Trusted EVV-Compliant Home Care Software Partner That Helps You Get Paid Faster

• Rosemark integrates with both HHAeXchange and Sandata, the 2 aggregators for Pennsylvania EVV
• HHAeXchange sends the EVV data to Sandata as EDI files. These claims bill through MCOs via HHAeXchange.
• Certain waivers (ACT150, DDD) process EVV directly through Sandata.
• All Sandata services bill through the Pennsylvania state site’s portal, Promise.
• For HHAeXchange, ALL shifts that cross MIDNIGHT must be split, per HHAeXchange’s system requirements.

Pennsylvania requires all home care agencies billing Medicaid to include the following profile data for each client:

• First and Last Name
• Medicaid Number
• Birthdate
• Primary ICD 10 Diagnosis Code
• MCO and Procedure Code

Home care agencies in Pennsylvania are required by the state to include the following caregiver information:

• First and Last Name
• Birthdate
• Social Security Number
• Email address
• Caregiver ID #

• For HHAXeXchange Service Providers

  • Register with the state to provide Medicaid services
  • Receive a Medicaid provider ID and services/procedure codes of the type of care they are authorized to provide
  • Have software that integrates with the aggregator
  • Get a client
  • Set up client details and schedule
  • Record EVV
  • Send EVV and billing info to HHAeXchange
  • HHAeXchange processes billing
  • The state releases remittance reports and disburses money

   

  For Sandata Service Providers

  • Register with the state to provide Medicaid services
  • Receive a Medicaid provider ID and services/procedure codes of the type of care they are authorized to provide
  • Have software that integrates with Sandata
  • Get a client
  • Set up client details and schedule
  • Record EVV
  • Send EVV info to Sandata
  • Record your billing through the Promise Portal
  • The state releases remittance reports and disburses money

Based on the Pennsylvania specs for building the integration, customers who have gone through audits, and working with HHAeXchange and Sandata for years, Rosemark’s Customer Success Team knows some best practices for home care agencies in Pennsylvania:

• Keep manual edits to Visits under 15% of all your total visits.
• When making a manual edit to a visit, choose a Reason Code that best matches the situation. For example:
  • Did the caregiver simply forget to clock in/out?
  • Or was there a problem with the visit?
• The Reason Code and note section are very important when making manual edits to visits, especially if your agency were to be audited. Be sure to keep detailed notes.
• Special documentation for manual edits to visits are required! This can be documentation of a phone call to the client verifying the visit was worked, a signed timesheet by the client, or – best case scenario – both.
  • If you’re audited, remember this: In the state’s eyes, if it isn’t documented, it didn’t happen.
• It’s always better to have EVV by the caregiver, even if, for example, the caregiver clocked out hours late because they forgot.
• To stay compliant, it is crucial to manage missing EVV and visit errors on a daily basis.