Provider EDI/New HHAX User Training Introduction VNSNY CHOICE - PowerPoint PPT Presentation

Provider EDI/New HHAX User Training Introduction

VNSNY CHOICE TRANSITION Training and Agenda items: Introduction to VNSNY implementation • Highlight of Payer vs. Provider Matrix • High level workflow overview • Member Management • Placement Management • Caregiver Compliance Scope • Authorization Management • Communication Notes • Scheduling/Visits • Pre-billing/Billing • Rebilling Rules • Reporting • Administration • Requesting user access • Coordinator setup • Rate Management • HHAX Portal and Access

HHAeXchange: At a Glance A Web-based system to help Providers effectively interact with Payers Member Communication Management With Payers Visit Billing and Entry Reporting

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

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

High-level workflow overview

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 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 – 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)

Events

Events  Travel Time Request – HHAX Function not used for VNSNY Choice  Missed Visits – Not in scope for phase 2 for EDI provider

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.

Communication Policy and Timeframes  Varies by Payers  Follow existing communication guidelines and SLA protocols outlined by Contract Administration. Urgent Messages: Same day response required. Non-Urgent: 24-48 hours.  24-48 hours—  Providers should only sent communication notes to CA for: reporting interruption of care, travel time and OT request • If reason is not listed in the communication note reason dropdown provided by VNSNY, provider will need to CALL CA. • Urgent messages should be flagged by provider accordingly.

Standard Note Reasons for VNSNY • Change of patient address • Change of Patients phone number • Expired • Nursing home placement • Patient away with family • Patient Hospitalized • Patient moved out of VNSNY Service Area • Patient on Vacation • Patient refusing all HHA services • Rehab Admission • Request for Overtime • Updated Authorization

Member Notes - Review  Home Page  Notes (Status = Open )  Member  General Page  Notes ( All Statuses – Open and Closed )

Member Notes – Create and Respond  Create (New) - See next slide for details  From Member  General Page only  Member  General Page  Notes Section   Reply  From Home: Home  Notes  Reply  From Member: Member  General Page  Notes Section  Reply  Close  From Home: Home  Notes  □ + (checkbox to left of Note) (Once closed, Notes will be removed from Home Page)  From Member: Member  General Page  Notes Section  Close

Member Notes – Create Notes Member  General Page  Notes Section   Complete Notes Window  Select Reason  Enter Note  Upload File (if necessary)   Click (Note Status = Open )  Note Reason Values  Varies By Payer

Member Notes – Print  Print Individual Notes (send to non-system users)  to obtain hardcopy of Individual Note (PDF)  Print Notes Report (Report  Other Reports  Member General Notes)

Caregiver Management

Caregiver - New Caregiver  Required Fields  Demographics (Employment Type)  Address  Emergency  Save  Creates Profile

Caregiver – Profile Overview  Demographics  Employment  Address  Emergency

Schedule management

Scheduling Visits – Requirements  Member Status = Active  Authorization = Valid Dates/Service Info  Plan of Care (POC) (Payer-specific)

Scheduling Visits – Functionality  Creating a Visit (Non-Skilled/Skilled)  Schedule Components 1. Scheduled Time 2. Caregiver 3. Optional: Plan of Care (POC) 4. Service Code 5. Save Schedule

Scheduling Visits - Calendar  Member Calendar (Member  Calendar Page) COLOR CODES: Green Pink White

Pre-billing/Billing – Phase 2 – Date TBD Slides with “Phase 2” = Action does not need to be take in HHAX at this point

Pre-billing/Billing – Phase 2 – Date TBD Prebilling  Prebilling Process  Billing  Prebilling Review  Exceptions (Problems)  Prebilling Validations  Review Exceptions (focus on Missed Visit and Authorizations)

Pre-billing/Billing – Phase 2 – Date TBD Billing – Process Overview  Perform Billing Review  Create Invoice Batch  Note: Batches will be dropped via an automated process overnight. Agencies will not be required to drop the file after invoice batch.  Perform Billing Review  Reviewing Billing Files (batches)  Claim Files (837)  Remittances (835)  Provider portal (VNSNY)  VNSNY CHOICE Remittances displayed in HHAX application

Pre-billing/Billing – Phase 2 – Date TBD Billing – Perform Billing Review  Billing  Billing Review  Search for Invoiced Visits  Review Details for “Hold Reasons”  Address Exceptions (Hold Reasons)

Pre-billing/Billing – Phase 2 – Date TBD Billing – Reviewing Billing Files  Nightly Processes (837 Generation)  Reviewing Billing Files (Admin  File Processing)  No action required. Files will be exported nightly to clearinghouse  Claim Files (837)  Remittances (835) – VNSNY Provider portal, will need to sign up through VNSNY. It will also be in Provider SFTP and shared with 3 rd party system. HHAX will receive a copy and will be under the remittances tab

Pre-billing/Billing – Phase 2 – Date TBD EDI workflow

Pre-billing/Billing – Phase 2 – Date TBD Working with 3 rd party on EDI rejections Secure File Transfer Protocol (SFTP) https://s3.amazonaws.com/hhaxsupport/SupportDocs /EDI+Guides/Professional+Job+Aid+- +Common+EDI+Rejections_Payers.pdf

Unbilling/Rebilling Rules and Process

Un-billing and Resubmission Process and Rules • Denied/Corrected Claims • Void • Split Shift • Duplicate claims • Appeals

Pre-billing/Billing – Phase 2 – Date TBD