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

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

Aug 08, 2023 49 likes •839 views

Enterprise Provider Training Introduction VNSNY CHOICE TRANSITION Training and Agenda items: Introduction to VNSNY implementation Rollout, Benefit of Linkage, Workflow differences Highlight of Payer vs. Provider Matrix Member

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SLIDE 1

Enterprise Provider Training Introduction

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VNSNY CHOICE TRANSITION

Training and Agenda items: Introduction to VNSNY implementation

  • Rollout, Benefit of Linkage, Workflow differences
  • Highlight of Payer vs. Provider Matrix
  • Member Management
  • Placement Management
  • Transition of VNSNY cases as unconfirmed or confirmed
  • Centralized Placement (Refer to Release Notes 12.3)
  • Authorization Management
  • Communication Notes
  • Discharge internal member record
  • Migration of internal contract contents to linked contract
  • Caregiver Compliance Scope
  • Scheduling/Visits
  • Nurse Assessment
  • Pre-billing/Billing
  • Unbilling/Rebilling Rules
  • Reporting
  • Administration
  • Requesting user access
  • Coordinator setup
  • Rate Management
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SLIDE 3

HHAX VNSNY Provider Information Center

https://hhaexchange.com/vnsny/

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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

Upcoming VNSNY Rollout to HHAX

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HHAX and VNSNY have partnered to connect VNSNY to its Providers base, through the HHAX platform. Beginning with the HOSPICE program and continuing with CHHA and CHOICE, soon all members across the entire New York area will be linked.  VNSNY is live with new members for the HOSPICE and CHHA programs.  Providers are actively billing through the linked environment for these programs.  VNSNY has been hosting a series of webinars to inform and prepare agencies for the linkage.

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Rollout Schedule

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CHHA Program ~  Rollout by County

  • July 16th 2018, Manhattan (New & Re-Cert)
  • October 1st, 2018, Queens, Nassau, Suffolk (New & Re-Cert)
  • October 29th, 2018, Bronx, Brooklyn, Staten Island, Westchester

(New & Re-Cert)

  • December 1st, All Regions (All Remaining Members)

CHOICE Program ~  Rollout by LHCSA

  • October through December (Reach out to VNSNY if you are not

aware the go-live wave for your agency)

*Note, these dates are subject to change by VNSNY.

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SLIDE 7

Benefits of the Linkage

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Current State (OPS) Future State (HHAX) Staff accept members in OPS for them to be available in HHAX. There is a potential for demographics mismatches between OPS and HHAX. For Hospice and CHHA program, member demographics are sent every 15 minutes to the HHAX professional platform from HCHB . For the Choice program, member demographics are sent every 20 minutes to the HHAX professional platform from Altruista/Guiding Care. In both situations, the information is available instantly, from one platform, for linked providers.

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Benefits of the Linkage

Current State (OPS) Future State (HHAX)

HHAX exports scheduled visits to VNSNY once they are created in the system. If there is a mismatch between the scheduled hours and the authorized hours in OPS, the visit will be rejected from

  • VNS. Rejections are only available

after an overnight process, manually pulling a rejection report from OPS and loading into HHAX. All billing (through pre-billing and billing review) will be managed as per HHAX rules. HHAX will then automatically export claims nightly. For HOSPICE and CHHA programs, 100% of successfully exported claims will be paid.

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SLIDE 9

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Benefits of the Linkage

Current State (OPS) Future State (HHAX) Agencies must validate and test compliance with VNSNY. This test is required in order to go live. Caregiver compliance rules will not be enforced within HHAX for the remaining of 2018. However, VNSNY will continue to monitor the scheduled caregivers. Going forward (2019) caregiver compliance will be managed using the compliance module within HHAX.

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Benefits of the Linkage

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Current State (OPS) Future State (HHAX) OPS requires unique VNSNY reason codes for confirming visits (Absence Codes, Overtime codes, Full service Codes). Professional system will allow the use of standard OMIG reason codes.

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Workflow Differences

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Known Workflow Difference What’s being Done

Authorization discrepancies cannot be handled through TEMP authorizations. Agencies will be able to use linked communication with the Payer, to elicit the need and make the request. Urgent requests will have a 24hr SLA (Note also that we will distribute a weekly “Note Aging” report to highlight payer responsiveness to Provider queries, both urgent and non-urgent). By November 2018, our goal is to allow the TEMP auth concept for linked contracts.

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Workflow Differences

Known Workflow Difference What’s being Done Placements from VNS will be sent as unconfirmed

  • placements. Agency staff

will need to be trained to accept the unconfirmed placement in the correct

  • ffice. Once placed, the

patient cannot be moved between offices. By end of 2018, HHAX will be introducing a concept

  • f Case Placement, where the agency can control the

patients office at the time of placement and after.

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Workflow Differences

Known Workflow Difference What’s being Done Agencies will need to contact HHAX support, to initiate an un-billing/re- billing.** Our new functionality allows for un-billing/re-billing across internal and linked contracts. **These requests will be processed within 48hrs.

