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Enterprise Provider Training Introduction

VNSNY CHOICE TRANSITION Training and Agenda items:Introduction to VNSNY implementation • Rollout, Benefit of Linkage, Workflow differences• Member Management • Placement Management

• Centralized Placement (Refer to Release Notes 12.3)• Authorization Management • Communication Notes • Discharge internal member record• Caregiver Compliance Scope • Scheduling/Visits

• Nurse Assessment• Pre-billing/Billing • Unbilling/Rebilling Rules• Reporting • Administration

• Requesting user access• Coordinator setup• Rate Management

HHAX VNSNY Provider Information Center

https://hhaexchange.com/vnsny/

Questions Anyone?

We expect you to have questions Questions Today Questions after Today’s Session support@hhaexchange.com

Questions after you begin to use HHAeXchange System support@hhaexchange.com

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.

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 April (Reach out to VNSNY if you are not aware

of the go-live wave for your agency)

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

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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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-Date TBD) caregiver compliance will be managed using the compliance module within HHAX.

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.

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).

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Workflow DifferencesKnown 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 office. Once placed, the patient cannot be moved between offices.

New Release- HHAX introduced a concept of Case Placement, where the agency can control the patients office at the time of placement and shortly after. Refer to Release Notes.

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Workflow DifferencesKnown 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.

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

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 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 – 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 (Not Used) Pending response from Vendor/Provide – Orange Highlight

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 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

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)

Discharging internal member

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.

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 Time2. Caregiver3. Optional: Plan of Care (POC)4. Service Code5. Save Schedule

Scheduling Visits - Calendar

Member Calendar (Member Calendar Page)

COLOR CODES:GreenPinkWhite

Nurse Assessment

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).

Pre-billing/Billing

Prebilling

Prebilling Process Billing Prebilling Review Exceptions (Problems)

Billing – Perform Billing Review

Billing Billing Review Search for Invoiced Visits Review Details for “Hold Reasons”

Address Exceptions (Hold Reasons)

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

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

Unbilling/Rebilling Rules and Process

Un-billing and Resubmission Process and Rules

• Denied/Corrected Claims• Void• Split Shift• Duplicate claims• Appeals

Unbilling the Visit

Rebilling the Visit

• For next day and overnight process occurred. 837s are already sent. Providers cannot perform unbillingfor 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

Re-submit claims

https://s3.amazonaws.com/hhaxsupport/SupportDocs/Enterprise/Releases/Release+Notes+12.0.pdf

Rebilling additional workflows

Unexport – Permission Granted from Payers- Split shifts- Change of service hours- Resubmit as void due to billing incorrectly

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

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 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

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 CHOICEEdit Rates Update Rates

For Post-Session Updates & Questions:

support@hhaexchange.com

HHAX VNSNY Provider Information Center

https://hhaexchange.com/vnsny/