6 Essential Claim Submission Steps to Master Billing in HHAeXchange

Authorization Requirements

• Providers will create authorization only when required based on the Home Health guidelines.
• Providers will manage diagnosis (DX) codes at contract level for billing.
  
  

Enter Diagnosis Codes (DX)

• Add Diagnosis (DX) Codes to Service Specific Authorization once received.

• • • Service Specific Authorizations will be issued by the Payer. Once issued, be sure to update the Diagnosis Code.
    • Example of Service Specific Authorization:
      
      
      
  
  
• 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.  
     

• For Home Health program services when an authorization is not required, then the Diagnosis (DX) Codes should be added to the Payer contract tab under the Member Profile. Select the contract and then click on the three dots for the action menu.
  
  
  
  
  
  
• A pop-up box will display, select Add on the Patient Diagnosis Code Override box to search and select code.
  
  

Verify Modifiers on Service Codes

• In some cases, a modifier must be added post-invoicing. These modifiers are an extension of the existing Service Provider Codes, identified as 2 characters following the Service Code, divided by a colon. These codes can be updated in the visit Schedule tab or in the Master Week page.
• From the Service Provider Code field, select the applicable value with modifier from the dropdown. Ensure to first unbill the visit and then update the Service Provider Code.
  
  
  
  
  
  
  
• If the required modifier is not available in the list of values, contact the Payer provider relations team or care management team. If that team identifies the service code is missing, they will work with the HHAeXchange Implementation or Client Success team to have the configuration updated.

Adding Attending Physician

• To add an attending physician, go to the Member's page and select the Profile link. Then, scroll down to the bottom, where you can input and save the physician's details, ensuring to include the NPI. 
  
  

Claim Status Check 

• Please allow approximately 48 hours to see the status in the HHAeXchange application.
  • 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 "MI Status Not Found." In HHAeXchange, run the Claims Status Report (Report > Billing > Claims Status).