Important Notification: New Changes to Personal Care Services and Home Health Services

Effective July 1, 2024, there will be significant changes to Personal Care Services (PCS) and Home Health Services (HHS) as North Carolina Medicaid launches new Medicaid LME payers. These changes will require your immediate attention to ensure compliance and uninterrupted service delivery.

NC Medicaid is launching Tailored Plans on July 1st - NC Medicaid is launching Tailored Plans on July 1st

New LMEs for Personal Care Services and Home Health Services Payer Codes: The following Local Management Entities (LMEs) are now integrated into the system:

• Alliance Health (Payer Code 892)
• Trillium Health Resources (Payer Code 894)
• Vaya Health (Payer Code 896)
• Partners (Payer Code 898)

These LMEs require Electronic Visit Verification (EVV) visits to be sent through HHAeXchange. PCS providers must start sending visits immediately, while HHS providers are encouraged to begin during this soft launch period.

Steps to Verify and Update Information

1. HHAeXchange Setup – Immediate Action Required - Monitor this step, it will need to be complete before sending EVV Visits to HHAeXchange

Log into your HHAeXchange portal and navigate to:

• Admin > Contract Setup > Search Contract
• Click Search to display your current contracts.

Verify that the new LMEs are listed. If not, contact the HHAeXchange helpdesk to add the contracts to your portal. It is crucial to complete this step promptly to allow sufficient time for the HHAeXchange team to update the information. CustomerLogin - Help Center - Jira Service Management (atlassian.net)

2. LME Portal 

If an LME portal account is not active, please create one for each payer. Each LME will have their own portal & process for signing up for the portal--please contact the LME for instructions & assistance on portal access. While HHAeXchange is supposed to forward the claim to the appropriate payer for adjudication, there are instances where this might not happen. In such cases, a claim generated from Barnestorm will need to be manually uploaded to the LME portal. 

Additionally, it is essential to review the priorauthorization guidelines for each payer to be prepared for future requirements.

3. Payer Verification – Eligibility Check

Run an eligibility check on all Medicaid patients. Ensure they have the correct Medicaid payer listed with an appropriate beneficiary ID on the Referral > Payers screen.

• Using Barnestorm: Follow your usual steps for NC Medicaid Eligibility checks. Compare checks for June and July 2024.
• Without Barnestorm: Utilize NC Tracks to run an eligibility batch.

Identify patients listed as NOT NC Medicaid Direct and verify their insurance internally.

4. Update Payer Information on Referral

Discharge the old payer and set the new one as the primary payer, keeping the old payer on the patient chart for historical billing and documentation. The discharged payer will need to reflect the correct discharge date, the last day of the month terminated. 

Example of what it should look like:

5. Aide Plan / Authorization Update - ** PCS customers **

Stop the aide plan with the discharged payer and copy the plan for the new payer. The stop date should be June 30, 2024 for patients with LME effective July 1. 

Update the authorization screen with entries for the new payer without editing or removing existing entries.

Example of what it should look like - New plan on top and old plan on the bottom

6. Visit Corrections Fix Payer / Job Code / Chart Number (Correct, Fix Chart, Fix Job Code, Fix Payer, Instructions, Visits / Assessments) (barnestorm.biz)

If visits are logged under the incorrect payer, update them as follows:

• Go to Employee Activity > Fix Payer/Job Cd/Chart#
• LEFT SIDE: Select the patient and the discharged payer.
• Choose the job code if necessary (typically only CAP/PCS).
• Set the from date for visits needing updated to 7/1/2024.
• Click Find All Visits Like This.
• RIGHT SIDE: Select the new payer and job code if necessary (typically only CAP/PCS).
• Click And Change Them to This and confirm any pop-up windows.

7. Billing Process - continue to complete your regular internal billing audits, including import visit charges

A) **Step 1 above will need completed before EVV Visits will attempt to import**

Use Billing > HIPAA Transactions > HHAeXchange/CareBridge to send EVV visits through HHAeXchange. Monitor the response file to verify success. EVV - Prepare and Send EVV Visits to HHAeXchange (barnestorm.biz)

B) Create claims from the All Other Billing screen and upload them to the LME following their specific instructions.

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---> Troubleshooting

When submitting the HHAeXchange EVV Visits file for a new payer, you may encounter the following issue:

'Payer is not configured for EDI Billing Rates. Please contact EDI Support to configure payer for EDI Billing Rates'

To resolve this, submit a new ticket to HHAeXchange, including the error message, and request assistance in setting up the billing rates. Once the update is confirmed, you can resend the EVV Visits file. Customer Login - Help Center - Jira Service Management (atlassian.net)