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HHAeXchange System Introduction

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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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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 17

Payer vs. Provider Responsibility Matrix

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SLIDE 18
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Member Management & Member Placement

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SLIDE 20
  • New Placement Request (Email Alerts)
  • New Placement Request (Home  Pending Placements)

Member Management – Placement Alerts

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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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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)
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Member Management

  • New Placement Request (Home  Action 

Pending Placements)

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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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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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Member Management – View Info

  • Member Module – Profile Page (from Payer Demographic)
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SLIDE 27

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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Transition of VNSNY cases as unconfirmed or confirmed

One time event:

  • Census: <100
  • Placement- unconfirmed.
  • ENT agencies will accept placement in proper office
  • Census: >100
  • Placement- confirmed.
  • ENT agencies will determine a “default” office so HHAX can place the confirmed

placement accordingly.

  • Contact Client Success Manager. If you do not have a client success manager,

please email prosupport@hhaexchange.com and indicate this information in the ticket

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Events

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Events

  • Travel Time Request
  • Pending response from Vendor/Provide – Orange Highlight
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Events

  • Travel Time Request
  • New Note for additional information for Payer to review and

approval

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Note Management

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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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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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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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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
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Member Notes - Review

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

(All Statuses – Open and Closed)

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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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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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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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Discharging internal member

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Payer and Provider will schedule when they will link on HHAeXchange Provider will accept the linked member. **VNSNY will discharge the internal member from OPS. Payer will place the member with the provider Payer will enter the Authorization in HHAeXchange

Provider will review for each member:

·Phone Number ·Address ·Authorization (service codes & dates) ·Rate Schedule

Provider will send note in HHAeXchange with any change requests Provider will review information transitioned over from internal contract

Discharging Internal Member

  • How To Guide - Enterprise Providers Linking with VNSNY
  • Includes the Discharge process below
  • Relevant information to the linking with payer
  • If you are not currently affiliated with OPS system, then you will have to manually

discharge patient as indicated in the guide.

** Note the date of discharge of internal contract patient SHOULD NOT overlap Start of care date for linked patient.

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Migration of internal contract contents to linked contract

  • The linked member record will be the active record.
  • Record will contain demographic data coming from the payer that needs to be validated by the

provider.

  • Providers with <50 census - Masterweeks will need to be created according to the new

authorization provided by the payer. Recommendation is to refer to the internal member record to create the new master week. Masterweek can be similar to internal contract but the service code may differ.

  • Providers with >50 Masterweeks will be copied from internal contract
  • The internal member record will be in discharge status.
  • Information will be retained in the system to review if needed.
  • Such as alerts, address, phone, nurse etc.
  • Note: These information may differ from what is coming from the payer from a linked contract.

To search for the discharged internal member record, in the Patient Search, change the ‘Status’ filter to “All” to view.

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Caregiver Management

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Caregiver - New Caregiver

  • Required Fields
  • Demographics

(Employment Type)

  • Address
  • Emergency
  • Save
  • Creates Profile
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Caregiver – Profile Overview

  • Demographics
  • Employment
  • Address
  • Emergency
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Schedule management

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Scheduling Visits – Requirements

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

(Payer-specific)

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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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Scheduling Visits - Calendar

  • Member Calendar (Member  Calendar Page)

COLOR CODES: Green Pink White

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Nurse Assessment

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Nurse visits

  • Reference table management >> contract service codes >> click add to create a new code
  • Select the payer from the contract drop down the pop up will refresh and you will be able to create a non-billable

service code.

  • Use this service code, within the linked patient to schedule a skilled visit that will work for EVV and can be paid to the

aide, but will not have an auth (it will not get hung up in pre-billing because of this, see checkbox).

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Pre-billing/Billing

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Prebilling

  • Prebilling Process
  • Billing  Prebilling Review
  • Exceptions (Problems)
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Billing – Perform Billing Review

  • Billing  Billing Review
  • Search for Invoiced Visits
  • Review Details for “Hold Reasons”
  • Address Exceptions (Hold Reasons)
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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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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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Unbilling/Rebilling Rules and Process

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Un-billing and Resubmission Process and Rules

  • Denied/Corrected Claims
  • Void
  • Split Shift
  • Duplicate claims
  • Appeals
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Unbilling the Visit

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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 63

Re-submit claims

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

  • tes+12.0.pdf
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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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Reporting

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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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Reporting – Overview of Report Layout

  • Report Generation and Navigation
  • System Reports
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Administration

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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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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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Administration – Provider Profile

  • Admin  Provider Profile
  • General Section
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Administration – Provider Profile

  • Admin  Provider Profile
  • Automatic Email Section
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Administration – User Management

  • Admin  User Management  User Search
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Administration – Coordinator Setup

  • Admin  Coordinator Setup  New Coordinator

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

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Administration – Rate Management

  • Admin  Contract Setup  Search  VNSNY CHOICE
  • Edit (Future)
  • Update Rate (Retroactive)
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Administration – Rate Management

  • Admin  Contract Setup  Search  VNSNY CHOICE

Edit Rates Update Rates

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

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HHAX VNSNY Provider Information Center

https://hhaexchange.com/vnsny/