VNSNY CHOICE Transition to HHAeXchange System April 24 & 26, 2018 VNSNY CHOICE Transition to HHAeXchange System Sal: Intro + Timeline

Member Placement Process Current Future: HHAX Contract Administration sends referrals through VNSNY placement portal Provider accepts/declines referrals through VNSNY placement portal Provider has a 20 minute window to accept/deny referral If window times out, provider can request additional time CHOICE Care Management and Contract Administration will send referrals through the HHAX portal Provider will accept/decline referrals through HHAX provider portal Provider has a 20 minute window to accept/decline referral If window times out, provider can request additional time On occasion referrals will be broadcasted to multi-providers Richard

Authorization Process Future: HHAX Current All referrals will be assigned an authorization number The authorization will be for 180 days or as specified Universal Billing codes will replace service type codes on referrals HHAX authorization Units 1 Unit=15 minutes (unless per diem, hourly) Total Bucket = Provider to manage hours based on authorization details Weekly # visits Total hours a week Services to member ends upon the ‘end date’ in authorization even if member shows as ‘Active’ in HHAX Reauthorization required? Send a communication note to Contract Administration and CA will notify Care Management of request Travel Time Approval – send communication note to Contract Admin with request for TT Overtime Approval – send communication note to Contract Admin with request for OT No authorization number is required for placement of referrals through OPS by Contract Administration Elizabeth

Service Interruptions (Black Out Dates) Black-out dates are utilized in HHAX if there is an interruption of care (ex: patient is hospitalized, on vacation, etc…) Contract Admin blacks out dates in HHAX for up to 15 days Provider is notified via an automated HHAX communication note that the dates have been blacked out. Contract Admin will be notified by CHOICE Care Management to resume service once member returns home Contract Admin will update existing authorization in HHAX to resume service Provider is notified via an automated HHAX communication note to resume service Elizabeth

Communication Notes HHAX allows for bi-directional communication between the Provider and Contract Administration Communication notes have categories and space for narrative text Providers will be required to communicate with Contract Admin based on existing protocols Contract Admin SLAs Urgent Communication: Response within Same Business Day Non-Urgent Communication: Response within 24-48 hours Richard

Service Entry Current Future: HHAX LHSCAs call-in systems interface with OPS or LHSCAs submit duty sheet for Contract Admin entry into OPS LHCSA hours verified via EVV or Manual entry by provider via HHAX Provider Portal (see visual on next slide) Katie

Provider Portal Entry: Replacement of Duty Sheet Katie

Claims Processing Future: HHAX Current Provider 3rd Party systems interface with HHAX provider portal Providers will submit EVV claims to HHAX via SFTP site Provider reject reports are generated against HHAX validation process and made available to providers on SFTP site. 837 file is created based on HHAX clean claims and forwarded to claims processing Provider receives remittance report via SFTP site Manual entry by provider via HHAX Provider portal Claims Denials: Electronic response file or physical EOB payment Appeals: 90 days from issue of remittance unless contract states otherwise Provider 3rd Party systems interface with VNSNY System Providers submit EVV claims to VNSNY via SFTP site Provider reject reports are generated against OPS validation process and made available via SFTP site Clean claims are processed and paid through VNSNY Accounts Payable Providers have ability to view claim status via VNSNY Mainframe Providers have ability to view and download remittance reports via SFTP site Provider submits paper duty sheet to Contract Admin for entry into OPS Maggie EVV/Manual Entry of Service HHAX validation –corrections performed in Provider Portal Claims Processing Remittance Report Denial Report

Contact Information Follow up questions to today’s webinar? Email: hhaxquestions@vnsny.org Looking for HHAX materials, please visit our site: http://vnsnychoice.org/health-professionals Questions regarding HHAX reject report generated against HHAX EVV validation? ContractAdminBillingCompliance@vnsny.org Questions regarding 837 claims denial/payment? Provider Call Center: 1-866-783-0222 Sal