Download - HHAeXchange 3rd Party EVV File

MatrixCare Home Care

HHAeXchange 3rd Party EVV File

User Guide

Version: 2018 R12 SP1

MatrixCare™ Home Care HHAeXchange 3rd Party EVV File User Guide

This document was written for use with MatrixCare Home Care 2018 R12 (V1.63) or greater.

© February 2020 MatrixCare is a registered trademark of MatrixCare. All rights reserved. Other

products are trademarks or registered trademarks of their respective holders.

This document and the software it represents are the exclusive property of MatrixCare.

Information in this document is subject to change without notice. The software described in this

document is furnished under a license agreement or nondisclosure agreement. The software

may be used or copied only in accordance with the terms of those agreements. No part of this

publication may in whole or in part be reproduced, stored in a retrieval system, or transmitted in

any form, or any means electronic or mechanical including photocopying and recording for any

purpose other than the purchaser’s personal use without prior consent, in writing, from

MatrixCare.

Companies, names, and data used in examples herein are fictitious unless otherwise noted.

MatrixCare 11555 Heron Bay Blvd

Suite 301 Coral Springs, FL 33076 Support: 561-447-7111

Support E-mail: [email protected]

Main: 561-447-7111 Fax: 954-827-0558

URL: http://www.matrixcare.com

mailto:[email protected]

http://www.matrixcare.com/

© 2020 MatrixCare, Inc. All Rights Reserved, For Licensed MatrixCare Users Only i

Table of Contents

HHAeXchange 3rd Party EVV File User Guide ........................................................................ 1

Setup Considerations ................................................................................................... 1

Initial Office Level Configuration Fields .................................................................... 1

Initial Payer Configuration Fields .............................................................................. 2

Initial/Ongoing Client Configuration .......................................................................... 3

Payer Configurations to Avoid .................................................................................. 3

Permission Configuration ......................................................................................... 4

HHAeXchange 3rd Party EVV File ............................................................................... 5

Configure the SFTP Client ....................................................................................... 7

HHAeXchange 3rd Party EVV File – Example Schedules and Resulting Extract File ... 7

Items to Note in the Extract File ............................................................................... 8

HHAeXchange 3rd Party EVV File – Example Multiple Service Schedules and Resulting

Extract File ................................................................................................................... 9

Important Points ......................................................................................................... 10

HHAeXchange EVV 3rd Party File – Extract Contents................................................ 10

© 2020 MatrixCare, Inc. All Rights Reserved, For Licensed MatrixCare Users Only 1

HHAeXchange 3rd Party EVV File User Guide

MatrixCare Home Care interfaces with HHAeXchange, the provider selected by PA Medicaid MCOs as

well as several FL Medicaid MCOs. Agencies may utilize the MatrixCare Home Care Mobile solution for

both EVV and clinical needs. MatrixCare Home Care provides an extract which combines EVV, billing,

and demographic data, and when uploaded to HHAeXchange, provides the data necessary for

HHAeXchange to create the electronic claims and submit those claims to the PA MCOs.

Agencies utilizing the MatrixCare Home Care 3rd party file will:

• Complete initial setup of important areas of MatrixCare Home Care required for the

HHAeXchange 3rd party file.

• Capture clock in, clock out, and telephony or GPS data via caregivers utilizing the Mobile

solution.

• Create and finalize invoices in MatrixCare Home Care (allows for future posting of remittance to

track A/R).

• Extract the 3rd party file in csv format from Finalized Invoices and send via an FTP client to

HHAeXchange.

Once HHAeXchange has processed all the data and any agency remediation of that data is complete,

the HHAeXchange system will generate and send the resulting 837s to the PA MCOs. In time, the remit

will pass to the agency, and the remit may be imported into MatrixCare Home Care for auto-posting.

If your agency is interested in utilizing this solution, please contact Implementation at 561-447-7111.

Setup Considerations For the HHAeXchange EVV 3rd party file to extract properly, it is important to ensure that user-entered

data is present prior to extracting the file. Listed below are specific fields which must be configured in

different areas of MatrixCare Home Care. Keep in mind that the Office and Payer configurations will

likely be completed once, but Client data will be continually entered as clients commence service.

Initial Office Level Configuration Fields

• Billing tab – Tax ID Number

2 © 2020 MatrixCare, Inc. All Rights Reserved, For Licensed MatrixCare Users Only

Initial Payer Configuration Fields

• Billing tab – Bill Type CMS 1500 V02-12 Split at Midnight

• EVV tab – Payer ID as it appears in the EDI Code Table document from HHAeXchange.

• Payer Services tab – Enter the HCPCs and Modifiers as needed for all services provided.

Check the EDI Code Table Guide (for the appropriate state) published by HHAeXchange for a

listing of HCPCs and modifiers accepted by payers.

• Bill Rates tab – Enter bill rates for all services provided.

