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 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 the 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 New Jersey Managed Care Organizations (MCOs), as part of the effort to implement methods of collecting and reporting EVV compliant data for all personal care services.

We understand that each MCO has offered their own solution to participating providers and you may already have an enterprise EVV solution in place  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

Provider Information Sessions below: 

  • System User Training: November 12th, 2020 with webinars beginning November 30th, 2020 (please refer to the “Training” tab)
  • Go-Live date for all Providers: December 14th, 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

Provider System User Training will be provided via the HHAeXchange Learning Management System (LMS) along with webinars. Providers will have the options listed below to complete their training to understand the use of the HHAeXchange Provider Portal along with its functionalities. Please keep in mind both options are available to the provider for training and can be leveraged to complete the training.

Options for System User Training (providers can utilize one or both training options listed below):

Option 1: Use the Learning Management System (LMS):

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

    • An email will be sent to the contact that completed the Cognito Survey
    • One Username will be sent for your Agency to use

Option 2: Attend a daily webinar for one week to be trained (11/30 – 12/4):

Register for User Training Webinars: Complete system user training by attending a series of webinars. The Webinars will provide the opportunity to view the same materials as the LMS courses. In addition, HHAeXchange staff will be available during the webinars to answer your questions live via an interactive Q/A chat feature. Training is scheduled for November 30th through December 4th, 2020. The training schedule plan is outlined below:

  • Training Day 1: Monday 11/30/2020
    • Video: HHAeXchange: Project Introduction
    • Provider Type: HHAX Free EVV and Third-Party EDI providers
    • Attendees: Admin + Biller + Coordinator
    • Functionalities Discussed: Project Overview, System Access, Support Resource, Workflows
  • Training Day 2: Tuesday 12/1/2020
    • Video: HHAeXchange Management
    • Provider Type: HHAX Free EVV and Third-Party EDI providers
    • Attendees: Admin + Biller + Coordinator
    • Functionalities Discussed: Patient Placement, Communication, Caregiver Management & Reporting
  • Training Day 3: Wednesday 12/2/2020 *Earlier Session
    • Video: HHAeXchange Scheduling and Visit Management
    • Provider Type: HHAX Free EVV
    • Attendees: Admin + Coordinator
    • Functionalities Discussed: Scheduling, Visit Management, EVV, Call Dashboard
  • Training Day 3: Wednesday 12/2/2020 *Later Session
    • Video: HHAeXchange Introduction to EDI Integration
    • Provider Type: Third-Party EDI providers
    • Attendees: Admin + Coordinator
    • Functionalities Discussed: EVV management for Integration
  • Training Day 4: Thursday 12/3/2020
    • Video: HHAeXchange: Billing
    • Provider Type: HHAX Free EVV and Third-Party EDI providers
    • Attendees: Attendees: Admin + Biller
    • Functionalities Discussed: Pre-billing, Billing, Billing Review, Re-billing
  • Training Day 5: Friday 12/4/2020
    • Video: HHAeXchange: Administration
    • Provider Type: HHAX Free EVV and Third-Party EDI providers
    • Attendees: Attendees: Admin
    • Functionalities Discussed: User Management, Provider Profile, Coordinator Setup, Rate Management

EDI INFO SESSIONS

For providers using 3rd party EVV system outside HHAX, please register for the NJ-DMAHS EDI Session that will be held on the given dates:

      • November 13th, 2020 at 12:00 PM
      • November 20th, 2020 at 10:00 AM
      • December 2nd, 2020 at 3:00PM – this is part of the afternoon session in the weekly webinar listed above

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:

HHAeXchange Overview (applicable to ALL providers):

An Information Session was 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 October 2020.

Please Note: The provider go-live has been extended to December 14th, 2020 for all providers. Please disregard the old dates mentioned in the pre-recorded webinar and review the updated dates in the Welcome Packets on the “Overview” page. 


HHAeXchange EDI Session (applicable only to EDI providers with their own third party EVV system)

For Providers that want to integrate with HHeXchange, an EDI Information Session was held to provide more information about key next steps in regards to your EDI Integration.  Please refer to the links below to access videos and presentations from the EDI Info Sessions, held via webinar in October 2020.

Please Note: The provider go-live has been extended to December 14th, 2020 for all providers. Please disregard the old dates mentioned in the pre-recorded webinar and review the updated dates in the Welcome Packets on the “Overview” page. 

 

Click here to review the detailed FAQ document in regard to the NJ DMAHS Implementation which will provide you with more insight on the program, patient placement, billing, EVV, Communications, as well as EDI and other functionalities.

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 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.

  • Personal Care Assistance_15M (T1019)
  • Personal Care Assistance Group (T1019_HQ)
  • Personal Care Assistance_PD (T1020)
  • Personal Care Assistance (Self Directed) Individual (T1019_SE)
  • Personal Care Assistance (Self Directed) Individual – Agency (T1019_SE_UI)
  • Personal Care Assistance Group (Self Directed) Group (S5125_SE_HQ)
  • Personal Care Assistance (Self Directed) Group – Agency (S5125_SE_U3)
  • DDD Individual Supports (H2016HI)
  • DDD Individual Supports (H2016HI22)
  • DDD Individual Supports (H2016HIU8)
  • DDD In Home Respite (T1005HI)
  • DDD In Home Respite (T1005HIU8)
  • DDD Community Based Supports (H2021HI)
  • DDD Community Based Supports (H2021HI22)
  • DDD Community Based Supports (H2021HI52)
  • MLTSS Home Based Supportive Care (S5130)
  • MLTSS Home Based Supportive Care – Self Directed (S5130_HQ)
  • MLTSS In Home Respite (T1005)

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

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

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

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