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 Senior Whole Health easy and efficient.
Senior Whole Health has partnered with HHAeXchange to leverage our platform to implement Electronic Visit Verification (EVV) for Personal Care services. As part of the approach for the 21st Century Cures Act, Senior Whole Health has elected to have HHAeXchange transmit EVV data via a web interface to eMedNY on behalf of the network providers.
Through the HHAX platform we will be able to electronically send new home health aide cases to you, manage authorizations, confirm visits using EVV, and most importantly send all communications in real-time.
The HHAeXchange Portal provides a direct connection from the agency to Senior Whole Health for:
Please check back here for key dates on the below items.
Here is a look at some of the benefits you will get from the HHAeXchange Portal:
Information Sessions were 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 November 2020.
Please Click Here for Additional Training Webinars
ENT Training Webinar- Enhanced Linked Patient Experience
For providers who are currently using the HHAeXchange Provider Platform as existing customers, please register for the Enhanced Linked Patient Experience. The purpose of this training is to cover several enhancements that allow for more flexibility and ease of use with linked payers. These enhancements include the Universal Patient Record linked contract functionality and improvements to the patient management experience. These sessions will provide you access to a live Q/A chat option with the HHAeXchange team.
If you would like, you can also review the recorded training session as listed below:
New Provider Training Experience
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.
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.
(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:
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 Senior Whole Health 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):
Click here to review the detailed FAQ document in regard to the Senior Whole Health 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
Efficient communication
Free tools
Through the HHAeXchange Portal, Senior Whole Health 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.
Senior Whole Health will be sending member demographics, authorizations and placements, and all communication through the HHAeXchange Portal. Senior Whole Health may send additional information as they deem necessary.
Yes. You’ll be able to schedule your caregivers through the HHAeXchange Portal either by creating schedules based on the authorization provided by Senior Whole Health, or through automatic creation of schedules based on EVV data imported into the HHAeXchange Portal from your 3rd party EVV system.
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 contract.
Processes for importing and exporting data from the HHAeXchange Portal can be found on this page under the “EDI PROCESS” tab.
The admin person within your organization will receive more information to identify super users and for training planning.
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