Enterprise Provider Training Introduction VNSNY CHOICE TRANSITION - PowerPoint PPT Presentation

Enterprise Provider Training Introduction

VNSNY CHOICE TRANSITION Training and Agenda items: Introduction to VNSNY implementation • Rollout, Benefit of Linkage, Workflow differences • Highlight of Payer vs. Provider Matrix • Member Management • Placement Management • Transition of VNSNY cases as unconfirmed or confirmed • Centralized Placement (Refer to Release Notes 12.3) • Authorization Management • Communication Notes • Discharge internal member record • Migration of internal contract contents to linked contract • Caregiver Compliance Scope • Scheduling/Visits • Nurse Assessment • Pre-billing/Billing • Unbilling/Rebilling Rules • Reporting • Administration • Requesting user access • Coordinator setup • Rate Management

HHAX VNSNY Provider Information Center https://hhaexchange.com/vnsny/

Questions Anyone?  We expect you to have questions  Questions Today  Questions after Today’s Session  prosupport@hhaexchange.com  Questions after you begin to use HHAeXchange System  prosupport@hhaexchange.com

Upcoming VNSNY Rollout to HHAX HHAX and VNSNY have partnered to connect VNSNY to its Providers base, through the HHAX platform. Beginning with the HOSPICE program and continuing with CHHA and CHOICE, soon all members across the entire New York area will be linked.  VNSNY is live with new members for the HOSPICE and CHHA programs.  Providers are actively billing through the linked environment for these programs.  VNSNY has been hosting a series of webinars to inform and prepare agencies for the linkage. 5

Rollout Schedule *Note, these dates are subject to change by VNSNY. CHHA Program ~  Rollout by County  July 16 th 2018, Manhattan (New & Re-Cert)  October 1 st , 2018, Queens, Nassau, Suffolk (New & Re-Cert)  October 29 th , 2018, Bronx, Brooklyn, Staten Island, Westchester (New & Re-Cert)  December 1 st , All Regions (All Remaining Members) CHOICE Program ~  Rollout by LHCSA  October through December (Reach out to VNSNY if you are not aware the go-live wave for your agency) 6

Benefits of the Linkage Current State (OPS) Future State (HHAX) Staff accept members in OPS For Hospice and CHHA program, member demographics for them to be available in are sent every 15 minutes to the HHAX professional HHAX. platform from HCHB . There is a potential for For the Choice program, member demographics are sent demographics mismatches every 20 minutes to the HHAX professional platform from between OPS and HHAX. Altruista/Guiding Care. In both situations, the information is available instantly, from one platform, for linked providers. 7

Benefits of the Linkage Current State (OPS) Future State (HHAX) All billing (through pre-billing and billing review) will be managed HHAX exports scheduled visits to as per HHAX rules. HHAX will then automatically export claims VNSNY once they are created in nightly. the system. If there is a mismatch between the scheduled hours and For HOSPICE and CHHA programs, 100% of successfully exported the authorized hours in OPS, the claims will be paid. visit will be rejected from VNS. Rejections are only available after an overnight process, manually pulling a rejection report from OPS and loading into HHAX. 8

Benefits of the Linkage Current State (OPS) Future State (HHAX) Agencies must validate and Caregiver compliance rules will not be enforced within test compliance with VNSNY. HHAX for the remaining of 2018. However, VNSNY will continue to monitor the scheduled caregivers. This test is required in order to go live. Going forward (2019) caregiver compliance will be managed using the compliance module within HHAX. 9

Benefits of the Linkage Current State (OPS) Future State (HHAX) OPS requires unique Professional system will allow the use of standard OMIG VNSNY reason codes for reason codes. confirming visits (Absence Codes, Overtime codes, Full service Codes). 10

Workflow Differences Known Workflow What’s being Done Difference Authorization discrepancies Agencies will be able to use linked communication with cannot be handled through the Payer, to elicit the need and make the request. TEMP authorizations. Urgent requests will have a 24hr SLA (Note also that we will distribute a weekly “Note Aging” report to highlight payer responsiveness to Provider queries, both urgent and non-urgent). By November 2018, our goal is to allow the TEMP auth concept for linked contracts. 11

