Billing Process for LME Managed Care Organizations (MCOs)
HHAeXchange has said that they will send Medicaid Managed Care EVV info to LME MCOs for billing.
This appears to be working only for Alliance and not for the other MCOs.
Please check your EVV info in the HHAeXchange portal, and please check your claims with the individual LME MCOS.
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NOTE: You must upload claims to Eastpointe and Trillium portals to get reimbursed by those MCOs.
You can build the claim in Barnestorm and upload to their portals.
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NOTE: Vaya must be billed directly in order to get reimbursed (by keying visits into their portal).
(they do not reimburse through HHAx connection):
https://providers.vayahealth.com/authorization-billing/claims/
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NOTE: Barnestorm cannot assist with Eastpointe, Trillium, or Vaya portals:
please contact the MCO for assistance with their portal.
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Sending HHAeXchange the EVV info is required as of August 31, 2021. You can feel free to send the EVV info for all of your visits from July 1, 2021 forward.
1. Audit your EVV info in EVV Visits. This is what gets sent to HHAeXchange (not charges!). So, if there are any missed visits that were actually done, complete them in EVV Visits. If any staff forgot to clock out of EVV, complete those. Make sure all of your EVV Visit information is cleaned up and complete before you do the process below.
2. Import Visit Charges: if you have not already imported the visit charges for the EVV date you want to send, we recommend doing that. We also recommend re-checking the import for the same dates to make sure you didn't miss anything.
3. Go to Billing > HIPAA Transactions > HHAeXchange/CareBridge. Please note that if you have not supplied Barnestorm with your HHAeXchange sftp credentials, you need to do so before this will work! There is a button on this screen (upper right) that allows you to add/change them in Barnestorm.
4. Change the from and thru date to match the dates you've cleaned up and prepared in EVV Visits.
5. Click the Select EVV Visits button.
6. If there are any issues, an error report will pop up. Print or save this so you can solve those issues and send those visits later.
7. The visits that are ready to send will appear in the main part of the screen.
IMPORTANT: Look these over, because if there are issues, you need to go back to EVV Visits and fix them before you complete the rest of this process!
8. Click the button to Prepare the Import File. What this does is takes all the EVV info on the screen and prepares a file that will go to HHAeXchange in the format they need to import the EVV visits.
9. A pop-up will appear. NOTE: If you click Yes, the file you created will automatically be sent to HHAeXchange right now. If you click No, the file was still created but will not send. So, if you're ready to send the info to HHAeXchange, click Yes.
You have complete the process to upload your EVV visits to HHAeXchange. The file gets sent to HHAeXchange automatically. HHAeXchange takes 24-48 hours to process files. They do not provide a response unless there is an error.
To check your visits, wait 24-48 hours and then check the HHAeXchange portal.
To re-send visits that were sent incorrectly: Pull up the dates, click the Send as Adjustments box, and Prepare the Import File, click Yes to send.
Common Issue: Overlapping Times
Overlapping times on the same day (example 1pm-4pm and 4pm-7pm) are not allowed and will reject
Should be 1pm-3:59pm, 4pm-7pm--must edit for these to be accepted.
Common Issue: Visit crosses midnight
HHAeXchange does not allow visits that cross midnight. These should be split into two visits, and the aide plan should be split as well.
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Health plans
For health plan questions, or to learn more about covered services, contact the health plan.
WellCare (Standard Plan)
wellcarenc.com
WellCare is offered statewide.
UnitedHealthcare Community Plan (Standard Plan)
uhccommunityplan.com/nc
UnitedHealthcare Community Plan is offered statewide.
Healthy Blue (Standard Plan)
healthybluenc.com
Healthy Blue is offered statewide.
AmeriHealth Caritas (Standard Plan)
amerihealthcaritasnc.com
AmeriHealth Caritas is offered statewide.
Carolina Complete Health (Standard Plan)
carolinacompletehealth.com
Carolina Complete Health is a provider-led entity offered to people who live in these counties: Alamance, Alexander, Anson, Bladen, Brunswick, Cabarrus, Caswell, Catawba, Chatham, Cleveland, Columbus, Cumberland, Durham, Franklin, Gaston, Granville, Harnett, Hoke, Iredell, Johnston, Lee, Lincoln, Mecklenburg, Montgomery, Moore, Nash, New Hanover, Orange, Pender, Person, Richmond, Robeson, Rowan, Sampson, Scotland, Stanly, Union, Vance, Wake, Warren, Wilson.
Alliance Health (Tailored Plan)
alliancehealthplan.org
Alliance Health is available in these counties: Cumberland, Durham, Johnston, Mecklenburg, Orange, Wake.
Eastpointe (Tailored Plan)
eastpointe.net
Eastpointe is available in these counties: Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Warren, Wayne, Wilson.
Partners Health Management (Tailored Plan)
partnersbhm.org
Partners Health Management is available in these counties: Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union, Yadkin.
Sandhills Center (Tailored Plan)
sandhillscenter.org
Sandhills Center is available in these counties: Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond, Rockingham.
Trillium Health Resources (Tailored Plan)
trilliumhealthresources.org
Trillium Health Resources is available in these counties: Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Gates, Halifax, Hertford, Hyde, Jones, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, Washington.
Vaya Health (Tailored Plan)
vayahealth.com
Vaya Health is available in these counties: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, Yancey.
The Eastern Band of Cherokee Indians (EBCI) Tribal Option
ebcitribaloption.com
The EBCI Tribal Option is for federally recognized tribal members or others who qualify for services through Indian Health Service (IHS) and live in Buncombe, Clay, Cherokee, Graham,Haywood, Henderson, Jackson, Macon, Madison, Swain or Transylvania counties. As a member of the EBCI Tribal Option, you can get services from any NC Medicaid provider.
NC Medicaid Direct
bit.ly/NCBeneficiaryPortal
NC Medicaid Direct is for members who qualify.
Other resources
NC Medicaid Contact Center
Phone: 1-888-245-0179
Website: medicaid.ncdhhs.gov/contact
NC Medicaid Ombudsman
Phone: 1-877-201-3750
Website: ncmedicaidombudsman.org
North Carolina Medicaid Application
Website: medicaid.ncdhhs.gov/medicaid/get-started/apply-for-medicaid-or-health-choice