• EDI Settings tab – EDI Type HHAeXchangeEVV


Initial/Ongoing Client Configuration

While certain client information is required, keep in mind that authorizations do not pass in the

HHAeXchange 3rd party file. The HHAeXchange system receives the authorization information directly

from AHCA and compares the data sent against those authorizations. MatrixCare Home Care

recommends that users still enter in authorizations in MatrixCare Home Care to ensure that clients are

not scheduled outside of authorization.

• Main tab – First and Last Name, HIC #

Payer Configurations to Avoid

There are certain configurations which should not be used in conjunction with the HHAeXchange EVV

3rd party file.

• The Medicaid payer should be configured as the sole payer with a Balance payment allocation

on both the Client Payer and Admission Payer tabs. Additionally, each Client Payer tab should

have the ExcludeHoliday field checked so that holidays from the Office Holidays tab will not be

billed to this payer.

• The Medicaid payer should be configured so the invoices do not split by shift, and the Group By

should be set to Group by HCPC and Day.


• Non-working hours (Schedule Bill Info tab) should not be used for Medicaid clients.

Permission Configuration

In order for users to view the Payers EVV tab, ensure that these users have the permission

Payers.EVV added to the appropriate Permission Groups.


HHAeXchange 3rd Party EVV File Once the services have been provided with clock in/out captured via Mobile or Telephony and the

invoices finalized, the HHAeXchange 3rd Party file can be extracted from MatrixCare Home Care and

sent via ftp to HHAeXchange.

In Finalized Invoices, select the finalized batch, select the payer from the Payer to Extract drop down

and click Extract.


The Save File dialog box will appear, and the file name will default to the required format

EDI_AgencyTaxID_YYYYMMDDHHMMSS where:

• AgencyTaxID is the Tax ID from the Office Billing tab.

• YYYYMMDDHHMMSS is the date and time stamp from the time the file is saved.

Click Save to save the csv file.

Once the file is saved, the file must be sent via SFTP to HHAeXchange.


Configure the SFTP Client

Upon registering with HHAeXchange, agencies should receive a SFTP user name and password.

HHAeXchange 3rd Party EVV File – Example Schedules and Resulting Extract File In this scenario, there are varied types of schedules and EVV combinations for the client.

• November 12: Two schedules with different services provided.

• November 13: Two schedules with the same service provided.

• November 14: One schedule (bill flag Hourly) spans midnight into November 15.

• November 15: One schedule (bill flag Visit) spans midnight into November 16.


Items to Note in the Extract File

EVV Start/End Times and Corresponding Telephony/Longitude and Latitude Values

• On 11/12 and 11/13, the caregiver failed to check in. The EVV Start Time for those two dates of

service are blank (Column P – boxed in red), as are the corresponding fields in Columns T, U

and V (also boxed in red). No Clock In Phone Number nor Latitude/Longitude values are

captured.

• On 11/13, the caregiver the caregiver failed to check out. The EVV End Time for this date of

service is blank (Column Q – circled in green), as is the corresponding field in Columns X, Y

and Z (also circled in green). No Clock Out Phone Number nor Latitude/Longitude values are

captured.

Schedules with Hourly Bill Flag Crossing Midnight

When a schedule with an Hourly Bill Flag crosses over midnight, the schedule is manually broken out

into two separate schedules.

The original schedule (11/14 from 7p-7a) has broken out into two separate schedules: 11/14 from 7p-

12a and 11/15 from 12a-7a.

• Schedule ID: The first part of the original schedule has an _1 appended to the Schedule ID (J6

– circled in green) while the newly created part of the schedule is appended with _2 (J7 – also

circled in green) so that all Schedule IDs are unique.

• Schedule Start/End Time: Both schedules retain the originally scheduled times – Start Time of

11/14 at 7p and End Time of 11/15 at 7a (Rows 6 and 7, Columns L and M – boxed in red)


• Visit Start/End Time: These fields represent the billing times for both schedules and reflect the

break at midnight (Rows 6 and 7, Columns N and O - boxed in blue).

• EVV Start/End Time: These fields display both the actual clock in/out times of the caregiver

(19:01p and 7:03a) on both sections of the 12-hour overnight schedule.

Note: Row 8 displays an overnight schedule with a Visit Bill Flag (red arrow). Schedules billed

by the Visit are not broken out when crossing over midnight.

• Invoice Line Item ID: The first half of the overnight schedule (boxed in orange) displays the

Invoice Line Item ID 73186 and the second half of the overnight schedule (boxed in purple)

displays 73187. The Invoice Line Item ID will be different for these two schedules because they

fall on two separate days.

HHAeXchange 3rd Party EVV File – Example Multiple Service Schedules and Resulting Extract File In this scenario, the client received both Personal Care and Homemaker services. The service was

scheduled from 8:00 AM through 10:00 AM using the Multiple Service code PC-HMK, and the individual

services of Personal Care and Homemaker were noted on the Multiple Services tab of the schedule.

