Auto-Placement by Service Code

The Auto-Placement by Service Code feature allows Providers to schedule and bill for services that do not require prior Payer authorization. When this feature is enabled by the Payer, the Allow Auto Placement checkbox field displays selected in the Contract Service Code window under Admin > Reference Table Management > Contract Service Codeas read-only.

Payers provide a list of eligible Service Codes that can be used to perform an Auto Placement. Once the Service Code is created and synced from the Payer system, Providers can create a new contract for a Patient.

Complete the following steps to create an Auto Placement for a Member.

1. Go to Member > Member Search to locate the Member.

   If a Member does not exist in the system, then go to Member > New Member to create a New Member Profile.

   Refer to New Patient for guidance and requirements.

   The Medicaid Number MUST be entered for a successful placement.

2. Select the Contracts link from the index to open the Contracts page. On the Contracts page, click the Add button to add a contract.

   

3. On the Contracts window, complete the required fields (Contract and Service Start Date) as well as the optional fields to include the applicable Service Code. Click Save.

   

4. Once saved, the Contract appears on the Contract page, pending the Alt. Patient ID. Allow a few seconds, for the system to refresh. Click the Refresh Page button to refresh, as needed.

   

5. A populated Alt. Patient ID indicates a successful auto placement. When an auto placement is submitted, the system validates the Patient information (such as Patient Name, Medicaid ID, etc.) against the Payer Member data. Once verified, a placement confirmation is sent to the Provider.

   

6. If a diagnosis code is required on the claim, then add it on the Patient contract or on the invoice.

Eligible service codes for the Florida Agency for Health Care Administration (AHCA) are listed on the Florida Information Center. Select the AHCA Home Health Provers (FFS) page and scroll to the State of Emergency Service Codes section to view the eligible SOE codes.

The following tables include the eligible Service Codes per participating Payer.

NC HHCS Contracts require auto-placement for all service codes.

Contract	Service Code
AmeriHealth Caritas of North Carolina HHCS	57537
Carolina Complete Health HHCS	57535
UnitedHealthcare Community Plan of NC HHCS	57542
WellCare of North Carolina LTSS HHCS	57538
Alliance Health HHCS	57533
Partners NC PROD HHCS	57539
Trillium Health Resources HHCS	57541
Vaya NC HHCS	57543

The following tables include the eligible Service Codes per participating Payer.

The following steps apply to Third-Party EDI Providers to ensure that auto placements are successfully imported for a Member.

Providers do not need to verify the Member Demographics in the HHAeXchange portal before submitting the visit.

1. HHAeXchange receives the import file from the Payer either loaded into the Payer Portal or stored in a staging table.

2. The Provider imports visit records via the EVV API/ Flat File.

   The Medicaid Number, Office NPI, and Payer ID MUST be entered for a successful placement.

   If multiple offices share the same NPI, the provider must send the HHAeXchangeOffice ID in User Field 3 (reference Homecare EDI Import). If the vendor is unable to send User Field 3, the provider needs to follow the manual HHAeXchange workflow.

3. If the visit data is correct, then the visit imports successfully into the system. The Member Profile is created and a placement is generated between the Member and Provider.

   If a visit is rejected by the system, then there is an information mismatch preventing the record from linking to the data received from the Payer. Verify that all data is entered correctly, and that the Office NPI value is included in the import.