Senior Whole Health Information Center

HHAeXchange & Senior Whole Health Partnership

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 21^st 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.

What does the HHAeXchange Portal provide to homecare agencies?

The HHAeXchange Portal provides a direct connection from the agency to Senior Whole Health for:

• Electronic case broadcasting, authorizations, plan of care management and entering confirmed visits
• Real-time two-way communications and messaging with Senior Whole Health
• Free EVV solution for time & attendance and duty tracking
• Electronic billing along with pre-billing review

Your Agency’s Options:

• Agencies currently using HHAeXchange:You will be able to continue using HHAeXchange, utilizing the system’s Linked Contract functionality.
• Agencies currently using another 3rd Party EVV Solution:Authorization data will become available in the HHAX Portal, rather than coming by fax. Schedule and visit data will be imported from your 3rd party system into HHAX. Please work with your EVV Vendor (e.g. Sandata or Arrow) to determine requirements to set up this interface.
• Agencies not currently using HHAeXchange:You will be setup with an HHAX Portal in order to receive authorizations and submit claims/invoice data. HHAeXchange Business Development team will reach out to you for portal agreements and credentials.
  • Please complete the Provider Portal Questionnaire Survey to ensure our team can create your unique credentials for access

Important dates

Please check back here for key dates on the below items.

• Go-Live Date: December 5th, 2020

Here is a look at some of the benefits you will get from the HHAeXchange Portal:

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.

UPCOMING WEBINARS

Senior Whole Health – Caregiver Experience Webinar

Thursday, August 5 @ 2pm EST

Monday, August 9 @ 12pm EST

Tuesday, August 10 @ 10am EST

• Audience: SWH Providers Servicing MAP Members
• Description: Senior Whole Health will be rolling out two new features for Caregivers in HHAeXchange to improve patient experience, track necessary compliance, monitor change in patient conditions, and target social determinants of health to improve value-based care. Starting next month, a payer-managed Plan of Care (POC) and new Care Insights functionality will be implemented.

  This webinar, hosted by Senior Whole Health, in partnership with HHAeXchange, will explain the new tools and the value behind them.

  We will cover details about the functionality and expectations from providers, provide a demo of the updated functionality, and learn about next steps to be ready for the implementation. During the webinar, representatives from Senior Whole Health and HHAeXchange will be available to answer any of your questions through a live Q&A chat option.

Please Click Here to register for this webinar.

INFO SESSIONS

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.

Information Session Recording (Click here)

Presentation Deck (Click here)

UPCOMING WEBINARS

• Please Click Here for Additional Training Webinars
  

RECORDED WEBINARS

• Care Insights/POC Mapping* (25 min): Video | Slides *applicable to Senior Whole Health MAP contract only
• Billing Process (7 min): Video | Slides
• Patient Placement (14 min): Video | Slides
• Patient Merge (6 min): Video | Slides
• Blended Services (10 min): Video | Slides
• SWH MLTC Transition (27 min): Video | Slides

Please visit the Provider Portal Resource Page in the HHAeXchange System Support Center to view additional previously recorded webinars

Provider system user training

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:

• Enhanced Linked Patient Training Recording: Click Here
• Enhanced Linked Patient Training PowerPoint: Click Here 

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.

• An email will be sent to the contact that completed the Cognito Survey
• 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 Support@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 3^rd 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 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 for the HHAexchange EDI Import Interface Guide
• Click here for the HHAexchange EDI Export Interface Guide
• Click here for the HHAeXchange NY EDI Code Table Guide

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.

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