Enterprise Base Provider Training Introduction

Transcription

1 Enterprise Base Provider Training Introduction

2 VNSNY CHOICE TRANSITION Training and Agenda items: Introduction to VNSNY implementation Highlight of Payer vs. Provider Matrix Member Management Placement Management Authorization Management Communication Notes Caregiver Compliance Scope Scheduling/Visits Pre-billing/Billing Unbilling/Rebilling Rules Reporting Administration Requesting user access Coordinator setup Rate Management HHAX Portal and Access

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 HHAeXchange System Introduction

6 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

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

8 Payer vs. Provider Responsibility Matrix

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10 Member Management & Member Placement

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

12 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

13 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

14 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)

15 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

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

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

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

19 Events

20 Events Travel Time Request HHAX Function not used for VNSNY Choice Missed Visits

21 Note Management

22 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.

23 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.

24 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.

25 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 Updated Authorization

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

27 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

28 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

29 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)

30 Caregiver Management

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

32 Caregiver Profile Overview Demographics Employment Address Emergency

33 Caregiver- Compliance

34 Schedule management

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

36 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

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

38 Pre-billing/Billing

39 Prebilling Prebilling Process Billing Prebilling Review Exceptions (Problems)

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

41 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

42 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

43 Unbilling/Rebilling Rules and Process

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

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46 Unbilling the Visit

47 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.

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

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

50 Reporting

51 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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53 Reporting Overview of Report Layout Report Generation and Navigation System Reports

54 Administration

55 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

56 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

57 Administration Provider Profile Admin Provider Profile General Section

58 Administration Provider Profile Admin Provider Profile Automatic Section

59 Administration User Management Admin User Management User Search

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

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

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

63 HHAX Portal and Access 1. Complete the Free Portal Agreement 2. Individual that completed the agreement submits request to for user provisioning

64 For Post-Session Updates & Questions:

65 HHAX VNSNY Provider Information Center