WellCare NY

Provider 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 WellCare easy and efficient.

Simple Claims Billing and EVV Implementation for WellCare

WellCare has selected HHAeXchange, a web-based software solution, to collect confirmed homecare visits, create claims and provide workflow efficiency tools.

There will be a two-phased go-live approach for all NY agencies:

1.  Phase 1 will go live on 9/16/19. During this phase, the requirement for the agencies is to validate the member and authorization data that WellCare will be sending electronically through the HHAeXchange Professional system.  Agencies will use communication notes within the HHAeXchange linked contract functionality to address any discrepancies.  Agencies will continue to manage and bill WellCare members outside the linked contract system during this phase.

2.  Agencies will be notified 60 days prior to the selected Phase 2 go-live date. Phase 2 go-live is TBD. Starting on that date, agencies will be expected to solely use the linked contract functionality in HHAeXchange to manage members and generate claims.

What does the HHAeXchange Portal provide to homecare agencies?

The HHAeXchange Portal provides a direct connection from the agency to WellCare for:

  • Electronic case broadcasting, authorizations, plan of care management and entering confirmed visits
  • Real-time two-way messaging with WellCare
  • Free EVV solution for time & attendance and duty tracking
  • Electronic billing

Your Agency’s Billing Options

Option 1: Our agency currently uses HHAeXchange’s Enterprise platform. Great! You will be able to continue to use HHAeXchange using the linked contract functionality, receiving members and authorizations directly from WellCare.

Option 2: Our agency has an existing EVV system that we’d like to keep. It’s simple to connect your existing EVV system to WellCare through the HHAeXchange Portal. The HHAeXchange Integrations Team will coordinate with your EVV vendor to create an interface to process your existing EVV visits and claims.

Here’s a look at some of the benefits you’ll get from the HHAeXchange Portal:

Ease of billing

  • Quickly enter confirmed visits in a user-friendly interface.
  • Increase billing acceptance rates with realtime pre-claim edit checks.

Efficient communication

  • Reduce payer communication time with realtime, 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.

Download the HHAeXchange Portal Benefits

For further information on Phase 1, please refer to the video and presentation from the Provider Info Session:

Video

Presentation

Further training and info session will be given prior to the full rollout in Phase 2.

NY MLTSS – NMD

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. All disputes between the health plan and in-network and out-of-network providers shall be solely between such providers and the health plan. The member shall not  be charged for any of the disputed costs.

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

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 WellCare 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):

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, WellCare 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.

It’s simple to connect your existing EVV system to WellCare through the HHAeXchange Portal. The HHAeXchange Integrations Team will coordinate with you to create an interface to process your existing EVV visits and claims. If you’re not ready to integrate your existing EVV system, you can temporarily manually enter your visit date into the HHAeXchange Portal.

WellCare will be sending new placements, authorizations and all communication through the HHAeXchange Portal. WellCare may send additional information as they deem necessary.

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 WellCare contract.

Yes. You’ll be able to schedule your caregivers through the HHAeXchange Portal either by creating schedules based on the authorization provided by WellCare, or through automatic creation of schedules based on EVV data imported into the HHAeXchange Portal from your 3rd party EVV system.

There is training scheduled for 8/21 @ 9:30am. Please register using the below link:

https://hhaexchange.com/WC-NY-Webinar

Afterwards, training materials and future education sessions will be posted under the Training tab.

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

Need Help? Contact Our Support Team