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
Training and Agenda items: Introduction to VNSNY implementation
A Web-based system to help Providers effectively interact with Payers
Member Management
Communication With Payers Visit Entry Billing and Reporting
➢ 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 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
➢ Super Users ➢ HHAeXchange System: Support Center
➢ Documentation Catalog
➢ Process Guides ➢ Job Aids ➢ Reference Material
➢ Videos and more to come
➢ New Placement Request (Email Alerts) ➢ New Placement Request (Home → Pending Placements)
➢ Review Placement
➢ Click on Admission ID to display Placement Window ➢ Review Member Info
➢ General: Demographics (Masked) ➢ Special Requests: Gender, Language, Notes
➢ 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)
➢ New Placement Request (Home → Action → Pending Placements)
➢ 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 Module – Index of Pages
➢ General
➢ Vendor Information ➢ Status History ➢ Member Notes
➢ Profile (Demographics) ➢ Authorization
➢ Primary Statuses (Active, Discharge)
➢ Member Module – Profile Page (from Payer Demographic)
➢ Process (Timing varies by Payer)
➢ Authorization with Provider matched to Member in HHAX ➢ Review Authorization as necessary (Member → Authorization Page)
➢ Travel Time Request
➢ Pending response from Vendor/Provide – Orange Highlight
➢ Travel Time Request
➢ New Note for additional information for Payer to review and approval
Member Notes are tag as Urgent or Non-Urgent priority.
Calendar Window (visit notations).
specific action (Missed Visit, Authorization Updates or Status Change) is performed.
to include HHAeXchange Notes.
will remain Open. Also, the recipient may close a note, note status will be Closed.
the Home Module. Note(s) will store in the patient profile.
➢ 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
by VNSNY, provider will need to CALL CA.
➢ Home Page → Notes (Status = Open) ➢ Member → General Page → Notes
(All Statuses – Open and Closed)
➢ 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 → 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
➢ Print Individual Notes (send to non-system users)
➢ to obtain hardcopy of Individual Note (PDF)
➢ Print Notes Report (Report → Other Reports → Member General
Notes)
➢ Required Fields
➢ Demographics (Employment Type) ➢ Address ➢ Emergency
➢ Save
➢ Creates Profile
➢ Demographics ➢ Employment ➢ Address ➢ Emergency
➢ Member Status = Active ➢ Authorization = Valid Dates/Service Info ➢ Plan of Care (POC) (Payer-specific)
➢ Creating a Visit (Non-Skilled/Skilled) ➢ Schedule Components
➢ Member Calendar (Member → Calendar Page)
COLOR CODES: Green Pink White
➢ Prebilling Process
➢ Billing → Prebilling Review ➢ Exceptions (Problems)
➢ Prebilling Validations
➢ Review Exceptions (focus on Missed Visit and Authorizations)
➢ 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 → Billing Review
➢ Search for Invoiced Visits ➢ Review Details for “Hold Reasons”
➢ Address Exceptions (Hold Reasons)
➢ 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
HHAX will receive a copy and will be under the remittances tab
https://s3.amazonaws.com/hhaxsupport/SupportDocs /EDI+Guides/Professional+Job+Aid+- +Common+EDI+Rejections_Payers.pdf
Secure File Transfer Protocol (SFTP)
Un-billing and Resubmission Process and Rules
➢ 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)
➢ Report Generation and Navigation ➢ System Reports
Path: Report → Members → List of Members
Path: Report → Billing → Invoicing → Batch Detail Report
Path: Report → Compliance → Unverified Visits Aging Detail
Path: Report → Other Reports → Member General Notes
Path: Report → Caregiver → List of Applicant/Caregivers
Provider Profile
➢ Email Alerts
➢ User Management
➢ Roles ➢ Permissions
➢ Coordinator Setup – Must Add At Least 1 (Default) ➢ Provider Reference Table Management ➢ Rate Management
➢ 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
➢ Admin → Provider Profile
➢ General Section
➢ Admin → Provider Profile
➢ Automatic Email Section
➢ Admin → User Management → User Search
➢ Admin → Coordinator Setup → New Coordinator (Note: Must have at least 1 created for Placements!)
➢ Admin → Contract Setup → Search → VNSNY CHOICE
➢ Edit (Future) ➢ Update Rate (Retroactive)
➢ Admin → Contract Setup → Search → VNSNY CHOICE Edit Rates Update Rates