Home Health and Personal Care Services

Section 12006 of the Twenty First Century Cures Act (Cures Act) and the Centers for Medicare & Medicaid Services (CMS) requires the State of North Carolina to begin utilizing an Electronic Visit Verification System (EVV) for all the Tailored Plan Programs by July 1, 2024.  The Cures Act mandate requires all visits to be timestamped via an electronic verification method utilizing EVV tools to record the member, caregiver, time the service begins and ends, location of the service, date of the service and the type of service performed.

To ensure that the provider community complies with the Cures Act mandate requirements, the state of North Carolina will require all Personal Care Services (PCS) and HHCS providers for the Tailored Plan Programs by July 1, 2024. As a result, Partners and Trillium will continue their partnership with HHAeXchange as its EVV solution. In preparation for the PCS hard launch and HHCS soft launch on July 1, 2024, we want to ensure your agency is ready to start using HHAeXchange Provider Portal for your patients.

PCS Hard Launch Guidelines effective July 1, 2024:

• All providers are expected to be fully compliant with EVV requirements
• EVV data must be validated prior to claims adjudication
• Claims without the required EVV criteria will deny.

HHCS Soft Launch Guidelines effective July 1, 2024:

• HHCS providers are encouraged to submit EVV visit information to HHAeXchange through the duration of the soft launch period to ensure all systems are operating as intended for a successful hard launch.
• If you experience challenges with claim submission through HHAeXchange during soft launch, you are able to submit claims outside of HHA while working collaboratively with Trillium and HHA to resolve any barriers.

The EVV program will operate as “Pay and Report”.  Claims will not deny if EVV visit information is not submitted to HHA.  A warning edit will be applied noting the missing EVV validation. We understand that some agencies may have an enterprise EVV solution already in place to help you be compliant.  Our intention is not to replace the EVV solution you have in place, but to ensure that we are able to collect the visit data for Partners, Trillium and North Carolina programs and provide options for providers that support our members to make this process as easy as possible.  As one of the options, HHAeXchange will provide a payer-funded EVV solution to manage EVV compliance for the members you service. Please see the action steps below that are required to ensure your path to success for the July 1, 2024 go-live.

Step #1: Choosing your EVV provider selection & the HHAeXchange Platform

HHAeXchange offers an EVV solution at no cost to providers.  The system can be used directly or set-up as a data integration workflow for providers who already have EVV software. The options available with HHAeXchange are outlined below, please review and determine which is right for your agency based on your EVV set up:

• Option 1 – Agencies currently without an EVV Solution: use the payer-funded EVV tools provided by HHAeXchange & Partners and Trillium
• Option 2 – Agencies currently using another 3rd Party EVV Solution: use your existing EVV system and import visit data into HHAeXchange – HHA will route visit data to Partners and Trillium
• Option 3 – Existing providers that currently utilize the HHAeXchange provider platform will be linked with the new service codes in scope

 
Step #2: Complete HHAeXchange Provider Onboarding Form

If your agency does not have a portal with HHAeXchange, we ask that you promptly complete the HHAeXchange Provider Onboarding Form. If your agency already has a portal set up with HHAeXchange for PCS and you will be providing HHCS services, you do not need to complete the onboarding form again.  This should be done as soon as possible, and no later than May 15th, 2024, for HHAeXchange to understand which EVV option you are selecting and create a new portal if needed.  The HHAeXchange team and Partners and Trillium team will continue to follow up until the HHAeXchange Provider Onboarding Form is complete as it is a requirement to ensure visit data is aggregated accurately on behalf of your agency and Partners and Trillium to NC DHS. Please note, the HHAeXchange Provider Onboarding Form only needs to be completed once. The HHAeXchange Provider Onboarding Form link can be found here:

• HHCS
• PCS

Have Questions?

For questions on navigating the HHAeXchange system or with completing your HHAeXchange survey, please email HHAeXchange  or visit us at North Carolina Tailored Plans.

Section 12006 of the Twenty First Century Cures Act (Cures Act) and the Centers for Medicare & Medicaid Services (CMS) requires the State of North Carolina to use Electronic Visit Verification (EVV) for all Home Health Care Services (HHCS). 

