Florida State Medicaid Managed Care Provider Information Center

At HHAeXchange, we believe that healthcare should be simple, effective, and transparent. Our mission is to provide better outcomes for patients who represent some of the most vulnerable and fragile members of our society. Since 2008, we have been at the forefront of delivering industry-leading homecare management solutions by helping payers and providers achieve operational efficiency, increased compliance, and improved patient outcomes.

Today, HHAeXchange is the premiere homecare management software solution for the Medicaid LTSS population. We act as the single source of truth in connecting payers, providers, and patients through our intuitive web-based platform, enabling unparalleled communication, transparency, and visibility.

EVV and Claims Billing for Florida’s State Medicaid Managed Care Program

Starting on December 1, 2018, Humana, Staywell, and Sunshine Health (the “MCOs”) will require providers to use HHAeXchange to submit confirmed visits and bill directly to each MCO through the free HHAeXchange Portal. 

The first step in effectively working with the MCOs is to fill out the following questionnaire for your organization. The answers from your questionnaire will allow HHAeXchange to configure your agency’s portal. Please note that you only need to fill out the questionnaire once, regardless of how many MCOs you are contracted with:

 

What are the key benefits of the HHAeXchange Portal to homecare agencies?

  • FREE Electronic Visit Verification (EVV) tools
  • Open Model EDI Integration with 3rd Party EVV Vendors
  • Real-time, two-way messaging with each MCO
  • Receive recipient demographics, authorizations, and plan of care electronically
  • Pre-bill scrubbing to ensure clean claims and accelerate revenue cycle

 

Your Agency’s Billing Options

Option 1, Free HHAeXchange EVV: Our agency wants to use HHAeXchange’s free EVV system, provided by the MCOs. Great! If you’ve indicated that you’d like to use HHAeXchange’s free EVV system, the contact person listed on your questionnaire will receive more information in the coming weeks on how to set up your agency’s 800 numbers, upload caregivers into the HHAeXchange Portal, and begin processing EVV and claims.

Option 2, Use my Current EVV System: Our agency has an existing EVV system that we’d like to keep. It’s simple to connect your existing EVV system to the MCOs through the HHAeXchange Portal. Ensure that you’ve completed the questionnaire, and the HHAeXchange Integrations Team – FLintegration@hhaexchange.com – will coordinate with you to create an interface to process your existing EVV visits and claims.

Option 3, Manual Visit Entry: Our Agency isn’t ready for EVV just yet. No problem, we have a solution for you, too. If you choose this option, you’ll manually enter your visit data into the HHAeXchange Portal. Remember that the 21st Century CURES Act mandates that all homecare agencies use EVV by January 1, 2020, so this is a temporary option to process your claims.

 

What Services are a part of the Program?

  • Attendant Care
  • Companion Care
  • Homemaker
  • PDN – LPN
  • PDN – RN
  • Personal Care
  • Respite (Home)

Info Session 

Upon completion of the Florida SMMC Visit Entry Options and MCO Billing Questionnaire, please refer to the links below to access videos and presentations from the Provider Info Sessions, held in Florida in October 2018.

These sessions provided a high-level introduction to the HHAeXchange System (including system demos), as well as MCO-program specific information.

Provider Information Sessions (English)

HHAeXchange Provider Information Session (60 min) VIDEO | SLIDES

MCO Provider Information Presentations:
– Humana Presentation (11 min)  VIDEO | SLIDES
– Staywell Presentation (12 min)  VIDEO | SLIDES
– Sunshine Presentation (13 min)  VIDEO | SLIDES

Provider Information Sessions (Spanish)

HHAeXchange Provider Information Session (45 min) VIDEO | SLIDES

MCO Provider Information Presentations:
– Humana Presentation (10 min)  VIDEO | SLIDES
– Staywell Presentation (12 min)  VIDEO | SLIDES
– Sunshine Presentation (13 min)  VIDEO | SLIDES

UPCOMING USER SYSTEM TRAININGS: 
*Please note the webinars below are exactly the same and will feature the same content. Choose one that best fits your schedule.

Tuesday, Nov 20: User System Training Webinar 9:00am – 11:30am
Register Here

Thursday, Nov 29: User System Training Webinar 9:00am – 11:30am
Register Here

 

Forms Coming Soon!

Thank you for your participation in working with HHAeXchange on the Electronic Data Interchange (EDI) project for your agency. Below you will find information about the general requirements and steps to take to successfully integrate your Agency Management System with HHAeXchange.

HHAeXchange coordinates directly with the Managed Care Organizations (MCOs) to ensure members and, if desired, authorizations are passed directly into the HHAeXchange system. Once this data is in the HHAeXchange system, a unique member key is created which HHAeXchange will pass to your Agency Management System to ensure seamless processing of member information between the systems. HHAeXchange will also give you a unique Provider Agency ID to include in all files used in the EDI processes.

In order to integrate between your Agency Management System and the HHAeXchange, you will need to create the EDI files corresponding to the HHAeXchange specifications found in the following documentation (links below):

CLICK HERE to access the HHAeXchange Provider System FAQ Document (check back often for updates to this document).

HHAeXchange is the premiere homecare management software solution for the Medicaid LTSS population. We act as the single source of truth in connecting payers, providers, and patients through our intuitive web-based platform, enabling unparalleled communication, transparency, and visibility.

  • FREE Electronic Visit Verification (EVV) tools
  • Open Model EDI Integration with 3rd Party EVV Vendors
  • Real-time, two-way messaging with each MCO
  • Intelligent case broadcasting for new referrals / cases
  • Receive recipient demographics, authorizations, and plan of care electronically in real-time
  • Pre-bill scrubbing to ensure clean claims and accelerate revenue cycle

Great! If you’d like to use HHAeXchange’s Free EVV system ensure that you’ve completed the HHAeXchange Portal Configuration Questionnaire. The contact person listed in your response will be contacted by HHAeXchange to set up your agency for EVV.

It’s simple to connect your existing EVV system to the MCOs through the HHAeXchange Portal. Ensure that you’ve completed the HHAeXchange Portal Configuration Questionnaire, and the HHAeXchange Integrations Team will coordinate with you to create an interface to process your existing EVV visits and claims. EDI Process Guides can be found in the EDI Process tab, above.

The MCOs will send placements, authorizations, plan of care, and all communication through the HHAeXchange Portal. MCOs may send additional information as they deem necessary.

All claims will be created through the HHAeXchange Portal and sent electronically via an 837 eBilling file. Agencies will then receive an 835 eRemittance file back into the HHAeXchange Portal.

Yes. The HHAeXchange Portal provides a Pre-billing Claims Scrubbing module designed to ensure that your claims are compliant with the authorization and MCO contract.

No. You’ll only need one Portal to connect to Humana, Staywell, and Sunshine Health for placements, authorizations, communication, and billing.

Yes. You’ll be able to schedule your caregivers through the HHAeXchange Portal either by creating schedules based on the authorization provided by the MCO, or through automatic creation of schedules based on EVV data imported into the HHAeXchange Portal from your 3rd party EVV system.

Please see the User Training tab, above. 
 

Please see the EDI Process tab, above.