Payer Management Solutions (US Only)

Welcome to HHAeXchange for Payers

HHAeXchange offers a unique platform designed specifically for “at-risk” Payers and Health Plans:

  • Managed Medicaid Long Term Care (MLTC) plans throughout the US
  • Managed Care Organizations (MCOs)
  • Integrated Delivery Networks (IDNs)
  • State Medicaid programs.

The HHAeXchange Payer Management Solution is a centralized, cloud platform where Payers dynamically link to their contracted network of Home Care Providers, creating a “real time” shared view of operational, financial, and clinical information.

It ensures visit and caregiver/ duty compliance, enhances care management and coordination, streamlines the authorization and billing process, and offers a complete audit trail of all communication between Payers and Home Care Providers.

Payers will have a new way to collaborate with their network of providers to achieve increased operational efficiency, improved patient outcomes, reduced fraud and abuse, and rock-solid compliance.

The solution works with your current IT environment, eliminating the stress of replacing existing systems while at the same time enhancing them. Experience almost immediate and substantial return-on-investment with HHAeXchange.

The HHAeXchange Payer Management Solution bridges gaps and breaks down walls providing real-time electronic workflow and full visibility of compliance data in a shared operational and care management platform. Payers shift to proactive, strategic ways to improve patient outcomes and reduce hospitalizations.

Payer Problems We Can Solve

As a Payer, do you face any of the following Care Coordination or Claims Management Issues? If so, the HHAeXchange Payer Management Solution can help.

Communication

The Problem

It is difficult to staff cases, and it could take up valuable hours or even days. Disparate faxes, texts, and phone calls often lead to confusion.

Our Solutions
Auto-Broadcasting

Payers can easily broadcast new cases to their network of home care providers or select the Providers they wish to alert who meet the specific characteristics of the member. This is especially useful for difficult-to-staff cases.

Audit Trail

All communication regardless of modality – fax, text, phone, email – is time stamped. This is useful for eliminating any confusion when communicating changes to authorizations and eligibility.

Case Management

The Problem

There is a lack of real-time visibility into visits, service delivery, patient schedules and calendars.

Our Solution
Electronic Visit Verification (EVV) Exception Alerts

EVV provides real-time data and alerts regarding missed/late visits, start/end times. Payers can also see schedule and visit confirmations.

Business Intelligence

The Problem

It is difficult to obtain reports across all home care agency providers to understand which providers are performing the best.

Our Solutions
Business Intelligence Scorecards

Payers can benchmark a full spectrum of performance categories with access to up-to-date views of key areas such as trends by hospitalization, caregiver compliance, vendor performance statistics, baseline/financial/clinical dashboards and EVV exception scorecards. This is useful to see reports across all Home Care Providers to understand which are performing the best.

Clinical Pathways

A robust population management tool that will provide insights to Payers on how to reduce hospital readmissions. Provides transparency and control to manage chronic care groups.

Claims Management

The Problem
Billing Errors!

We receive bills for hours that have not been authorized. There are discrepancies between the EVV and the claims data. We are still getting paper claims. Our workflows are redundant and therefore inefficient. Setting up new providers requires significant EDI setup.

Our Solution
Pre-Billing

Claims cannot pass through the Exchange unless the service reconciles with both the authorization and electronic verification of the visit, reducing claims efforts for both Payers and Home Care Providers. All paper invoices are converted to electronic files for greater efficiency and reporting. Medicaid eligibility and surpluses are also automatically checked.

Key HHAeXchange Payer Solutions Features

The HHAeXchange Payer Management Solution Platform provides real-time electronic workflow and full visibility of compliance data in a shared operational and care management platform. For a personal demonstration contact us today!

  • Home Screen: In one centralized dashboard view, Payers can see urgent notes, events and requests from Home Care Providers and can prioritize which need immediate attention. Call Dashboard: Easily see flagged missed in and missed out visits across your Home Care Provider network.
  • Auto Broadcast: A clear differentiator in the marketplace, Payers can easily broadcast new cases to their network of Home Care Providers or select the Providers they wish to alert who meet the specific characteristics of the member. This is especially useful for difficult-to-staff cases.
  • Patient/Member Calendar: Payers can view schedules and activity for any member. Green indicates the scheduled visit is within authorization and pink indicates it is outside of authorization.
  • Caregiver Compliance: The Payer gains full visibility to all user-defined compliance information such as criminal background status checks, references verified, training certificates issued, last evaluations and pre-employment physicals/annual health assessments.

Testimonials

I've been managing and submitting my claims via HHA eXchange and I have one word....fantastic! My billing time has been cut drastically. I better control my visits and employees, but work less at it. It is so much easier to stay in compliance with HHA eXchange… thanks Homecare Software Solutions!

Greater NY Homecare

Our experiences using the HHA eXchange program have been very positive. Their compliance toolset is excellent, and really gives us confidence that we are billing as near error-free as possible. It has greatly decreased unnecessary workload. It all just flows and is extremely user-friendly. My staff is extremely happy with it.

Susan Katz, Summit Home Health Care

We looked at several systems and realized that HHAeXchange had what we needed for now and into the future.

Yelena Davydenko, Victor’s Home Care