Workflow Differences Known Workflow What’s being Done Difference Placements from VNS will By end of 2018, HHAX will be introducing a concept be sent as unconfirmed of Case Placement, where the agency can control the placements. Agency staff patients office at the time of placement and after. will need to be trained to accept the unconfirmed placement in the correct office. Once placed, the patient cannot be moved between offices. 12

Workflow Differences Known Workflow What’s being Done Difference Agencies will need to Our new functionality allows for un-billing/re-billing contact HHAX support, to across internal and linked contracts. initiate an un-billing/re- billing.** **These requests will be processed within 48hrs. 13

HHAeXchange System Introduction

HHAeXchange System Introduction  HHAeXchange System Nomenclature  Member = Patient  Caregiver = Attendant = Aide  Provider = Agency = Vendor  Payer = MCO = “Plan”  Log In Process (www.hhaexchange.com  CLIENT LOGIN)  Home Module  Landing Page  Reviewing Pending Placements, Events and Communications with Payers

System Support  Super Users  HHAeXchange System: Support Center  Documentation Catalog  Process Guides  Job Aids  Reference Material  Videos and more to come

Payer vs. Provider Responsibility Matrix

Member Management & Member Placement

Member Management – Placement Alerts  New Placement Request (Email Alerts)  New Placement Request (Home  Pending Placements)

Member Management – Placement Review  Review Placement  Click on Admission ID to display Placement Window  Review Member Info  General: Demographics (Masked)  Special Requests: Gender, Language, Notes

Member Management – Placement Acceptance  Accept Placement  Select Member Team and Coordinator  Select Button at bottom of Placement Window    (Must select Reason Code for denial)  Placement is cleared from Pending Placements on Home Page  Member Module  Profile Page (Status = Active)

Member Management  New Placement Request (Home  Action  Pending Placements)

Member Management – Placement Queue  Action  Pending Placement Queue  4 Placement Queue Sections  Pending  20 minutes ( Cut off Time)  Approaching Cut Off (in red)  Removed from Queue after Cut Off  Staffed with Temp Caregiver  Staffed  Accepted with no Masterweek

Member Management – Member Profile  Member Module – Index of Pages  General  Vendor Information  Status History  Member Notes  Profile (Demographics)  Authorization  Primary Statuses ( Active, Discharge )

Member Management – View Info  Member Module – Profile Page (from Payer Demographic)

Member Management – Authorizations  Process (Timing varies by Payer)  Authorization with Provider matched to Member in HHAX  Review Authorization as necessary (Member  Authorization Page)

Transition of VNSNY cases as unconfirmed or confirmed One time event: • Census: <100 • Placement- unconfirmed. • ENT agencies will accept placement in proper office • Census: >100 • Placement- confirmed. • ENT agencies will determine a “default” office so HHAX can place the confirmed placement accordingly. • Contact Client Success Manager. If you do not have a client success manager, please email prosupport@hhaexchange.com and indicate this information in the ticket

Events

Events  Travel Time Request  Pending response from Vendor/Provide – Orange Highlight

Events  Travel Time Request  New Note for additional information for Payer to review and approval

Note Management

Types of Notes • Member Notes are communications regarding a Member. Member Notes are tag as Urgent or Non-Urgent priority. • Visit Notes refers to any note created and stored on the Calendar Window (visit notations). • HHAeXchange will automatically create a new Note if a specific action (Missed Visit, Authorization Updates or Status Change) is performed. • Recommendation: VNSNY updates communication policies to include HHAeXchange Notes.

Notes • Provider/Payer can generate a note for any linked member. • The recipient may opt to Reply to the Note, the note status will remain Open. Also, the recipient may close a note, note status will be Closed . • Closing a note will remove the note from the Note section of the Home Module. Note(s) will store in the patient profile.