North Carolina PHP 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 North Carolina’s State Medicaid Prepaid Health Plan (PHP)

Carolina Complete Health, AmeriHealth Caritas of North Carolina, UnitedHealthcare Community Plan of North Carolina, and WellCare of North Carolina (the PHPs) have partnered with HHAeXchange to provide software that allows providers to have a single login for all PHPs to access authorizations, communicate, and meet Electronic Visit and Verification (EVV) requirements of the 21st Century Cures Act. 

As a result, all the PHPs have partnered with HHAeXchange to provide you with a free EVV system and billing tool for member placement, scheduling, authorization management, communication, and EVV compliance. 

To get started, the first step will be to complete the HHAeXchange Provider Enrollment Form listed below, which will provide you access to your HHA Provider Portal.

Click here to complete the HHAeXchange Provider Enrollment Form

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

The HHAeXchange Portal provides a direct connection from the agency to the PHP for:

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

Your Agency’s EVV Options

Agencies utilizing Free HHAX tools HHAeXchange (New Providers  HHAX): Your agency wants to use HHAeXchange’s free EVV tools along with the portal, provided by the PHPs. Great! If you’ve indicated that you’d like to use HHAeXchange’s free EVV tools! You will receive an HHAeXchange Portal in order to receive authorizations and submit claims/invoice data. Please complete the Provider Portal Questionnaire Survey to ensure our team can create your unique credentials for access. Providers will have the choice to either use the free HHAeXchange EVV tools or select to integrate with their own third party EVV system.

Agencies utilizing their own 3rd Party EVV Solution (Existing and New EDI Providers): Your agency has decided to continue the use of your existing EVV system along with the HHAeXchange portal. It’s simple to connect your existing EVV system to the PHPs through the HHAeXchange Portal. Authorization data will become available in the HHAeXchange Portal, rather than coming by fax. Schedule and visit data will be imported from your 3rd party system into HHAeXchange. Please work with your EVV Vendor to determine requirements to set up this interface and ensure that you’ve completed the questionnaire. Refer to the EDI Process tab for more details or reach out to the HHAeXchange EDI Integrations Team – edisupport@hhaexchange.com.

What Services are a part of the Program?

Personal Care

Important Dates

Go-Live Date: Providers to begin using the HHAX Enterprise platform for all home health aide services

    • The Soft Launch period has been extended through November 1st, 2021
      • Please refer to the bulletin presented by the State for more details

NORTH CAROLINA MEDICAID PREPAID HEALTH PLAN INFORMATION SESSIONS

An Information Session was held for all providers to provide them with the key dates and details about this implementation, including key workflow changes, system benefits, and next steps. Please refer to the links below to access videos and presentations from Provider Info Sessions, held via webinar in May 2021.

Pre-Go Live Webinars

This webinar provided answers to the top EVV questions, scenarios, and any unique process that are part of this implementation submitted by providers in a summarized format. Please refer to the links below to access videos and presentations from Pre-Go Live Webinar Sessions, held via webinar in June 2021.

UPCOMING WEBINARS

Please Click Here for Additional Training Webinars

 
recorded webinars

North Carolina PHP Pre-Go Live Refresher (58 min): VIDEO SLIDES

Please visit the Provider Portal Resource Page in the HHAeXchange System Support Center to view additional previously recorded webinars

 
Provider System User Training

Provider System User Training will be provided via the HHAeXchange Learning Management System (LMS). Providers will have to log on the Learning Management System to complete their training to understand the use of the HHAeXchange Provider Portal along with its functionalities. This training is required to ensure you have a clear understanding of the functionalities available to you in the HHAeXchange Provider Portal. The courses include a variety of videos, documents, and tests to help ensure you have a clear understanding of the different aspects of the Provider Portal to use for your EVV benefits.

Receive LMS Credentials from the HHAeXchange Onboarding Team and follow instructions to complete the courses and videos on a self-paced format to complete:

    • An email will be sent to the contact that completed the NC PHP Provider portal questionnaire
    • One Username will be sent for your Agency to use. Username can be distributed amongst all members of your agency to complete the assigned courses.
    • Login to the LMS website using the provided credentials in the email
    • Work on completing the courses by reviewing the information provided
    • Any updates made to the password should be distributed amongst all members who have access to the account
    • For any questions or concerns, please reach out to Support@hhaexchange.com

 

EDI Provider Onboarding Training Webinars

Attending this webinar session is the first step in ensuring a successful integration between HHAeXchange and your current third party Electronic Visit Verification (EVV) Vendor. In this session you will receive an overview on how to integrate your agencies EDI management software with HHAeXchange. In addition, you will learn how the North Carolina PHP utilizes HHAeXchange to ensure that members and authorizations are passed directly to your agency’s HHAeXchange portal. Please Click Here to register

 

 

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 your contracted MCO 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):

*Note: Please open each link and save each guide for your records along with sharing it to your third party EVV vendor.

 
 

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 PHP
  • 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 PHPs 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. EDI Process Guides can be found in the EDI Process tab, above.

The PHPs will send placements, authorizations, plan of care, and all communication through the HHAeXchange Portal. PHPs 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 PHP contract.

No. You’ll only need one Portal to connect to Wellcare, Carolina Complete, United Healthcare, and Amerihealth 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 PHP, 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.

Here’s a look at some of the benefits you’ll get from the HHAeXchange Portal:
 

Ease of billing

  • Quickly enter confirmed visits in a user-friendly interface.
  • Increase billing acceptance rates with realtime pre-claim edit checks.

Efficient communication

  • Reduce payer communication time with realtime, two-way messaging.
  • Increase census by accepting new cases via the broadcasting module.
  • Access real-time authorization and notification of changes to the care plan (increase or decrease of units, change of service code, etc…).

Free tools

  • Free scheduling module to manage schedules online in real-time.
  • Free EVV solution to electronically track time and attendance.
  • Free interface with your agency management system.
Provider Services in Scope: Please see below all the provider services in scope for this implementation.

Service Code Description
99509:HA Personal Care Services, Private Residences, Beneficiaries Under 21 Years
99509:HB Personal Care Services, Private Residences, Beneficiaries 21 Years and Older
 

For questions and issues, email HHAeXchange at NCSupport@hhaexchange.com.

For questions or issues over the phone, please call at: 866-242-2465.

Need Help? Contact Our Support Team