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WellCare NY Phase 1 Rollout Webinar
September 9th, 2019
WellCare NY Phase 1 Rollout Agenda
• Introduction to WellCare NY Phase 1 Rollout
• Rollout, Benefit of Linkage, Workflow differences
• Important Dates
• Member & Auth Management
• Billing Management
• Communication Notes
• Reporting
• CDPAP cases
• Questions?
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HHAeXchange System Introduction
CURES Act EVV System RequirementsThe 21st Century CURES Act requires that the following data elements
be captured and verified through Electronic Visit Verification
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Two Companies Partnering for Best-In-Breed Solution
• WellCare has contracted with HHAeXchange, a leader in SaaS-based
Homecare Software solutions to provide a best-in-breed EVV solution for
our provider agencies.
• HHAeXchange provides Billing, Scheduling, Authorization, point-of-care
verification and documentation capabilities for WellCare members
• Visits are provided to WellCare in near real time with all required elements
to satisfy billing needs/claims
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Benefits of Linking
• Ensure that you receive member/auth information and case broadcasting
electronically
• Confirm visits and bill directly in the system
• Communicate with WellCare in real time
• Phased approach:
• Validates that patient and auth information from WellCare is correct to
ensure a smooth transition to using the linked record
• Confirms patient demographic information (phone number, address etc…) to
enable accurate EVV
• Ensures all serviced members are loaded to HHAX
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WellCare Rollout
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Upcoming WellCare NY Rollout to HHAX
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HHAX and Wellcare NY have partnered to connect Wellcare to its Providers
base, through the HHAX platform. All participating WellCare members will be
linked to providers.
• Phase 1 go live date will be 9/16/2019
• During phase 1, providers will receive member/auth information from the
linked contract in addition to keeping the existing internal member
• Providers will validate the information on the linked member, but will
continue to schedule, confirm visits, and bill on the internal patient.
• Full Go Live date is TBD
• More communication to follow prior to defined go live date
• Additional info session reviewing system functionality, workflow differences,
and linked patient management will be held prior
Important Dates
• 9/16/19: Phase 1 go live
• During phase 1, providers will receive member and auth information
from the linked contract but will continue to manage WellCare patients
using the internal contract.
• TBD: Phase 2 full go live
• Communication and additional info session to follow
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Contract & Member Management
• You will be linked to a new contract titled: “WellCare of New York – PHASE
1 DO NOT USE”
• WellCare will only be able to see communication notes on this contract
• This contract should just be used to validate the member information and
submit communication notes
• Make sure to not create schedules, confirm visits, or create invoices on this
record
• You will not be charged PMPM for the linked contract
Contract Management
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EDI Providers
• If your agency uses a 3rd party EVV vendor, members/auths will not be
exported in Phase 1
• Exports will be turned on for the full Phase 2 rollout
• Please review the information directly in HHAeXchange
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Searching for Linked vs Internal Patients
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Identifying Internal Contract
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Identifying Linked Contract
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• Members will be sent as confirmed, since they are already being serviced by you
• All existing WellCare members you service should be sent
• For any new members after the Phase 1 go-live, WellCare will still fax information for the
internal patient and send the linked patient via HHAX
• Continue to manage your members using the internal contract
• Please validate the linked patient demographics and Auth info to ensure they
match what you have for the Internal patient.
• Full active membership
• Member address, phone number, emergency contact etc…
• Auth hours, service codes, diagnosis codes, from and to dates etc…
• If there is a discrepancy, please use the note communication in the linked platform to
notify Wellcare of the issue.
Member Management
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• Authorization Edit
• Overtime/Travel Time
• No Services
• Incorrect Units or dates communication
• Initial request for authorization- PCA Services
• Member Hospitalized
• Member On Vacation or out of Service area
• Reauthorization request for PCA services
• Other
• Member Demographic Info Update
• Member Missing from Linked Portal
Note Reasons
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Sending Payer Communication Notes
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Billing
• Please keep Internal and Linked patients for now.
• Do not use the linked billing functionality yet. Continue to bill the internal
patients as normal.
• HHAeXchange will send out communication when Full Go Live is scheduled,
which will include billing on the linked patient
Billing Review
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Reporting
• Duplicate internal and linked patients will cause overstated numbers in the
below census and authorization reports
• Since no action should be taken with the linked patients, no other reports will be
impacted
• When running these reports, ensure to deselect the “WellCare of New York
– PHASE 1 DO NOT USE” contract from the filter.
• *note that all reports may not have the multi-contract filter option by 9/16. We are
working on implementing this as soon as possible, but if not ready then make
sure to remove any linked WellCare members from your reports in excel after
running. Notice will be sent once the functionality is fully available
Reporting
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Report Path
Authorizations Over Utilized Report >> Visits >> Scheduling
Census - Detail Report >> Vendor Management
Census - Summary Report >> Vendor Management
Deselecting Specific Contracts from Reports
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Reporting – Linked Contract Monitoring
• To make sure that no scheduling is occurring on the linked contracts, we
recommend running the below reports on a regular basis
• Any results for the linked contract should be copied over to the internal
contract
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Report Path
Schedule by Patient (Detail) Report >> Visits >> Scheduling
Schedule by Patient (Summary) Report >> Visits >> Scheduling
➢ This function will work as normal
Auto-Schedule Creation for CDPAP Cases
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For Post-Session Updates & Questions:
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Questions Anyone?
• We expect you to have questions
• Questions Today
• Questions after Today’s Session
• WellCare Contact
• Questions after you begin to use HHAeXchange
System
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System Support
• Super Users
• HHAeXchange System: Support Center
• Documentation Catalog
• Process Guides
• Job Aids
• Reference Material
• Videos and more to come
• WellCare NY Provider Info Center
• https://hhaexchange.com/wellcare-ny/
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