Why Every MCO Needs an Aggregator

Under the 21^st Century Cures Act, states will face serious financial consequences if EVV compliance requirements are not upheld by their Managed Care Organizations (MCOs) and provider networks. Ultimately, those consequences will be passed down to MCOs and providers in the form of claim non-payments, recoupments, and recovery audits.

At HHAeXchange, we believe that ensuring optimal compliance and minimizing risk begin with actively managing EVV compliance. Without an aggregator to capture visit information and offer full visibility across their provider networks, MCOs deny themselves access to valuable data and risk non-compliant visits slipping through the cracks.

Let’s take a closer look at the key reasons why it’s important for MCOs to have an aggregator.

	False Claims Savings Without an aggregator, plans lack visibility across their network. For example, if one 15-minute segment is inaccurately recorded for every member just once a month, that could amount to thousands of dollars in potential over-billings monthly.
	Audit Expense Savings Costly internal or third-party expenses, necessary today to validate caregiver visit compliance, are eliminated or greatly reduced as only validated claims will be accepted from the provider network in accordance with plan pre-bill edit rules. State and legislative audits focusing on recovery audits and compliance may also be avoided.
	Claim Processing Efficiencies Higher data integrity (Authorization, Member Info, Patient Diagnosis (DX) Data, etc.) shared across aggregator platforms like HHAeXchange allows for more accurate claims processing and fewer denied claims. The result is fewer hours required by payer staff to work denials and other administrative items.
	Referral Management & Care Coordinator Efficiencies By automating the placement and care coordination processes through HHAeXchange, plans experience a reduction in staff time necessary to place difficult cases and for manually responding to faxes, phone calls, and emails about member activity and member needs. Additionally, real time data and information gathering related to social determinants of health and change of condition can be electronically transmitted and integrated into critical care management work queues.
	Tracking and Reporting HHAeXchange captures your providers’ missed visits, short visits, and late visits to ensure that you are paying only for visits that are in your members’ plan of care and within the allotted authorization. MCOs that have worked with our platform to capture this data have been able to ensure plan of care compliance for members and report to agencies on aide timeliness.

HHAeXchange dynamically links state Medicaid agencies to their MCOs and networked homecare providers, enabling EVV compliance, full transparency, and monitoring of several key compliance metrics. Request a demo to learn more.