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
- PDN – LPN
- PDN – RN
- Personal Care
- Respite (Home)