enterprise provider training introduction€¦ · 6 chha program ~ rollout by county july 16th...
TRANSCRIPT
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Enterprise Provider Training Introduction
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VNSNY CHOICE TRANSITION Training and Agenda items:Introduction to VNSNY implementation • Rollout, Benefit of Linkage, Workflow differences• Highlight of Payer vs. Provider Matrix• Member Management • Placement Management
• Transition of VNSNY cases as unconfirmed or confirmed• Centralized Placement (Refer to Release Notes 12.3)
• Authorization Management • Communication Notes • Discharge internal member record
• Migration of internal contract contents to linked contract• Caregiver Compliance Scope • Scheduling/Visits
• Nurse Assessment• Pre-billing/Billing • Unbilling/Rebilling Rules• Reporting • Administration
• Requesting user access• Coordinator setup• Rate Management
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HHAX VNSNY Provider Information Center
https://hhaexchange.com/vnsny/
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Questions Anyone?
We expect you to have questions Questions Today Questions after Today’s Session [email protected]
Questions after you begin to use HHAeXchange System [email protected]
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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.
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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 December (Reach out to VNSNY if you are not
aware the go-live wave for your agency)
*Note, these dates are subject to change by VNSNY.
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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) caregiver compliance will be managed using the compliance module within HHAX.
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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.
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Workflow Differences
11
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).
By November 2018, our goal is to allow the TEMP auth concept for linked contracts.
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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.
By end of 2018, HHAX will be introducing a concept of Case Placement, where the agency can control the patients office at the time of placement and after.
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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.
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HHAeXchange System Introduction
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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
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System Support
Super Users HHAeXchange System: Support Center Documentation Catalog Process Guides Job Aids Reference Material Videos and more to come
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Payer vs. Provider Responsibility Matrix
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Member Management & Member Placement
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New Placement Request (Email Alerts)
New Placement Request (Home Pending Placements)
Member Management – Placement Alerts
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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
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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)
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Member Management
New Placement Request (Home Action Pending Placements)
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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
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Member Management – Member Profile
Member Module – Index of Pages General Vendor Information Status History Member Notes Profile (Demographics) Authorization Primary Statuses (Active, Discharge)
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Member Management – View Info
Member Module – Profile Page (from Payer Demographic)
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Member Management – Authorizations
Process (Timing varies by Payer) Authorization with Provider matched to Member in HHAX Review Authorization as necessary (Member Authorization Page)
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Transition of VNSNY cases as unconfirmed or confirmedOne time event: • Census: <100
• Placement- unconfirmed. • ENT agencies will accept placement in proper office
• Census: >100 • Placement- confirmed. • ENT agencies will determine a “default” office so HHAX can place the confirmed
placement accordingly.• Contact Client Success Manager. If you do not have a client success manager,
please email [email protected] and indicate this information in the ticket
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Events
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Events
Travel Time Request Pending response from Vendor/Provide – Orange Highlight
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Events
Travel Time Request New Note for additional information for Payer to review and
approval
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Note Management
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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.
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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.
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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.
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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
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Member Notes - Review
Home Page Notes (Status = Open)
Member General Page Notes(All Statuses – Open and Closed)
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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
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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
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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)
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Discharging internal member
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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.
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Migration of internal contract contents to linked contract The linked member record will be the active record.
Record will contain demographic data coming from the payer that needs to be validated by the provider.
Providers with <50 census - Masterweeks will need to be created according to the new authorization provided by the payer. Recommendation is to refer to the internal member record to create the new master week. Masterweek can be similar to internal contract but the service code may differ.
Providers with >50 Masterweeks will be copied from internal contract
The internal member record will be in discharge status. Information will be retained in the system to review if needed.
Such as alerts, address, phone, nurse etc. Note: These information may differ from what is coming from the payer from a linked contract.
To search for the discharged internal member record, in the Patient Search, change the ‘Status’ filter to “All” to view.
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Caregiver Management
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Caregiver - New Caregiver
Required Fields Demographics
(Employment Type) Address Emergency Save Creates Profile
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Caregiver – Profile Overview
Demographics
Employment
Address
Emergency
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Schedule management
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Scheduling Visits – Requirements
Member Status = Active
Authorization = Valid Dates/Service Info
Plan of Care (POC)(Payer-specific)
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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
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Scheduling Visits - Calendar
Member Calendar (Member Calendar Page)
COLOR CODES:GreenPinkWhite
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Nurse Assessment
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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).
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Pre-billing/Billing
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Prebilling
Prebilling Process Billing Prebilling Review Exceptions (Problems)
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Billing – Perform Billing Review
Billing Billing Review Search for Invoiced Visits Review Details for “Hold Reasons”
Address Exceptions (Hold Reasons)
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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
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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
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Unbilling/Rebilling Rules and Process
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Un-billing and Resubmission Process and Rules
• Denied/Corrected Claims• Void• Split Shift• Duplicate claims• Appeals
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Unbilling the Visit
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Rebilling the Visit
• For next day and overnight process occurred. 837s are already sent. Providers cannot perform unbillingfor an already billed claim.
• Contact [email protected] 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
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Re-submit claims
https://s3.amazonaws.com/hhaxsupport/SupportDocs/Enterprise/Releases/Release+Notes+12.0.pdf
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Rebilling additional workflows
Unexport – Permission Granted from Payers- Split shifts- Change of service hours- Resubmit as void due to billing incorrectly
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Reporting
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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)
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Reporting – Overview of Report Layout
Report Generation and Navigation
System Reports
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Administration
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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
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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
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Administration – Provider Profile
Admin Provider Profile General Section
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Administration – Provider Profile
Admin Provider Profile
Automatic Email Section
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Administration – User Management
Admin User Management User Search
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Administration – Coordinator Setup
Admin Coordinator Setup New Coordinator(Note: Must have at least 1 created for Placements!)
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Administration – Rate Management
Admin Contract Setup Search VNSNY CHOICE Edit (Future) Update Rate (Retroactive)
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Administration – Rate Management
Admin Contract Setup Search VNSNY CHOICEEdit Rates Update Rates
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HHAX VNSNY Provider Information Center
https://hhaexchange.com/vnsny/