Enterprise Provider Training Introduction

Transcription

1 Enterprise Provider Training Introduction

2 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

3 HHAX VNSNY Provider Information Center

4 Questions Anyone? We expect you to have questions Questions Today Questions after Today s Session prosupport@hhaexchange.com Questions after you begin to use HHAeXchange System prosupport@hhaexchange.com

5 Upcoming VNSNY Rollout to HHAX 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. 5

6 Rollout Schedule CHHA Program ~ *Note, these dates are subject to change by VNSNY. Rollout by County July 16 th 2018, Manhattan (New & Re-Cert) October 1 st, 2018, Queens, Nassau, Suffolk (New & Re-Cert) October 29 th, 2018, Bronx, Brooklyn, Staten Island, Westchester (New & Re-Cert) December 1 st, 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) 6

7 Benefits of the Linkage Current State (OPS) Staff accept members in OPS for them to be available in HHAX. There is a potential for demographics mismatches between OPS and HHAX. Future State (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. 7

8 Benefits of the Linkage Current State (OPS) 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. Future State (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. 8

9 Benefits of the Linkage Current State (OPS) Agencies must validate and test compliance with VNSNY. This test is required in order to go live. Future State (HHAX) Caregiver compliance rules will not be enforced within HHAX for the remaining of However, VNSNY will continue to monitor the scheduled caregivers. Going forward (2019) caregiver compliance will be managed using the compliance module within HHAX. 9

10 Benefits of the Linkage Current State (OPS) OPS requires unique VNSNY reason codes for confirming visits (Absence Codes, Overtime codes, Full service Codes). Future State (HHAX) Professional system will allow the use of standard OMIG reason codes. 10

11 Workflow Differences Known Workflow Difference Authorization discrepancies cannot be handled through TEMP authorizations. What s being Done 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. 11

12 Workflow Differences Known Workflow Difference 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. What s being Done 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. 12

13 Workflow Differences Known Workflow Difference Agencies will need to contact HHAX support, to initiate an un-billing/rebilling.** What s being Done Our new functionality allows for un-billing/re-billing across internal and linked contracts. **These requests will be processed within 48hrs. 13

14 HHAeXchange System Introduction

15 HHAeXchange System Introduction HHAeXchange System Nomenclature Member = Patient Caregiver = Attendant = Aide Provider = Agency = Vendor Payer = MCO = Plan Log In Process ( CLIENT LOGIN) Home Module Landing Page Reviewing Pending Placements, Events and Communications with Payers

16 System Support Super Users HHAeXchange System: Support Center Documentation Catalog Process Guides Job Aids Reference Material Videos and more to come

17 Payer vs. Provider Responsibility Matrix

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19 Member Management & Member Placement

20 Member Management Placement Alerts New Placement Request ( Alerts) New Placement Request (Home Pending Placements)

21 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

22 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)

23 Member Management New Placement Request (Home Action Pending Placements)

24 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

25 Member Management Member Profile Member Module Index of Pages General Vendor Information Status History Member Notes Profile (Demographics) Authorization Primary Statuses (Active, Discharge)

26 Member Management View Info Member Module Profile Page (from Payer Demographic)

27 Member Management Authorizations Process (Timing varies by Payer) Authorization with Provider matched to Member in HHAX Review Authorization as necessary (Member Authorization Page)

28 Transition of VNSNY cases as unconfirmed or confirmed One 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 prosupport@hhaexchange.com and indicate this information in the ticket

29 Events

30 Events Travel Time Request Pending response from Vendor/Provide Orange Highlight

31 Events Travel Time Request New Note for additional information for Payer to review and approval

32 Note Management

33 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.

34 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.

35 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: hours 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.

36 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

37 Member Notes - Review Home Page Notes (Status = Open) Member General Page Notes (All Statuses Open and Closed)

38 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

39 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

40 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)

41 Discharging internal member

42 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. Payer and Provider will schedule when they will link on HHAeXchange Payer will enter the Authorization in HHAeXchange Payer will place the member with the provider Provider will accept the linked member. **VNSNY will discharge the internal member from OPS. 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 ** Note the date of discharge of internal contract patient SHOULD NOT overlap Start of care date for linked patient.

43 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.

44 Caregiver Management

45 Caregiver - New Caregiver Required Fields Demographics (Employment Type) Address Emergency Save Creates Profile

46 Caregiver Profile Overview Demographics Employment Address Emergency

47 Schedule management

48 Scheduling Visits Requirements Member Status = Active Authorization = Valid Dates/Service Info Plan of Care (POC) (Payer-specific)

49 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

50 Scheduling Visits - Calendar Member Calendar (Member Calendar Page) COLOR CODES: Green Pink White

51 Nurse Assessment

52 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).

53 Pre-billing/Billing

54 Prebilling Prebilling Process Billing Prebilling Review Exceptions (Problems)

55 Billing Perform Billing Review Billing Billing Review Search for Invoiced Visits Review Details for Hold Reasons Address Exceptions (Hold Reasons)

56 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

57 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

58 Unbilling/Rebilling Rules and Process

59 Un-billing and Resubmission Process and Rules Denied/Corrected Claims Void Split Shift Duplicate claims Appeals

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61 Unbilling the Visit

62 Rebilling the Visit For next day and overnight process occurred. 837s are already sent. Providers cannot perform unbilling for an already billed claim. Contact 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.

63 Re-submit claims pportdocs/enterprise/releases/release+n otes+12.0.pdf

64 Rebilling additional workflows Unexport Permission Granted from Payers - Split shifts - Change of service hours - Resubmit as void due to billing incorrectly

65 Reporting

66 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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68 Reporting Overview of Report Layout Report Generation and Navigation System Reports

69 Administration

70 Administration and System Support Provider Profile Alerts User Management Roles Permissions Coordinator Setup Must Add At Least 1 (Default) Provider Reference Table Management Rate Management

71 Requesting HHAeXchange User Access New User: Admin users to Send: User s First Name, Last Name, HHAX Role, Office: Default, and unique Address Requestor Receives: Confirmation, HHAX Username(s) New User Receives: with Temporary Password New Role: Admin users to support@hhaexchange.com Only HHAeXchange can create new roles Provider Agency can assign/remove permissions from roles Deactivate User: Admin users to support@hhaexchange.com Send: User s Username, First Name, Last Name, HHAX Role, Address, and Date to deactivate Username Receive: Confirmation

72 Administration Provider Profile Admin Provider Profile General Section

73 Administration Provider Profile Admin Provider Profile Automatic Section

74 Administration User Management Admin User Management User Search

75 Administration Coordinator Setup Admin Coordinator Setup New Coordinator (Note: Must have at least 1 created for Placements!)

76 Administration Rate Management Admin Contract Setup Search VNSNY CHOICE Edit (Future) Update Rate (Retroactive)

77 Administration Rate Management Admin Contract Setup Search VNSNY CHOICE Edit Rates Update Rates

78 For Post-Session Updates & Questions:

79 HHAX VNSNY Provider Information Center