WellCare Hawaii has selected HHAeXchange, a web-based software solution, to collect confirmed homecare visits, create claims and provide workflow efficiency tools.
The first step in preparing for WellCare Hawaii is to fill out the WellCare Provider Survey by June 4, 2018. The answers to your survey will allow us to set your agency up for success when it comes to processing your confirmed home care visits and preparing your claims.
The HHAeXchange Portal provides a direct connection from the agency to WellCare for:
Option 1: Our agency wants to use HHAeXchange’s EVV partner system, CellTrak EVV, provided by WellCare at no cost. Great! If you’ve indicated that you’d like to use HHAeXchange’s EVV partner, CellTrak EVV, the contact person listed on your survey will receive more information in the coming weeks, upload caregivers into the HHAeXchange Portal and begin processing EVV and claims.
Option 2: Our agency has an existing EVV system that we’d like to keep. It’s simple to connect your existing EVV system to WellCare through the HHAeXchange Portal. Ensure that you’ve completed the survey, and the HHAeXchange Integrations Team will coordinate with you to create an interface to process your existing EVV visits and claims.
More information to come soon.
Your Agency’s Billing Options
Option 1: Our agency wants to use HHAeXchange’s free EVV system, provided by WellCare. Great! If you’ve indicated that you’d like to use HHAeXchange’s free EVV system, the contact person listed on your survey 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: 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 survey, and the HHAeXchange Integrations Team –[email protected] – will coordinate with you to create an interface to process your existing EVV visits and claims.
Option 3: 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, 2019, so this is will only be a temporary option to process your claims.
HI MLTSS – ZAB
In compliance with 42 CFR 455.18 and 455.19, I understand that payment and satisfaction of this claim will be from Federal and State funds, and that any false claims, statements, documents, or concealment of material fact, may be prosecuted under applicable Federal and/or State laws. Contracted providers participating in provider network(s) for Medicare Advantage plans may request an appeal of a denial determination. Appeals must be submitted within 90 days of the date on this remittance advice. Pursuant to federal regulations governing the Medicare Advantage program, non-contracted providers may request reconsideration of a Medicare Advantage plan denial determination. Requests for reconsideration must be submitted within 60 days of the date on this remittance advice and a signed waiver of liability (WOL) statement will be required. Medicaid providers must submit requests for appeal within 90 days of the date of this notice. Appeals and requests for reconsideration of a denial determination must be submitted in writing to the address identified below and include at a minimum: a summary of the appeal or reconsideration request, the member’s name, member’s identification number, date of service(s), reason(s) why the denial should be reversed and copies of related documentation and/or applicable medical records to support appropriateness of the services rendered.
Appeals and requests for reconsideration for medical necessity or authorization related issues should be sent to: Appeals Department, PO Box 31368, Tampa, FL33631-3368. Providers may submit these requests using the Provider Administrative Request Form which can be accessed on our website at www.ohanahealthplan.com. Contracted/participating providers must submit inquiries or disputes within 120 days (or as stated in your Provider Contract) and all other providers must submit within 365 days. All disputes between the health plan and in-network and out-of-network providers shall be solely between such providers and the health plan. The member shall not be charged for any of the disputed costs.
HI MLTSS – ZMD
In compliance with 42 CFR 455.18 and 455.19, I understand that payment and satisfaction of this claim will be from Federal and State funds, and that any false claims, statements, documents, or concealment of material fact, may be prosecuted under applicable Federal and/or State laws. Contracted providers participating in provider network(s) for Medicare Advantage plans may request an appeal of a denial determination. Appeals must be submitted within 90 days of the date on this remittance advice. Pursuant to federal regulations governing the Medicare Advantage program, non-contracted providers may request reconsideration of a Medicare Advantage plan denial determination. Requests for reconsideration must be submitted within 60 days of the date on this remittance advice and a signed waiver of liability (WOL) statement will be required. Medicaid providers must submit requests for appeal within 90 days of the date of this notice.
Appeals and requests for reconsideration of a denial determination must be submitted in writing to the address identified below and include at a minimum: a summary of the appeal or reconsideration request, the member’s name, member’s identification number, date of service(s), reason(s) why the denial should be reversed and copies of related documentation and/or applicable medical records to support appropriateness of the services rendered. Appeals and requests for reconsideration for medical necessity or authorization related issues should be sent to: Appeals Department, PO Box 31368, Tampa, FL 33631-3368. In accordance with 42 C.F.R. §422.214, non-contracted providers are prohibited from balance billing members for covered Medicare services and must accept as payment in full from a Medicare Advantage health plan the amounts that they could collect if the beneficiary were enrolled in original Medicare.
