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case study

How Three MCOs Prepared for the Cures Act EVV Mandate and Achieved 92% Provider Adoption with HHAeXchange

“HHAeXchange came in at a critical time in our State and they have been a true partner to us in implementing and meeting the State’s requirements. They are hands down my favorite vendor, and we couldn’t have met the EVV mandate without them.” - MCO Operations Director

Challenge

The 21st Century Cures Act was passed in 2016, requiring states to implement electronic visit verification (EVV) for all Medicaid-funded personal care and home health services.

While an overwhelming majority of states have applied for a good faith effort (GFE) exemption to delay EVV until 2021, many MCOs have already started preparing their provider networks for the shift to EVV.

In one Northeastern state, three managed care organizations (MCOs) representing all of the members in that state independently chose HHAeXchange’s payer management platform to collect EVV data, perform billing, and ensure their provider networks were in compliance with the Cures Act mandate.

Strategy

With all three of the State’s MCOs joined together in using the HHAeXchange platform, HHAeXchange worked with the MCOs on a phased roll-out plan based on the state’s geography and concentration of providers. This phased approach included three waves, with Wave 1 beginning in 2018, Wave 2 in 2019, and Wave 3 in 2020.  

In order to balance the needs of the three MCOs and ensure a smooth roll-out to the MCOs' provider networks, HHAeXchange appointed an internal project lead and invited key individuals from each MCO for weekly check-ins. HHAeXchange then led all of the implementation efforts across the State from start-to-finish including provider registration and onboarding, in-person info sessions, webinars, and the development of an HHAeXchange hosted support center for the State’s providers.

Solution

Reducing Fraud, Waste, and Abuse (FWA) with Advanced Reporting

The MCOs have reduced FWA across their provider networks by leveraging HHAeXchange’s advanced reporting and business intelligence, giving them actionable data at a 30,000-foot view, as well as on an individual provider level. The MCOs were able to reduce their audit workload with HHAeXchange’s preventative compliance tools, rather than correcting issues after-the-fact.

Additionally, using the automatic authorization guardrails in HHAeXchange, the MCOs were able to see utilization of the authorization and reduce their claims spending by decreasing the number of over-utilizations.

Streamlined Provider-Payer Operations

Under HHAeXchange’s open model approach, providers were able to choose between using the HHAeXchange free Provider Portal platform or their existing EVV solution. HHAeXchange’s Provider Portal is a complete EVV and billing solution with multiple methods of EVV (mobile app, telephony, Bluetooth Beacon) as well as a real-time communication module with the MCOs.

For providers using an existing EVV tool or software, HHAeXchange integrated more than 31 unique EVV tools on behalf of 350+ providers.  

By offering the free HHAeXchange Provider Portal and accommodating existing EVV tools through integrations, the MCOs were able to reduce provider abrasion throughout the EVV implementation process, resulting in an increased satisfaction rating amongst providers.

"The HHAeXchange Provider Portal is multi-functional and easy to navigate. Communication to the MCOs is at your fingertips. It allows my staff immediate access to members and their schedules and it’s easy to correct billing issues.”- Administrator, Homecare Agency

Improved Member Care

With reporting on authorization utilization, as well as missed and short visits, the MCOs are now able to identify non-compliant or poor-performing providers immediately. Armed with this data, the MCOs work with individual providers on compliance and reward those that are providing services according to the member’s authorization.

Seamless Member Placement & Communication

Prior to HHAeXchange, the MCOs typically communicated new member cases and authorizations via fax and email. Using HHAeXchange’s case broadcasting tool, the MCOs now broadcast open member cases to their entire provider network and match providers based on unique member requirements. HHAeXchange also serves as a real-time communication platform with a full audit trail of all payer-provider communications, which has eliminated the need for phone calls, faxes, and emails.

Results

  • 129 million annual confirmed visits

  • 6,300 members served

  • 92% provider adoption

  • 64% reduction in denial rates