Provider Training Introduction · Introduction to VNSNY implementation • Highlight of Payer vs....
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Provider Training Introduction
Transcript of Provider Training Introduction · Introduction to VNSNY implementation • Highlight of Payer vs....
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 Scope
• Authorization Management
• Communication Notes
• Scheduling/Visits
• Pre-billing/Billing
• EDI workflows
• EDI issue management (SFTP - 3rd party rejection file and EDI Rejection Job Aide)
• Rebilling Rules
• Reporting
• Administration
• Requesting user access
• Coordinator set
• Rate Management
HHAeXchange: At a Glance
A Web-based system to help Providers effectively
interact with Payers
Member
ManagementCommunication
With Payers
Visit
EntryBilling and
Reporting
HHAX VNSNY Provider Information Center
https://hhaexchange.com/vnsny/
Questions Anyone?
➢ We expect you to have questions
➢ Questions Today
➢ Questions after Today’s Session
➢ Questions after you begin to use HHAeXchange System
HHAeXchange System Introduction
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
System Support
➢ Super Users
➢ HHAeXchange System: Support Center
➢ Documentation Catalog
➢ Process Guides
➢ Job Aids
➢ Reference Material
➢ Videos and more to come
Payer vs. Provider Responsibility Matrix
High-level workflow overview
Member Management & Member Placement
➢ New Placement Request (Email Alerts)
➢ New Placement Request (Home → Pending Placements)
Member Management – Placement Alerts
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
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)
Member Management
➢ New Placement Request (Home → Action →
Pending Placements)
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
Member Management – Member Profile
➢ Member Module – Index of Pages
➢ General
➢ Vendor Information
➢ Status History
➢ Member Notes
➢ Profile (Demographics)
➢ Authorization
➢ Primary Statuses (Active, Discharge)
Member Management – View Info
➢ Member Module – Profile Page (from Payer Demographic)
Member Management – Authorizations
➢ Process (Timing varies by Payer)
➢ Authorization with Provider matched to Member in HHAX
➢ Review Authorization as necessary (Member → Authorization Page)
Events
Events
➢ Travel Time Request
➢ Pending response from Vendor/Provide – Orange Highlight
Events
➢ Travel Time Request
➢ New Note for additional information for Payer to review and
approval
Note Management
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.
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.
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.
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
Member Notes - Review
➢ Home Page → Notes (Status = Open)
➢ Member → General Page → Notes(All Statuses – Open and Closed)
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
Member Notes – Create Notes
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
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)
Caregiver Management
Caregiver - New Caregiver
➢ Required Fields
➢ Demographics
(Employment Type)
➢ Address
➢ Emergency
➢ Save
➢ Creates Profile
Caregiver – Profile Overview
➢ Demographics
➢ Employment
➢ Address
➢ Emergency
Schedule management
Scheduling Visits – Requirements
➢ Member Status = Active
➢ Authorization = Valid Dates/Service Info
➢ Plan of Care (POC)
(Payer-specific)
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
Scheduling Visits - Calendar
➢ Member Calendar (Member → Calendar Page)
COLOR CODES:
Green
Pink
White
Pre-billing/Billing
Prebilling
➢ Prebilling Process
➢ Billing → Prebilling Review
➢ Exceptions (Problems)
➢ Prebilling Validations
➢ Review Exceptions (focus on Missed Visit and Authorizations)
Billing – Process Overview
➢ 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 – Perform Billing Review
➢ Billing → Billing Review
➢ Search for Invoiced Visits
➢ Review Details for “Hold Reasons”
➢ Address Exceptions (Hold Reasons)
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) – VNSNY Provider portal, will need to sign up through
VNSNY. It will also be in Provider SFTP and shared with 3rd party system.
HHAX will receive a copy and will be under the remittances tab
EDI workflow
Working with 3rd party on EDI rejections
https://s3.amazonaws.com/hhaxsupport/SupportDocs
/EDI+Guides/Professional+Job+Aid+-+Common+EDI+Rejections_Payers.pdf
Secure File Transfer Protocol (SFTP)
Rebilling Rules and Process
Un-billing and Resubmission Process and Rules
• Denied/Corrected Claims
• Void
• Split Shift
• Duplicate claims
• Appeals
Reporting
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)
Reporting – Overview of Report Layout
➢ Report Generation and Navigation
➢ System Reports
Reporting – List of Members
Path: Report → Members → List of Members
Reporting – Batch Detail Report
Path: Report → Billing → Invoicing → Batch Detail Report
Reporting – Unverified Visits Aging Detail
Path: Report → Compliance → Unverified Visits Aging Detail
Reporting – Member General Notes
Path: Report → Other Reports → Member General Notes
Reporting – List of Caregivers
Path: Report → Caregiver → List of Applicant/Caregivers
Administration
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
Requesting HHAeXchange User Access
➢ New User: Admin users Email to [email protected]
➢ 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 [email protected]
➢ Only HHAeXchange can create new roles
➢ Provider Agency can assign/remove permissions from roles
➢ Deactivate User: Admin users Email to [email protected]
➢ Send: User’s Username, First Name, Last Name, HHAX Role, Email
Address, and Date to deactivate Username
➢ Receive: Email Confirmation
Administration – Provider Profile
➢ Admin → Provider Profile
➢ General Section
Administration – Provider Profile
➢ Admin → Provider Profile
➢ Automatic Email Section
Administration – User Management
➢ Admin → User Management → User Search
Administration – Coordinator Setup
➢ Admin → Coordinator Setup → New Coordinator
(Note: Must have at least 1 created for Placements!)
Administration – Rate Management
➢ Admin → Contract Setup → Search → VNSNY CHOICE
➢ Edit (Future)
➢ Update Rate (Retroactive)
Administration – Rate Management
➢ Admin → Contract Setup → Search → VNSNY CHOICE
Edit Rates Update Rates
HHAX VNSNY Provider Information Center
https://hhaexchange.com/vnsny/