Codes Address CEXXX, IHXXX, MKXXX, or PDXXX Payment Policy Disputes Department PO BOX 31426 Tampa, FL 33631-3426
RVXX (Except RV059) Recovery PO BOX 31658 Tampa, FL 33631-3658 DN227, DN228, or RV213 Cotiviti Healthcare Attn: WellCare Clinical Chart Validation 555 East North Lane, Suite 6120 Conshohocken, PA 19428 Phone: 1-203-202-6107 Fax: 1-203-202-6607
Appeals and requests for reconsideration related to Explanation of Payment Codes and Comments beginning with DN227, DN228 or RV213 must be submitted in writing to the appropriate address/fax identified above and include a minimum: a summary of the appeal or reconsideration request, the member’s name, member’s identification number, date of service(s), reason(s) why the denial should be reversed and copies of related documentation and all applicable medical records related to both stays to support appropriateness of the services rendered.
DN001, DN004, DN038, DN039, VSTEX, DMNNE, HRM16, KYREC Appeals PO Box 31368 Tampa, FL 33631 This is not an all-encompassing list of Appeals codes. Anything else related to authorization, or medical necessity that is in question should be sent to the Appeals PO Box with all substantiating information like a summary of the appeal, relevant medical records and member specific information. If the provider is non-contracted a waiver of liability must also be executed prior to an appeal review.
SYSTRIGE Retrospective Review PO Box 31406 Tampa, FL 33631 All other claim inquiries or disputes should be sent to (including RV059) Claims Department PO Box 31370 Tampa, FL 33631-3370
What is HHAeXchange?
HHAeXchange is the premiere Homecare Management Software company for the Medicaid non-skilled LTSS population. We are the leaders in connecting payers and homecare agency providers to enable more collaboration, communication, and workflow efficiencies.
What are the benefits of the HHAeXchange Portal?
Ease of billing
Efficient communication
Free tools
How will the free HHAeXchange EVV System work?
Through the HHAeXchange Portal, WellCare Ohana is offering free telephony for clock-in and clock-out functionality, including capturing completed plan of care duties. Each agency who has indicated they’d like to use HHAeXchange’s free EVV system will be set up with a toll-free 800 number to provide to their caregivers.
What if we’d like to use our CellTrak EVV partner or HHAeXchange’s free EVV System?
Great! If you’ve indicated that you’d like to use HHAeXchange’s free EVV system, the contact person listed on your survey 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.
What if we have an EVV System that we’d like to keep?
It’s simple to connect your existing EVV system to the OHANA through the HHAeXchange Portal. Ensure that you’ve completed the survey, and the HHAeXchange Integrations Team – [email protected] – will coordinate with you to create an interface to process your existing EVV visits and claims. If you’re not ready to integrate your existing EVV system prior to January 1, 2018, you can temporarily manually enter your visit date into the HHAeXchange Portal.
What information will the OHANA send to my agency through the HHAeXchange Portal?
The OHANA will be sending new placements, authorizations and all communication through the HHAeXchange Portal. OHANA may send additional information as they deem necessary.
How will the HHAeXchange Portal bill to the OHANA?
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.
Can I check my claims before submitting them to each OHANA?
Yes. The HHAeXchange Portal provides a Prebilling Claims Scrubbing module designed to ensure that your claims are compliant with the authorization and OHANA contract.
Can I schedule my caregivers through the HHAeXchange Portal?
Yes. You’ll be able to schedule your caregivers through the HHAeXchange Portal either by creating schedules based on the authorization provided by the OHANA, or through automatic creation of schedules based on EVV data imported into the HHAeXchange Portal from your 3rd party EVV system.
How will I be trained on the HHAeXchange Portal?
The person within your organization that filled out the survey will receive more information to identify super users and for training planning.
For questions and issues please contact us by submitting a ticket via the Client Support Portal: https://www.hhaexchange.com/supportrequest
Providers with an existing HHAeXchange portal please use the HHAeXchange Live Chat within your Support Center to receive assistance from a Live Agent. The live chat option is recommended for quicker response times.