6 Essential Claim Submission Steps to Master Billing in HHAeXchange

Review EVV Aggregation Transaction Manager 

• To streamline billing efficiency, it is crucial to take action in the EVV Transaction Manager. EVV Holds should be corrected and visits should be submitted to and accepted by the Aggregator before invoicing. The EVV Transaction Manager Guide outlines all holds and how to resolve them.

• If you have already invoiced, you will need to unbill the visit, edit the visit, and rebill. Refer to the Unbilling and Rebilling topics for details and instructions. 

Enter Diagnosis Codes (DX)

• Ensure Diagnosis Codes (DX) are added to the authorization. A Diagnosis Code is required to create a claim and successfully bill and is derived from ICD-10 diagnosis codes published by the Centers for Medicare & Medicaid Services (CMS).  
  
  • If DX Code is blank, the invoice is held under Billing Review until codes are added. 
  • To check or add codes, click on the Auth/Orders page in the Member Profile.  Locate the authorization and click on the edit icon (). On the Edit Authorizations page, under the Billing Diagnosis Codes section, review the information or click on the Add button to enter a DX Code.
    
    

• The Add Diagnosis Code pop-up window opens for you to enter or search and select the ICD Codes. Once a Dx Code is selected, mark the code as an Admitting Diagnosis or a Primary Diagnosis. 
  • Note: The system automatically selects the diagnosis code as Primary, if it is the only code assigned in the authorization.  
     

Billing/Pay-to Provider (Taxonomy) Code Verification

• A taxonomy code is a unique 10-character code that designates the classification and specialization. Please use the taxonomy code that was selected during credentialing when enrolling with the payer. i.e. In Home Supportive Care: 253Z00000X. 

• Check the e-billing configuration to verify that the correct Billing/Pay-to Provider (Taxonomy) code is correct.

• Go to Admin > Payer Setup > Search Payer to locate and select the Payer by clicking on the Payer Name link. On the Payer Setup page, go to the Billing Collections tab and click on the E-billing Configuration hyperlink at the top section of the page. 

  
  

• The E-Billing Configuration pop-up window opens. Scroll to Segment ID PRV-03, described as Billing/Pay-to Provider Specialty Information, and verify that the correct code is listed in the Values column. If the code needs to be added, corrected or updated, then please contact support via the Client Support Portal. 

Authorization Review

• Confirm that the Budget Number or Referral Number matches your intended submission.
  • The Budget Number applies only to Long-Term Care (LTC) family care, with values of 1 to 5, as assigned by the Payer.

• If applicable, the Budget Number is seen in the visit Schedule tab or in the Master Week, available to edit. On the visit Schedule tab, the Budget Number field is seen on the right of the Duration field. 
  
  

• To edit on the Master Week, locate the applicable Master Week and click on the edit icon to open the Master Week page. The Budget Number field(s) displays under the Service Code(s) field, per day.

• Other programs may use a Referral Number or an Authorization Number. To verify this information, go to the Patient Profile, Auth/Orders page. This is the number loaded and displayed in the Authorization # field.
  • If incorrect, then update the field BEFORE invoicing.  
  • If rejected, then unbill the visit, update the authorization, and rebill. Refer to the Unbilling and Rebilling topics for details and instructions.

Verify Modifiers on Service Codes (HCPCS) 

• In some cases, a modifier must be added post-invoicing. These modifiers are an extension of the existing Service Codes (HCPCS), identified as two characters following the Service Code (HCPCS), divided by a colon. These codes can be updated in the visit Schedule tab or in the Master Week page. 
• From the Service Code field, select the applicable value with modifier from the dropdown. Ensure to first unbill the visit and then update the Service Code.
  
  
  
  
  
  
• If the required modifier is not available in the list of values, then submit a request to our team via the Client Support Portal.   

Check Plan Codes Rates 

• If Billing Rates are showing as $0.00 when invoicing, then the Plan Code rates must be entered for that contract.  
• Go to Admin > Payer Setup > Search Payer to locate and select the Payer. Click on the Payer Name link to open the Payer Setup page. Select the Billing Rates tab and click on the edit icon for the Service Code to edit.  (DO NOT use the Update Rate button!)  
• On the Payer Rate window, enter the applicable codes in each Plan Code field as required by the system (required fields are denoted by a red asterisk). 
  
  
  
  
• If the agency does not know the Plan Code rate, then check the rates on the Texas Medicaid Healthcare Partnership (TMHP) website, reach out to the Payer, or enter the main rate amount for each Plan Code. 
• Loaded Plan Codes display on the Payer Placements section of the Member’s Payers page.  
  
  

Claim Status Check 

• Please allow approximately 48 hours to see the status in HHAX or TMHP. 
• You can complete a claim status inquiry in TexMedConnect to check the status of a claim. Visit the TMHP TexMedConnect resource page for more information. 
• Run the Claims Status Report (Report > Billing > Claims Status).
  • If the status is rejected, then the reason(s) for rejection are listed under the Claim Status Reason column. 
  • If the status is not available after 48 hours, then submit a ticket via the Client Support Portal with the subject line "TX Status Not Found." 
    

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