROVAL, PENDING_PAYMENT, APPROVED, or REJECTED
    • Requested Tier: Growth, Pro, or Enterprise
    • Requested Date: When you submitted the request
    • Last Updated: Most recent status change
    • Admin Notes: Any comments from Betasky staff (if applicable)

13.6 After Going Live: Post-Production Considerations

13.6.1 Immediate Post-Go Live Tasks

Once your agency is live in Production:

1. Verify System Access

  • Log in again to confirm access
  • Confirm the Sandbox banner is gone
  • Check that your subscription tier is active (view in Settings → Subscription)

2. Begin Patient Admissions

  • Start admitting real patients (Chapter 14: Patient Intake)
  • Assign real clinicians to patients
  • Create live care orders and schedules

3. Train Staff on Production Workflows

  • Remind staff that this is now live patient data
  • Review data entry accuracy and documentation standards
  • Emphasize HIPAA compliance and patient privacy

4. Configure Payer Credentials (If Not Done)

  • Ensure all payers are correctly configured (Chapter 6)
  • Verify HIPPS rates for Medicare are current
  • Test claim submission to clearinghouse (if applicable)

13.6.2 Sandbox Access After Going Live

What Happens to Your Sandbox?

  • Your original Sandbox account remains available (separate from Production)
  • You can still log in to Sandbox for:
    • Staff training and onboarding
    • Testing new features or workflows
    • Demonstrating the system to new hires

How to Switch Between Sandbox and Production:

  • Sandbox and Production are separate environments with different login URLs (or agency selection)
  • Contact Betasky Support if you need help accessing Sandbox after Go Live

13.6.3 Subscription Management

Billing and Payments:

  • Your subscription is billed monthly via Stripe (or your chosen payment method)
  • View invoices and payment history in Settings → Subscription → Billing
  • Update payment method or subscription tier by contacting Betasky Sales

User Limits:

  • Your active user count is monitored against your subscription tier
  • If you exceed your limit, you'll be prompted to upgrade
  • Contact Sales to upgrade (e.g., Growth → Pro)

13.6.4 Support and Assistance

Production Support:

  • Email: support@betaskyhealth.com
  • Phone: (Contact Betasky for phone support number)
  • Response Time:
    • Growth: Standard support (24-48 hours)
    • Pro: Priority support (12-24 hours)
    • Enterprise: SLA-backed support (4-8 hours, 24/7 critical issues)

What Support Can Help With:

  • Technical issues (login problems, bugs, errors)
  • Configuration assistance (payers, clinical settings, reports)
  • Training and onboarding guidance
  • Billing and subscription questions

What Support Cannot Help With:

  • Medical or clinical decision-making (contact your clinical manager)
  • Legal or compliance advice (consult your agency's legal counsel)
  • Third-party issues (e.g., clearinghouse, EVV vendor)

13.7 Troubleshooting Common Issues

Issue 1: "CCN Required to Submit Go Live Request"

Error Message: "You must enter a CMS Certification Number before going live"

Solution:

  1. Go to Settings → Agency Settings
  2. Enter your 6-character CCN in the CMS Certification Number field
  3. Click Save Changes
  4. Return to the Go Live page and resubmit

Issue 2: "NPI Invalid or Missing"

Error Message: "Your NPI is invalid or not entered"

Solution:

  1. Verify your NPI is exactly 10 digits
  2. Check for typos (no dashes or spaces)
  3. Verify via NPPES NPI Registry
  4. Update in Settings → Agency Settings and resubmit

Issue 3: "Request Pending for Over 2 Business Days"

Problem: Your Go Live request has been pending for longer than expected

Solution:

  1. Check your email (including spam folder) for messages from Betasky
  2. Contact Betasky Sales or Support: support@betaskyhealth.com
  3. Provide your agency name and request date for follow-up

Issue 4: "Payment Link Expired"

Problem: The Stripe payment link you received has expired

Solution:

  1. Contact Betasky Support to request a new payment link
  2. Payment links typically expire after 7 days for security reasons
  3. A new link will be sent to your email within 24 hours

Issue 5: "Request Rejected - CCN Not Found"

Problem: Your CCN was not found in CMS records

Solution:

  1. Verify your CCN with your state survey agency
  2. Ensure it's entered correctly (exactly 6 characters)
  3. If your CCN is very recent, it may not yet be in CMS systems (contact Betasky for manual verification)
  4. Resubmit after correcting the CCN

13.8 Best Practices

✅ Do This:

  1. Complete All Setup Before Going Live:

    • Add all payers, pharmacies, physicians, and users before submitting your Go Live request
    • This ensures your staff can start working immediately after activation

  2. Double-Check CCN and NPI:

    • Verify these identifiers are correct before submitting
    • Incorrect credentials cause delays and rejections

  3. Train Staff in Sandbox First:

    • Ensure all staff are comfortable with the system before going live
    • Use Sandbox for at least 1-2 weeks of training

  4. Choose the Right Subscription Tier:

    • Consider your current user count and anticipated growth
    • Upgrading later is possible, but starting at the right tier avoids interruptions

  5. Plan Your Go Live Timeline:

    • Submit your request at least 3-5 business days before you need to be live
    • Account for payment processing time (especially for manual payments)

  6. Communicate with Your Team:

    • Notify all staff when the agency goes live
    • Emphasize the shift from test data to real patient data

❌ Avoid This:

  1. Don't Rush the Go Live Process:

    • Going live without proper setup creates confusion and delays care
    • Take time to configure everything correctly in Sandbox first

  2. Don't Submit Without a CCN:

    • You cannot go live without a CMS Certification Number
    • Your request will be immediately rejected

  3. Don't Use Incorrect Payment Information:

    • Ensure your billing contact and payment method are accurate
    • Failed payments delay your Go Live activation

  4. Don't Ignore Admin Communication:

    • Betasky staff may email you for clarifications or additional information
    • Check your email regularly and respond promptly

  5. Don't Assume Instant Activation:

    • Even with Stripe, allow a few minutes for the system to update
    • Manual payments take 1-3 business days

13.9 Key Takeaways

  • ✅ Sandbox is for testing and training; Production is for real patient care
  • ✅ CCN and NPI are mandatory for going live in Production
  • ✅ Go Live requires admin approval from Betasky staff
  • ✅ Payment activates your subscription (Stripe or manual)
  • ✅ The process typically takes 1-3 business days from request to activation
  • ✅ After going live, you can still access Sandbox for training purposes