IMPORTANT UPDATE: Carolina Complete Health has reverted back to a "Soft Launch" for EVV for HHCS providers. Claims with dates of service 10/01/2023 and after which previously denied for EVV will be reprocessed by Carolina Complete Health. 

GUIDANCE FOR SOFT LAUNCH PERIOD:

• During "soft launch", HHCS providers are expected to continue submitting EVV visit information to HHA.
• The EVV program will operate as “Pay and Report”.
• Claims will not pend based on failed validation. If a claim fails validation, a report will be generated noting the validation issue and the provider will be allowed to receive payment. 

STAY ENGAGED:

• Both NC DHHS and Carolina Complete Health encourage providers to assess and analyze their operating procedures and make necessary changes to come into compliance with the EVV federal requirements. This includes a review of your organization’s procedures and practices, training requirements and other EVV related activities.
• This time is intended to help providers address issue resolution. Please continue to work with CCH and our EVV vendor during this time period to ensure your visit files align with our service code cross walk. See more information on our provider guide: Home Health Care Services Billing, Claims, and Authorizations Guide (PDF).
• Please work closely with your Provider Engagement and Network Support teams at Carolina Complete Health Network. If you would like to request a meeting to review this information, please reach out!
  • View our PE Team page for contact information or 
  • email the Network Support team at: NetworkRelations@cch-network.com

UPON EVV HARD LAUNCH (date to be determined):

• Claims for HHCS filed outside of an EVV solution will deny.
• Claims without the required EVV criteria will deny.
• All HHCS providers will be expected to be fully compliant with EVV requirements.
• EVV data must be validated prior to claims adjudication.

Beginning Wednesday, November 1, 2023, Carolina Complete Health will allow Providers to edit rates in HHAeXchange.  All claims billed to Carolina Complete Health will be billed at the current rate set by the health plan, and claims are paid according to your contracted rate with Carolina Complete Health. If the rate in HHAeXchange does not match your contracted rate, then you can manually update the rate. Refer to the Rate Management Job Aid (PDF) for instructions and details.

Moving forward, your Agency is responsible for managing the rate (including any contractual updates) if the rate is updated.

**If additional offices are linked with Carolina Complete Health in the future, rates will default to $0 and must be updated by your agency prior to billing.

Note: EDI Providers must coordinate with their EVV Vendor to ensure rates are being sent. Once confirmed, open a ticket with EDI Support to request your configurations be updated. 

For further information concerning the contents of this notification, please open a ticket with HHAeXchange Customer Support.

Please Note: Claims including Home Health (HH) services and supplies must be split. HH services must be billed through EVV, while HH supplies should be billed directly to Carolina Complete Health. If providers submit a claim including HH services and supplies, the claim will deny.

View our Home Health Provider Guide for more information

HHAeXchange is the premiere Homecare Management Software company for the Medicaid LTSS population. They are the leaders in connecting payers and homecare agencies to enable more collaboration, communication, and workflow efficiencies. Through the use of the HHAeXchange portal, their goal is to make working with Carolina Complete Health easy and efficient.

How HHAeXchange Helps the PHP Meet the Cures Act Mandate​

• Industry-leading scheduling and billing platform for back-office users and EVV confirmations​
• Easy-to-use point-of-care visit confirmation tools for caregivers

What does the HHAeXchange Portal provide to homecare agencies?

• Electronic case placement and authorization transfer
• Efficient schedule and visit management
• Free EVV solution for time & attendance and duty tracking
• Electronic billing

Your agency will receive login credentials for the HHAX Learning Management System when your portal is created.  Your team should use the LMS to review videos, documents, and test questions to ensure an understanding of the HHAeXchange Provider Portal.  Access the LMS system.

*Login credentials were emailed to the user who completed the portal creation survey.  Please submit a ticket via the HHA support portal with any questions regarding credentials.

The HHAeXchange provider information center outlines necessary requirements to set up access to the HHAeXchange system. If your agency does not have a portal with HHAeXchange, please complete the Provider Portal survey.

