New Jersey Home Health 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 Home Health easy and efficient.

Bringing the 21st Century Cures Act across New Jersey

New Jersey DMAHS is continuing its partnership 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 Home and Community based services for the New Jersey FamilyCare program. As part of the New Jersey FamilyCare 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 Home Health Provider Portal Survey found below.

NJ Home Health 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 Home Health, 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 FamilyCare 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 FamilyCare, you have multiple options provided to you to ensure EVV compliance:

  • Option 1 – Agencies currently without an EVV Solution: use the free EVV tools provided by HHAeXchange & New Jersey
  • Option 2 – Agencies currently using another 3rd Party EVV Solution: use your existing EVV system and import visit data into HHAeXchange – HHA will route visit data to New Jersey
  • Option 3 – Existing providers that currently utilize the HHAeXchange provider platform will be linked with the new service codes in scope

Important Updates

  • Go-Live date for Cohort 1 & 2 Providers: July 1, 2022
    • Providers are expected to have completed integration and required training and are expected to begin submitting EVV data to the individual payers.
  • Go-Live date for Cohort 3 Providers: August 19, 2022
    • Providers are expected to have completed integration and required training and are expected to begin submitting EVV data to the individual payers.
  • EVV Mandate for verification and billing for all Home and Community Based Services: January 1, 2023

If you chose Option 2 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

More Information will be

 

EDI Provider Resources

EDI Provider Rebilling Job Aid: This job aid provides guidance to the various rebilling scenarios for EDI Providers. This aid can also be found in the provider portal resources page in the HHAeXchange support center.

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 will be held for all providers to provide them with key dates and details about the implementation, including key workflow changes, system benefits, and next steps. More Information regarding the information session will be made available in the coming days.

  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. Service codes are broken out into three cohorts, with Cohorts 1 and 2 going live on July 1, 2022 and Cohort 3 going live August 19, 2022.

Please note, phase 2 service codes can be found at the bottom of the page

Phase 1 Service Codes- Cohort 1(Skilled Nursing Services) and Cohort 2 (Therapies)

Service Code Procedure Name
97597

Debridement , open wound, wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, total wound(s) surface area; first 20 sq cm or less

99601

Infusion- Skilled nursing

99602

Infusion- Skilled nursing-additional hour(s)

G0299

Direct skilled nursing services of a registered nurse (run) in the home health or hospice setting

S9122

Home Health Aide/Certified Nurse Assistant

S9123

Nursing care, in the home; by registered nurse, 

S9124

Nursing care, in the home; by licensed practical nurse

S9127

Social work visit, in the home

T1000

Private duty / independent nursing service(s) 

T1002

Private duty / independent nursing service(s) / RN

T1003

LPN/LVN SERVICES

T1030

Nursing care, in the home, by registered nurse

T1031

Nursing care, in the home, by licensed practical nurse

92507

Speech, Language and Hearing Therapy Individual

97110

Physical Therapy, Therapeutic procedure, 1 or more areas; therapeutic exercises to develop strength and endurance, range of motion and flexibility

97129

Cognitive Therapy, Individual 

97130

Therapeutic interventions that focus on cognitive function and compensatory strategies to manage the performance of an activity, direct (one-on-one) patient contact (List separately in addition to code for primary procedure)

97535

Occupational Therapy, Individual –  Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact

G0151

Services performed by a qualified physical therapist in the home health or hospice setting

G0152

Services performed by a qualified physical therapist in the home health or hospice setting

S9128

Speech therapy, in the home

S9129

Occupational therapy, in the home

S9131

Physical therapy; in the home

 

Phase 2-  Cohort 3 (Applied Behavioral Analysis (ABA) Services)

Service Code Procedure Name
97151

Behavior assessment by physician, QHP

97152

Supporting assessment by Tech

97153

Adaptive treatment by tech

97154

Group adaptive treatment by tech

97155

Adaptive treatment with modification by QHP

97156

Family adaptive treatment by QHP with or without patient present

97157

Multiple family group adaptive guidance by QHP

97158

Group adaptive treatment by QHP

0362T

Behavior identification assessment requiring administration by QHP, assistance of two or more techs, to address destructive behavior, in a customized environment

0373T

Adaptive treatment with modifications by QHP, assistance of two or more techs, to address destructive behavior, in a customized environment to address behavior

96156_EP

DIR Health behavior assessment or re-assessment

96158_EP

DIR Health behavior intervention

96159_EP

DIR Health behavior intervention

96164_EP

DIR Health behavior intervention

96165_EP

DIR Health behavior intervention

96167_EP

DIR Health behavior intervention, family

96168_EP

DIR Health behavior intervention, family

96170_EP

DIR Health behavior intervention

96171_EP

DIR Health behavior intervention

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, please contact us at:

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.

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

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