Enterprise Base Provider Training Introduction VNSNY CHOICE - - PowerPoint PPT Presentation

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Enterprise Base Provider Training Introduction VNSNY CHOICE - - PowerPoint PPT Presentation

Feb 09, 2024 244 likes •900 views

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

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SLIDE 1

Enterprise Base Provider Training Introduction

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SLIDE 2

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
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SLIDE 3

HHAX VNSNY Provider Information Center

https://hhaexchange.com/vnsny/

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SLIDE 4

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
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SLIDE 5

HHAeXchange System Introduction

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SLIDE 6

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
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SLIDE 7

System Support

  • Super Users
  • HHAeXchange System: Support Center
  • Documentation Catalog
  • Process Guides
  • Job Aids
  • Reference Material
  • Videos and more to come
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SLIDE 8

Payer vs. Provider Responsibility Matrix

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SLIDE 9
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SLIDE 10

Member Management & Member Placement

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SLIDE 11
  • New Placement Request (Email Alerts)
  • New Placement Request (Home  Pending Placements)

Member Management – Placement Alerts

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SLIDE 12

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
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SLIDE 13

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
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SLIDE 14

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)
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SLIDE 15

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
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SLIDE 16

Member Management – Member Profile

  • Member Module – Index of Pages
  • General
  • Vendor Information
  • Status History
  • Member Notes
  • Profile (Demographics)
  • Authorization
  • Primary Statuses (Active, Discharge)
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SLIDE 17

Member Management – View Info

  • Member Module – Profile Page (from Payer Demographic)
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SLIDE 18

Member Management – Authorizations

  • Process (Timing varies by Payer)
  • Authorization with Provider matched to Member in HHAX
  • Review Authorization as necessary (Member  Authorization Page)
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SLIDE 19

Events

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SLIDE 20

Events

  • Travel Time Request – HHAX Function not used for VNSNY

Choice

  • Missed Visits
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SLIDE 21

Note Management

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SLIDE 22

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.

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SLIDE 23

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.

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SLIDE 24

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.
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SLIDE 25

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
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SLIDE 26

Member Notes - Review

  • Home Page  Notes (Status = Open)
  • Member  General Page  Notes

(All Statuses – Open and Closed)

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SLIDE 27

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
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SLIDE 28

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
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SLIDE 29

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)

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SLIDE 30

Caregiver Management

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SLIDE 31

Caregiver - New Caregiver

  • Required Fields
  • Demographics

(Employment Type)

  • Address
  • Emergency
  • Save
  • Creates Profile
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SLIDE 32

Caregiver – Profile Overview

  • Demographics
  • Employment
  • Address
  • Emergency
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SLIDE 33

Caregiver- Compliance

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SLIDE 34

Schedule management

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SLIDE 35

Scheduling Visits – Requirements

  • Member Status = Active
  • Authorization = Valid Dates/Service Info
  • Plan of Care (POC)

(Payer-specific)

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SLIDE 36

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
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SLIDE 37

Scheduling Visits - Calendar

  • Member Calendar (Member  Calendar Page)

COLOR CODES: Green Pink White

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SLIDE 38

Pre-billing/Billing

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SLIDE 39

Prebilling

  • Prebilling Process
  • Billing  Prebilling Review
  • Exceptions (Problems)
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SLIDE 40

Billing – Perform Billing Review

  • Billing  Billing Review
  • Search for Invoiced Visits
  • Review Details for “Hold Reasons”
  • Address Exceptions (Hold Reasons)
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SLIDE 41

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
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SLIDE 42

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

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SLIDE 43

Unbilling/Rebilling Rules and Process

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SLIDE 44

Un-billing and Resubmission Process and Rules

  • Denied/Corrected Claims
  • Void
  • Split Shift
  • Duplicate claims
  • Appeals
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SLIDE 45
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SLIDE 46

Unbilling the Visit

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SLIDE 47

Rebilling the Visit

  • For next day and overnight process
  • ccurred. 837s are already sent.

Providers cannot perform unbilling for an already billed claim.

  • Contact support@hhaexchange.com 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

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SLIDE 48

Re-submit claims

https://s3.amazonaws.com/hhaxsupport/Su pportDocs/Enterprise/Releases/Release+N

  • tes+12.0.pdf
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SLIDE 49

Rebilling additional workflows

Unexport – Permission Granted from Payers

  • Split shifts
  • Change of service hours
  • Resubmit as void due to billing incorrectly
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SLIDE 50

Reporting

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SLIDE 51

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)
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SLIDE 52
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SLIDE 53

Reporting – Overview of Report Layout

  • Report Generation and Navigation
  • System Reports
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SLIDE 54

Administration

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SLIDE 55

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
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SLIDE 56

Requesting HHAeXchange User Access

  • New User: Admin users Email to support@hhaexchange.com
  • 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 support@hhaexchange.com
  • Only HHAeXchange can create new roles
  • Provider Agency can assign/remove permissions from roles
  • Deactivate User: Admin users Email to support@hhaexchange.com
  • Send: User’s Username, First Name, Last Name, HHAX Role, Email

Address, and Date to deactivate Username

  • Receive: Email Confirmation
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SLIDE 57

Administration – Provider Profile

  • Admin  Provider Profile
  • General Section
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SLIDE 58

Administration – Provider Profile

  • Admin  Provider Profile
  • Automatic Email Section
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SLIDE 59

Administration – User Management

  • Admin  User Management  User Search
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SLIDE 60

Administration – Coordinator Setup

  • Admin  Coordinator Setup  New Coordinator

(Note: Must have at least 1 created for Placements!)

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SLIDE 61

Administration – Rate Management

  • Admin  Contract Setup  Search  VNSNY CHOICE
  • Edit (Future)
  • Update Rate (Retroactive)
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SLIDE 62

Administration – Rate Management

  • Admin  Contract Setup  Search  VNSNY CHOICE

Edit Rates Update Rates

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SLIDE 63

HHAX Portal and Access

1. Complete the Free Portal Agreement 2. Individual that completed the agreement submits request to support@hhaexchange.com for user provisioning

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SLIDE 64

For Post-Session Updates & Questions: prosupport@hhaexchange.com

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SLIDE 65

HHAX VNSNY Provider Information Center

https://hhaexchange.com/vnsny/