HHAeXchange offers EVV solutions at no cost to providers and data integration options for providers who already have EVV software. Based on your provider set up, below are the options available with HHAeXchange:

• Option 1 – Agencies currently without an EVV Solution: use the free EVV tools provided by HHAeXchange & Carolina Complete Health
• Option 2 – Agencies currently using another 3rd Party EVV Solution: use your existing EVV system and import visit data into HHAeXchange – HHA will route visit data to Carolina Complete Health
• Option 3 – Existing providers that currently utilize the HHAeXchange provider platform will be linked with the new service codes in scope

Have Questions?

If you have questions or need help, please feel free to contact your Carolina Complete Health provider representative at 833-552-3876 or email networkrelations@cch-network.com.

For questions or help with HHAX, please email HHAeXchange at ncsupport@HHAeXchange.com or visit us online.

Optimize Customer Support Experience:  To best support our customers, HHAeXchange highly encourages users to submit requests via the Client Support Portal. The Client Support Portal is the fastest method for us to answer and address issues. Through a simple set of questions and selections, we can easily determine assignment and answer questions directly online without waiting.

For more information, please refer to the Client Support Portal Job Aid (PDF) for step-by-step instructions and videos on how to

• Register for a Client Support Portal account
• Submit a support request
• Manage existing requests

Phone: 866-242-2465

Provider Portal Resource Page:

• Access from Provider Portal Support Center

For a 1:1 with HHAX, submit a ticket via HHAX support and select  “Training Request”

Training Links:

• PHP Pre-Go Live Webinar
• Billing Refresher Training

HHAeXchange North Carolina Resoures Page

• HHAeXchange Provider Support Portal (PDF)
• HHAeXchange Client Support Portal Job Aid (PDF)
• Provider Managed Billing Diagnosis Codes Job Aid (PDF)
• Billing Review Problems and Resolutions (PDF)
• Prebilling Problems and Resolutions (PDF)
• Common EDI Rejections (PDF)
• EDI Tool Job Aid (PDF)
• Reviewing Visits on the Prebilling Page (PDF)
• Viewing Claims Status Job Aid (PDF)
• Patient Office Move (PDF)
• Rate Management (PDF)
• Secondary Billing (Linked Contracts) Job Aid (PDF)
• EDI Provider Rebilling Job Aid (PDF)
• Accepting Placements (Linked Patients) Job Aid (PDF)

View a recording training with the HHAeXchange team for a discussion on the recent Home Health implementation for the North Carolina PHPs. There is a brief presentation detailing workflows for frequently asked questions, followed by a townhall style discussion with the HHAeXchange team. Key topics for discussion include:

• Placement without Authorization
• Service Code Bundles
• Service Code by PHP
• Capturing EVV in HHAeXchange and billing to the PHPs

Recording | Presentation Slides (PDF)

HHAX Webinar on Common Questions and Resolution Tips for 3^rd party EVV vendor providers

• Recording 
• Slides 

Do you have a Carolina Complete Health member who is in need of initial PCS?

1. The CCH Personal Care Services Request "3051" Form is to be completed by member's primary care provider or attending physician. This can be found on the Manuals, Forms, and Guides page.
2. Fax the 3051 form to Carolina Complete Health Care Management: 1-833-706-0238
3. Once this form is received a face to face visit will be scheduled within 30 days by CCH Care Manager
4. After assessment is completed and start of care date is determined, an authorization will be created by CCH and will be shared with the agency. This document will include purchased tasks to be completed by PCS attendant. Agencies will receive the authorization via fax and can also view on the CCH Secure Provider Portal.

Reauthorization of Personal Care Services

• Providers do not need to request reauthorization of PCS.
• CCH LTSS Care Managers are responsible for reauthorizing personal care services through comprehensive face-to-face visits and assessments.
• Providers can access member health records, assessments and authorization status through the Secure Provider Portal. For support in navigating the Secure Provider Portal, reach out to your Provider Engagement Administrator.

Questions?

• Please contact our customer service department at 1-833-552-3876. If the member is in active care management for PCS, you may request to speak to the assigned Care Manager or LTSS Manager.