New Jersey DMAHS 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 DMAHS easy and efficient.

Bringing the 21st Century Cures Act across New Jersey

New Jersey DMAHS has partnered with HHAeXchange as their EVV Aggregation solution to help ensure the provider community complies with the Cures Act Mandate requirements. The HHAeXchange solution will focus on collecting and reporting EVV compliant data for all personal care services for New Jersey Family Care program. 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 New Jersey Family Care program Provider Portal Survey found below.

Provider Portal Questionnaire

Selecting an EVV solution that fits your provider agency

This questionnaire is designed to capture information about your provider agency necessary for New Jersey DMAHS and other New Jersey MCOs, as part of the effort to implement methods of collecting and reporting EVV compliant data for all personal homecare services.

We understand that each MCOs has offered their own solution to participating providers and you may already have an enterprise EVV solution in place already to help you be compliant. In connection with all New Jersey MCOs and the New Jersey Family Care program, this survey will allow us to understand your choice for EVV data collection and provide the best viable option for your agency. 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 Family Care, you have multiple options provided to you to ensure EVV compliance:

  • Option 1 – Use your existing EVV system or a system you intend to implement by January 1 to collect and report to each plan and/or to DMAHS
  • Option 2 – Use Free EVV tools provided by each Health Plan (HHAeXchange for WellCare, Aetna, UHC* and Fee-for-Service members; CareBridge for Horizon and Amerigroup members)
    *pending finalization of SOW and risk assessment
  • Option 3 – Use the Free EVV tools provided by DMAHS (HHAeXchange) to collect and report visit data for all members regardless of Health Plan or Fee-for-Service.

Important dates

Please check back for exact dates.

  • New Jersey EVV Stakeholder Information Session: TBD
  • System User Training: November through December 2020
  • EVV Mandate for Personal Care Services: January 1, 2021

If you chose Option 3 on the survey – (I want to use the free HHAeXchange EVV solution for all New Jersey Payers), below are some of the benefits you will see by utilizing our solution:

EVV

  • Member Managament for NJ FFS & 5 MCOs
  • Clock-In / Clock-Out Exception Dashboard
  • Submission / Aggregation of EVV Data to NJ FFS & 5 MCOs
  • Mobile Application in Multiple Languages
  • Telephony Lines in English and Spanish

Scheduling

  • Master Week Scheduling
  • Case & Scheduling Coordination
  • Plan of Care Management for NJ FFS, Aetna, United, and Wellcare

Communication

  • Real-Time Two-Way Messaging with NJ FFS, Aetna, United, and Wellcare

Billing

  • Prebilling Claims Scrubbing
  • eBilling (837) / eRemittance (835) for NJ FFS, Aetna, United, and Wellcare

Compliance

  • Automatic Authorization Receipt from NJ FFS, Aetna, United, and Wellcare
  • Manual Authorization Input for Amerigroup and Horizon
  • Plan of Care Adherence
  • Visit Confirmation Compliance
  • Visit reporting to Horizon and Amerigroup

Training is scheduled for [November and December 2020]. To find our more information, please complete the Provider Portal Questionnaire if you have not already done so.

If you have already completed the survey, you will receive a notification from HHAeXchange and or each MCO that you are contracted with.

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 payer(s) 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.

Note: Detailed specifications will be posted at a future date

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 DMAHS 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 DMAHS 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’s simple to connect your existing EVV system with your payer(s), through the HHAeXchange Portal. Ensure that you’ve completed the survey, and the HHAeXchange Integrations Team – EDISupport@HHAeXchange.com – will coordinate with you to create an interface to process your existing EVV visits and claims. If you are not ready to integrate your existing EVV system, you can temporarily manually enter your visit date into the HHAeXchange Portal.

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.

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

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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