Elderplan has partnered with HHAeXchange to leverage our platform for Personal Care Worker and CDPAS services providers. We are strong believers in the ability of their technology to help us communicate and work with you to ensure the best quality care of our members. Not only will this allow for a smoother partnership between your organization and ours, it will also make your work easier.
Through the HHAX platform we will be able to broadcast new home health aide cases to you, create and manage authorizations, confirm visits, and communicate certain types of issues in real-time.
In addition, the HHAX platform offers a robust agency management solution that can help streamline and automate time-consuming agency functions including placement, scheduling, compliance, and billing of services.
The HHAeXchange Portal provides a direct connection from the agency to Elderplan for:
Starting 11/13/2020, Elderplan will be sending out weekly communications for providers until the scheduled go-live date of 12/6/2020. Please find below copies of each of the communications:
Please refer to the links below to access videos and presentations from the Provider Info Sessions, held via webinar in September 2020.
Please Note: The provider go-live has been extended to December 6th, 2020 for all providers. Please keep that in mind and disregard the old date mentioned in the webinar.
Download the HHAeXchange Portal Benefits
Please Click Here for Additional Training Webinars
Please visit the Provider Portal Resource Page in the HHAeXchange System Support Center to view additional previously recorded webinars
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.
Receive LMS Credentials from the HHAeXchange Onboarding Team and follow instructions to complete the courses and videos on a self-paced format to complete.
ENT Training Webinar – Enhanced Linked Contract Experience
Webinar sessions for provider training will occur mid-September. More information to follow as we conduct Information Sessions.
As you may be aware, Elderplan has partnered with HHAeXchange to implement the Professional Platform and Linked Contract Functionality by 12/6/2020. 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.
Elderplan Homefirst ENT Provider Training: Slides | Recording
EDI Provider Rebilling Job Aid: This job aid provides guidance to the various rebilling scenarios for EDI Providers. This aid can also be found in the provider portal resources page in the HHAeXchange support center.
(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 Elderplan 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):
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
Click here to review the detailed FAQ document in regard to the Elderplan Homefirst implementation, which will provide you with more insight on the program, patient placement, billing, EVV, Communications, as well as EDI and other functionalities.
Can I check my claims before submitting them to Elderplan?
Yes. The HHAeXchange Portal provides a Prebilling Claims Scrubbing module designed to ensure that your claims are compliant with the authorization and contract.
Can I schedule my caregivers through the HHAeXchange Portal?
Yes. You’ll be able to schedule your caregivers through the HHAeXchange Portal either by creating schedules based on the authorization provided by Elderplan, or through automatic creation of schedules based on EVV data imported into the HHAeXchange Portal from your 3rd party EVV system.
How will I be trained on the HHAeXchange Portal?
The admin person within your organization for training will receive more information to identify super users and for training planning.
Can I Import and Export data into the HHAeXchange Portal?
Processes for importing and exporting data from the HHAeXchange Portal can be found on this page under the “EDI PROCESS” tab.
What is HHAeXchange?
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.
What are the benefits of the HHAeXchange Portal?
Ease of billing
Efficient communication
Free tools
How will the free HHAeXchange EVV System work?
Through the HHAeXchange Portal, Elderplan 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.
What information will Elderplan send to my agency through the HHAeXchange Portal?
Elderplan will be sending new placements, authorizations and all communication through the HHAeXchange Portal. Elderplan may send additional information as they deem necessary.
How will the HHAeXchange Portal bill to Elderplan?
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.
All providers can use our Client Support Portal to find answers to questions and create support requests.