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

2. 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

3. 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

4. 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

5. 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 hours
Richard

6. 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

7. Provider Portal Entry: Replacement of Duty Sheet
Katie

8. 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

9. Contact Information
Follow up questions to today’s webinar? Looking for HHAX materials, please visit our site: Questions regarding HHAX reject report generated against HHAX EVV validation? Questions regarding 837 claims denial/payment? Provider Call Center:
Sal