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 Florida SMMC Provider Portal Configuration Questionnaire 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.

EVV Mandate Updates

The Medicaid health plans have implemented the federal mandate that requires providers to verify the delivery of home health services (i.e., skilled nursing, personal care services, etc.) using electronic visit verification (EVV) technology. During this state of emergency, the Medicaid health plans will not require providers to submit claims through the EVV system. Providers can continue to submit claims through the EVV system if they wish, but are not required to do so. Providers must, however, continue to verify the delivery of services (checking in at the start of a visit and checking out at its conclusion) using EVV technology, to the fullest extent possible.

In accordance with the AHCA reporting requirement, please report any technical difficulties to HHAeXchange and our partner MCOs—Humana, Molina Healthcare, Staywell and Sunshine Health—by completing this form.

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.

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
– Molina Presentation (6 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
– Molina Presentation (6 min) VIDEO | SLIDES

 

UPCOMING WEBINARS
  • Wednesday, September 23 @ noon EST: EVV Call Dashboard – Fixing Exceptions
    • Audience: Homecare Provider Agencies using HHAeXchange EVV
    • Description: This webinar will help Provider Homecare Agencies who are using HHAeXchange EVV functionality to address exceptions appearing in the Call Dashboard. Specifically, this webinar will focus on how to identify the most frequent exceptions that appear on the EVV Call Dashboard, and the best practices for how to address each one in order to clear them from the Call Dashboard.

 

  • Thursday, September 24 @ noon EST: Rebilling in HHAeXchange
    • Audience: ALL Homecare Provider Agencies (EVV, Manual Entry, and EDI)
    • Description: This webinar will review the processes and workflows related to Rebilling in HHAeXchange, based on the most common situations which would result in the need to rebill a visit/claim, including the following:
      • Split Shifts: When one shift has already been billed, but another shift is entered for the same day, resulting in that shift being held in “Billing Review”
      • Voids: When an agency needs to negate an original claim entirely
      • Adjustments: When information on the original claim needs to be updated, such as modifying hours or units or rates)

 

LUNCH-AND-LEARN RECORDED WEBINARS (RECENT)
  • August 27: Preparing to Bill – Prebilling and Billing Review (23 min)  VIDEO | SLIDES
  • August 26: Communications and Notes (25 min)  VIDEO | SLIDES
  • August 20: Unbilling in HHAeXchange (20 min) VIDEO | SLIDES
  • August 19: EVV Call Dashboard – Fixing Exceptions (26 min) VIDEO | SLIDES
  • August 13: Billing Review – On Hold Reasons (23 min)  VIDEO | SLIDES
  • August 12: Automatic Email Notifications (11 min) VIDEO | SLIDES
  • July 30: Rebilling in HHAeXchange (20 min) VIDEO | SLIDES | JOBAID
  • July 23: Creating New Users, Assigning User Roles & Member Teams (26 min)  VIDEO | SLIDES
  • May 28: Capturing Missed Visits in HHAeXchange (incl COVID-19) (20 min) VIDEO | SLIDES
  • December 11: EDI Tool – Using the EDI Tool (13 min)  VIDEO | SLIDES | JOBAID
  • December 26: Go-Live Tips for Florida (15 min) VIDEO | SLIDES
  • December 20: Rate Management (16 min) VIDEO | SLIDES


Updating Member Alternate Address and GPS Coordinates Job Aid

Assigning Members to an Office by NPI for Billing Job Aid

 


FL PROVIDER HOMECARE USER SYSTEM TRAINING WEBINAR

Please click on this link to register and view a recording of the Florida Provider Homecare User System Training Webinar, originally delivered in November 2018.
Register Here
Download Presentation Only

 

USER SYSTEM TRAINING VIDEOS (November 2018)
Please click on the links below to view a video for specific segment of User Training for the HHAeXchange Portal.

To request new user access, users with the ADMIN role can add new users to the HHAeXchange system.  Please refer to the Creating New Users Job Aid.

 

To obtain 835 Remittances that correspond to claims generated out of HHAeXchange for our five linked Payers, please refer to the Obtaining 835 Remittance Job Aid.

Importing Caregivers into HHAeXchange

(Note: This is not required for agencies using an EDI Import file to integrate with their 3rd Party Agency Management System)

To assist organizations with a large census of Caregivers, HHAeXchange has created a Caregiver Bulk Import tool to expedite the entry process. 

Please CLICK HERE to access the Caregiver Bulk Import Process Guide, which provides instructions for how to:

  • Access and Save the Caregiver Import Template
  • Prepare the Caregiver import File for your Agency
  • Send the file to HHAeXchange (EDISupport@hhaexchange.com) for File Processing

EDI Overview (Integrating with a 3rd Party Agency Management System)

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.

In accordance with the AHCA reporting requirement, please report any technical difficulties to HHAeXchange and our partner MCOs—Humana, Molina Healthcare, Staywell and Sunshine Health—by completing this form.