New Jersey CSOC Information Center

HHAeXchange is the premiere Homecare Management Software company for the Medicaid LTSS population. We are the leaders in connecting payers and homecare agency providers to enable more collaboration, communication, and workflow efficiencies. Through the use of the HHAeXchange Portal, our goal is to make working with New Jersey CSOC easy and efficient.

Bringing the 21st Century Cures Act across New Jersey

To ensure that the Provider community complies with the Cures Act Mandate, New Jersey Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS) is requiring that all Providers, including New Jersey Children’s System of Care (CSOC) to be fully integrated by October 1, 2021.

The HHAeXchange solution will focus on collecting and reporting EVV compliant data for all personal care services (PCS) for the New Jersey Children’s System of Care (CSOC). As part of the New Jersey Family Care EVV program initiative, we will need to gather more information from your provider agency.

The first step will be to fill out the Provider Enrollment Form listed below as you are identifying yourself as a CSOC provider: CSOC Provider Enrollment Form

Selecting an EVV solution that fits your provider agency

This questionnaire is designed to capture information about your provider agency necessary for New Jersey DCF along with HHAeXchange as part of the effort to implement methods of collecting and reporting EVV compliant data for all personal care services related to CSOC. Below you will find more information on each method of EVV data collection.

Your provider agency plays a vital role in the success of our EVV program.  As part of your participation with New Jersey Department of Children and Families (DCF), you have multiple options provided to you to ensure EVV compliance:

  • Option 1 – Agencies currently without an EVV Solution: You can be set up to use Free EVV tools from HHAeXchange for Homecare services.
  • Option 2 – Agencies currently using another 3rd Party EVV Solution: You can use your existing EVV system and import visit data into HHAeXchange using Electronic Data Interchange (EDI). Please contact EDISupport@hhaexchange.com to begin your integration.

Important dates

  • Go-Live date for all Providers: October 1st, 2021

 

HHAeXchange is offered at no cost to the providers. Here is a look at some of the benefits you will get if you choose the HHAeXchange Portal as your EVV solution.

EVV

  • Member Management for the DCF CSOC Program
  • Clock-In / Clock-Out Exception Dashboard
  • Submission / Aggregation of EVV Data to DCF CSOC
  • Mobile Application in Multiple Languages
  • Telephony Lines in English and Spanish

Scheduling

  • Master Week Scheduling
  • Case & Scheduling Coordination
  • Plan of Care Management for

Billing

  • Prebilling Claims Scrubbing
  • eBilling (837) / eRemittance (835) for DCF CSOC team

Compliance

  • Automatic Authorization Receipt from DCF CSOC team
  • Plan of Care Adherence
  • Visit Confirmation Compliance
  • Visit reporting
PROVIDER SYSTEM USER TRAINING
  • 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 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 NJSupport@hhaexchange.com

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. Note, this process applies specifically for providers that chose option 1, found on the “Overview” tab above. Below you will find information about the general requirements and steps to take to successfully integrate your 3rd Agency Management System with HHAeXchange. To integrate between your 3rd Party Agency Management System and HHAX, providers will be required to comply with both the business requirements and technical specifications listed below. Upon review of the documents below, please initiate contact with HHAX to begin the integration process Initial steps EDI providers should follow:

*DISCLAIMER– For CSOC providers, please note that you will use the same integration API/BRD form that has been used for the previous New Jersey DMAHS implementation. Please disregard mention of DMAHS or MCOs. 

HHAeXchange Overview (applicable to ALL providers):

Information Sessions are being held for all providers to provide them with key dates and details about the implementation, including key workflow changes, system benefits, and next steps. Please refer to the links below to access videos and presentations from the Provider Info Sessions, held via webinar in August-September 2020.

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.

Ease of billing

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

Efficient communication

  • Reduce payer communication time with real-time, 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

Through the HHAeXchange Portal, New Jersey CSOC 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. A caregiver will also be given the option to download the free HHAeXchange Mobile App available for both iPhone and Android users that can be used to clock-in and clock-out, review patient information and visit information.

Through the HHAeXchange Portal, New Jersey CSOC 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. A caregiver will also be given the option to download the free HHAeXchange Mobile App available for both iPhone and Android users that can be used to clock-in and clock-out, review patient information and visit information.

It is simple to connect your existing EVV system with your payer(s), through the HHAeXchange Portal. Ensure that you’ve completed the survey, and review the EDI welcome packet. Upon reviewing the welcome packet, please submit a ticket to the HHAX EDI support email at: EDIsupport@hhaexchange.com with the subject ‘NJ EVV’. The HHAeXchange Integrations Team will coordinate with you to create an interface to process for your existing EVV visits. If my payer(s) plans to utilize or is currently utilizing the HHAeXchange portal, what information will my payer(s) send to my agency through the HHAeXchange Portal? Your payer(s) will be sending new placements, authorizations, and all communications through the HHAeXchange Portal. Additional information may be sent as deemed necessary by the payer.

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 Prebilling Claims Scrubbing module designed to ensure that your claims are compliant with the authorization and the payer contract.

Yes. You’ll be able to schedule your caregivers through the HHAeXchange Portal either by creating schedules based on the authorization provided by the payer, or through automatic creation of schedules based on EVV data imported into the HHAeXchange Portal from your 3rd party EVV system.

The person within your organization that filled out the survey will receive more information to identify super users and for training planning.

Processes for importing and exporting data from the HHAeXchange Portal can be found on this page under the “EDI PROCESS” tab.

Provider Services in Scope: Please see below all the provider services in scope for this implementation.

Service Code Service Description
H2015:HM Individual Supports – Individual Support Technician 1 BA/BS with 1 year relevant experience
H2015:HA:HO Individual Supports-Behavioral Technician, HS Diploma/GED with 3 yrs of relevant experience (Habilitative-In Home)
H2016:HA:HO Individual Supports-Behavioral Technician: Behavioral, BA/BS with 1 year relevant experience)-(Habilitative-In Home)
H2015:HA:HN Behavioral Technician, HS Diploma/GED with 3 yrs of relevant experience
H2016:HA:HN Behavioral Technician: Behavioral, BA/BS with 1 year relevant experience)
T2021:HA:HN II-Habilitation Bachelors Level/Master’s Level-BCaBA
T2021:HA:HO II-Habilitation Masters Level BCBA 
S9125:HA:52 Agency Hired Respite: Hourly
H0031:HA Functional Behavior Assessment (BCaBA)
H0031:HA:22 Functional Behavior Assessment (BCBA) 
H0031:HA:HP Functional behavioral Assessment (BCBA-D) 
96158:HA Functional behavioral Assessment (BCBA-D) 
96159:HA Behavior Consultative Supports ( BCS)- Doctor Level IIH habilitation  (BCBA -D )

NJ MLTSS – JMR 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. CODE PR209 PLEASE READ: If code appears on this statement, this DSNP member is cost share protected per federal and state guidelines and via your provider contract with WellCare. If an amount is listed in the Total PR section along with code PR209 you cannot bill member for this cost share. You will automatically receive another EOP for what will be paid by Medicaid from WellCare. If your provider agreement includes a capitated payment for any services associated with this code you will receive no additional payment to cover the PR amount. 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. 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. http://www.cms.gov/Medicare/Appeals-and-Grievances/MMCAG/Downloads/Appendix-7-Waiver-of-Liability-Notice.pdf.   NJ MLTSS – JMD 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

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

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