Provider Training Introduction VNSNY CHOICE TRANSITION Training and - PowerPoint PPT Presentation

Provider Training Introduction

VNSNY CHOICE TRANSITION Training and Agenda items: Introduction to VNSNY implementation • Highlight of Payer vs. Provider Matrix • Member Management • Placement Management • Caregiver Compliance Scope • Authorization Management • Communication Notes • Scheduling/Visits • Pre-billing/Billing • EDI workflows • EDI issue management (SFTP - 3rd party rejection file and EDI Rejection Job Aide) • Rebilling Rules • Reporting • Administration • Requesting user access • Coordinator set • Rate Management

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 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)

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.

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

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

Prebilling ➢ Prebilling Process ➢ Billing → Prebilling Review ➢ Exceptions (Problems) ➢ Prebilling Validations ➢ Review Exceptions (focus on Missed Visit and Authorizations)

Billing – Process Overview ➢ 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) ➢ HHAX remittances

Billing – Perform Billing Review ➢ Billing → Billing Review ➢ Search for Invoiced Visits ➢ Review Details for “Hold Reasons” ➢ Address Exceptions (Hold Reasons)

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

EDI workflow

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

Rebilling Rules and Process

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

Reporting

Reporting – Key HHAeXchange Reports ➢ List of Members ➢ Census Information (Data from Member Module) ➢ Batch Detail Report ➢ Revenue Generation (by Individual Invoice Batch) ➢ Unverified Visits Aging Detail ➢ Listing Visits with Exceptions (before Prebilling processes) ➢ Member General Notes ➢ Listing of Notes captured in HHAX (Related to Member Services)