When a client receives homecare services through an agency, there are many moving parts behind the scenes working to ensure that they successfully receive high-quality care. These many stakeholders make up what we call the homecare ecosystem. The ecosystem includes providers, caregivers, clients and their families, state Medicaid programs, and other payers like managed care organizations (MCOs). HHAeXchange recognized a need to increase communication and transparency between these groups— and through a desire to create more efficiency and decrease instances of fraud, waste, and abuse (FWA) we created a single platform that connected them all. Today, HHAeXchange is the only homecare management software that seamlessly connects the homecare ecosystem through a single platform. 

The Connection Starts with EVV 

The 21st Century Cures Act was signed into law in December 2016. Included in the Cures Act is a provision requiring the use of Electronic Visit Verification (EVV) for all personal care services, home health visits, and private duty nursing provided under Medicaid. Created in response to long-standing FWA concerns, EVV uses electronic means like mobile apps, interactive voice response (IVR), and fob devices, to verify that care is delivered for homecare services. Agencies use EVV not only to remain compliant with federal requirements, but also as an effective tool to track caregiver arrivals and departures, ensuring clients get the care they need, when they need it.  

How are Claim Submissions and EVV Data Connected? 

The beauty of intersecting EVV data with homecare claims generation and processing is that it can help facilitate a more efficient billing process between the homecare providers and payers. When the ecosystem is connected through one platform the EVV data becomes the basis for the submission of a claim. Here is how the automated HHAeXchange billing process works: 

  • As soon as a caregiver clocks in and clocks out with EVV, that data appears in the HHAeXchange provider portal, allowing schedulers to manage any exceptions, like missed or late visits.  
  • After these exceptions are cleared, HHAeXchange’s pre-billing function will automatically verify that the visit matched the contract, authorization, and plan of care.  
  • Once this pre-billing process is complete, providers can perform a final billing review to resolve any remaining contractual issues with the visits.  
  • HHAeXchange will then generate the 837 file to be sent electronically to payers in their preferred format.  
  • A claim status is then generated back to HHAX via a 277ca response from the clearinghouse 

Just in the last year in New York State alone, the HHAeXchange billing process was responsible for facilitating the successful processing and payment of more than 3 million homecare claims on average each month. Additionally, estimated clearinghouse savings for NY providers is upwards of $150K per month, or $400 per provider per month on average. 

The HHAeXchange process ensures that there is an EVV compliant visit before there is a claim paid. This helps reduce FWA by identifying providers who would submit claims erroneously for things like overlapping visits/EVV times. Most importantly, it ensures errors are caught in the pre-claim generation EVV validation process, which leads to more operational efficiencies and lower costs for everyone in the homecare ecosystem. 

The Benefits of a Transparent System 

Connecting payers, providers, and caregivers streamlines more than just the EVV, billing, and claims submission processes. HHAeXchange’s solutions have far-reaching implications for every facet of the ecosystem. For payers this means: 

  • Centralized payer and provider communication 
  • Simplified authorization management 
  • Effective case broadcasting 
  • Robust business intelligence and reporting tools that give actionable insights on operational efficiencies and member care compliance resulting in better member care and outcomes 
  • Easy monitoring of network performance by claim, member, caregiver, or system-wide 
  • Insight into social determinants of health risk data provided by caregivers  

For providers it means: 

  • Time saved on costly EVV/claim submission errors 
  • Tools that empower caregivers to proactively monitor client progress and reduce readmissions.
  • Centralized payer and provider communication 
  • Compliance assistance, ensuring up-to-date plan of care 

Maintaining an Efficient System for All Stakeholders  

Ultimately, keeping payers, providers, and caregivers operating through one single source of truth helps providers maintain their compliance, enables caregivers to provide the best care possible through accurate plans of care, gives payers insight into their providers’ performance and their members’ well-being, and ensures everyone gets paid on time and accurately. 

To learn more about how your organization can take advantage of our connected homecare solution, request a demo today.