MCOs and state organizations must work hand-in-hand with providers to ensure proper billing is performed for their members. However, with the sheer number of paper claims, billings received with wrong member IDs or billing codes, and denial processing, homecare billing management is not easy for payers. Billing in a timely manner and managing cashflow to providers and members is an ongoing struggle.
HHAeXchange streamlines the entire homecare billing process from start to finish, allowing you to increase efficiencies and minimize disruptions and risk. Payers and providers are directly connected to each other in real-time on our platform, providing one single source of truth. Using our homecare billing management platform, payers can securely and electronically send participating information like authorization and plan of care directly to the chosen provider, who in turn can schedule the right caregiver for the participant.
Once a visit is performed and logged, the provider sends the claim through a pre-bill scrubbing process to ensure compliant claims. Those claims are sent directly to the payer via the submission of an electronic 837 file, with the provider receiving an electronic 835 file in return.
As a result, claims cannot pass beyond HHAeXchange unless the service rendered reconciles with both the authorization and the electronic verification of the visit. This reduces claims efforts for both the payer and provider. Additionally, by eliminating denials, payers can reallocate their resources to other areas of their business.