The caregiver utilized Mobile for check in and check out, and the GPS location was captured for both.

The schedule was billed and HHAeXchange file was extracted. Of note in the extract file:

• The Schedule IDs for both the individual services share the original Schedule ID with an

appended _1, _2.

• The Schedule Start and End Times for both individual services display the original scheduled

time for the multiple service schedule (8:00 AM through 10:00 AM).

• The Visit Start and End Times for both individual services display the actual billed time for each

service (1 hour each).


• The EVV Start and End Times for both individual services display the original clock in at 8:05

AM and the clock out at 10:01 AM.

Important Points 1. There are no file edits to keep users from entering in incorrect data. Users must take care to

correctly enter such data as the Payer Number, HCPC/Modifiers, and Client HIC Number.

2. All Schedule IDs will be appended with _1, _2, etc. to ensure that all Schedule IDs remain

unique.

3. Agencies should upload the HHAeXchange file early in the day, to ensure they have proper time

to remediate any issues prior to the nightly sweep for files.

4. Agencies should NOT open or save the extract file in Excel. (This document does so for ease of

viewing the file.) This will result in formatting changes which will render the file unusable for

upload to HHAeXchange.

HHAeXchange EVV 3rd Party File – Extract Contents The following chart displays the data that pulls to the HHAeXchange EVV 3rd Party file.

Field Name MatrixCare Home Care Location Location/Notes

Agency Tax ID Office Billing tab Tax ID Number

field

Column A

Payer ID Payer EDI tab Column B – Values should be selected from the EDI Code Table Guide from HHAeXchange.

Medicaid Number Client Main tab HIC # field Column C – Member identifier/Medicaid Number

Caregiver Code Caregiver Main tab Column D – Caregiver System ID in MatrixCare

Caregiver First Name Caregiver Main tab Column E – Caregiver First Name

Caregiver Last Name Caregiver Main tab Column F – Caregiver Last Name

Caregiver Gender Not passed in extract.

Caregiver Date of Birth Not passed in extract.

Caregiver SSN Not passed in extract.

Schedule ID Schedule Record Info tab Column J – Unique Schedule ID from MatrixCare, appended with _1, _2, _3 etc. for breaks in the schedule due to Multiple Services or the date of service passing over midnight.



Procedure Code HCPC plus modifiers from invoice detail which pull from Payer’s Payer Services tab

Column K – passes both HCPC and modifier with no spaces

Schedule Start Time Schedule Info tab (individual schedule)

Column L - Historical/Scheduled Start Date and Time of client schedule

Schedule End Time Schedule Info tab (individual schedule)

Column M - Historical/Scheduled End Date and Time of client schedule

Visit Start Time Invoice Detail Column N - Service Start Date and Time (clock in) used for billing

Visit End Time Invoice Detail Column O - Service End Date and Time (clock out) used for billing

EVV Start Time Telephony Call Log Column P - Displays the clock in time of the caregiver when recorded by EVV or IVR. This field is blank when no clock in is recorded.

EVV End Time Telephony Call Log Column Q - Displays the clock out time of the caregiver when recorded by EVV or IVR. This field is blank when no clock out is recorded.

Service Location Not passed in extract.

Duties Not passed in extract.

Clock-In Phone Number Telephony Call Log Column T - Phone number captured when clock in is via telephone.

Clock-In Latitude EVV Latitude collected but not displayed in UI

Column U - GPS latitude of service location clock in recorded by EVV system. Empty if GPS data was not captured or IVR was utilized.

Clock-In Longitude EVV Longitude collected but not displayed in UI

Column V - GPS longitude of service location clock out recorded by EVV system. Empty if GPS data was not captured or IVR was utilized.

Clock-In EVV Other Info Not passed in extract.

Clock-Out Phone Number

Telephony Call Log Column X - Phone number captured when clock out is via telephone.

Clock-Out Latitude EVV Latitude collected but not displayed in UI

Column Y - GPS latitude of service location clock out recorded by EVV



system. Empty if GPS data was not captured or IVR was utilized.

Clock-Out Longitude EVV Longitude collected but not displayed in UI

Column Z - GPS longitude of service location clock out recorded by EVV system. Empty if GPS data was not captured or IVR was utilized.

Clock-Out EVV Other Info

Not passed in extract.

Invoice Number Invoice Details Column AB - Displays Invoice Number attached to date of service

Visit Edit Reason Code Not passed in extract.

Visit Edit Action Taken Not passed in extract.

Notes Not passed in extract.

Is Deletion Not passed in extract.

Invoice Line Item ID Invoice Group ID not visible in MatrixCare UI.

Column AG - Displays InvoiceGroupID,

which allows for proper posting of

corresponding 835.

Missed Visit Not passed in extract.

Missed Visit Reason Code


Missed Visit Action Taken Code


Timesheet Required Not passed in extract.

Timesheet Approved Not passed in extract.

User Fields 1-5 Not passed in extract.