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Enterprise Base Provider Training Introduction
VNSNY CHOICE TRANSITION Training and Agenda items:Introduction to VNSNY implementation • Highlight of Payer vs. Provider Matrix• Member Management • Placement Management • Authorization Management • Communication Notes • Caregiver Compliance Scope • Scheduling/Visits • Pre-billing/Billing • Unbilling/Rebilling Rules• Reporting • Administration
• Requesting user access• Coordinator setup• Rate Management • HHAX Portal and Access
HHAX VNSNY Provider Information Center
https://hhaexchange.com/vnsny/
Questions Anyone?
We expect you to have questions Questions Today Questions after Today’s Session [email protected]
Questions after you begin to use HHAeXchange System [email protected]
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
New Placement Request (Email Alerts)
New Placement Request (Home Pending Placements)
Member Management – Placement Alerts
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 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
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 Note Reason Values Varies By Payer
Internal: Check if this note is meant for internal record Emergency of priority will send message as URGENT to payers
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
Caregiver- Compliance
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 Time2. Caregiver3. Optional: Plan of Care (POC)4. Service Code5. Save Schedule
Scheduling Visits - Calendar
Member Calendar (Member Calendar Page)
COLOR CODES:GreenPinkWhite
Pre-billing/Billing
Prebilling
Prebilling Process Billing Prebilling Review Exceptions (Problems)
Billing – Perform Billing Review
Billing Billing Review Search for Invoiced Visits Review Details for “Hold Reasons”
Address Exceptions (Hold Reasons)
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.
Reviewing Billing Files (batches) Claim Files (837) Remittances (835)
Provider portal (VNSNY) VNSNY CHOICE Remittances displayed in HHAX application
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) – Received through the Provider’s SFTP of which a copy would
then be displayed in HHAX application under files processing->remittances tab. In addition to this information, providers can access remittances by signing up for a VNSNY provider portal
Unbilling/Rebilling Rules and Process
Un-billing and Resubmission Process and Rules
• Denied/Corrected Claims• Void• Split Shift• Duplicate claims• Appeals
Unbilling the Visit
Rebilling the Visit
• For next day and overnight process occurred. 837s are already sent. Providers cannot perform unbillingfor an already billed claim.
• Contact [email protected] to have functionality enabled and for further information.
• Providers with Linked Contracts can rebill a claim without having to submit a request to the HHAX Support Team; like the existing Rebill functionality for Internal Contracts.
https://s3.amazonaws.com/hhaxsupport/SupportDocs/Enterprise/Releases/Release+Notes+12.0.pdf
Re-submit claims
https://s3.amazonaws.com/hhaxsupport/SupportDocs/Enterprise/Releases/Release+Notes+12.0.pdf
Rebilling additional workflows
Unexport – Permission Granted from Payers- Split shifts- Change of service hours- Resubmit as void due to billing incorrectly
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)
Reporting – Overview of Report Layout
Report Generation and Navigation
System Reports
Administration
Administration and System Support
Provider Profile Email Alerts User Management Roles Permissions Coordinator Setup – Must Add At Least 1 (Default) Provider Reference Table Management Rate Management
Requesting HHAeXchange User Access
New User: Admin users Email to [email protected] Send: User’s First Name, Last Name, HHAX Role, Office: Default, and unique
Email Address Requestor Receives: Email Confirmation, HHAX Username(s) New User Receives: Email with Temporary Password Email
New Role: Admin users Email to [email protected] Only HHAeXchange can create new roles Provider Agency can assign/remove permissions from roles
Deactivate User: Admin users Email to [email protected] Send: User’s Username, First Name, Last Name, HHAX Role, Email
Address, and Date to deactivate Username Receive: Email Confirmation
Administration – Provider Profile
Admin Provider Profile General Section
Administration – Provider Profile
Admin Provider Profile
Automatic Email Section
Administration – User Management
Admin User Management User Search
Administration – Coordinator Setup
Admin Coordinator Setup New Coordinator(Note: Must have at least 1 created for Placements!)
Administration – Rate Management
Admin Contract Setup Search VNSNY CHOICE Edit (Future) Update Rate (Retroactive)
Administration – Rate Management
Admin Contract Setup Search VNSNY CHOICEEdit Rates Update Rates
HHAX Portal and Access
1. Complete the Free Portal Agreement
2. Individual that completed the agreement submits request to [email protected] for user provisioning
HHAX VNSNY Provider Information Center
https://hhaexchange.com/vnsny/
