Getting Started with EDI

Before setting up your integration, review your account details and make sure that all the information is accurate via Admin > Agency Profile and Admin > Office Setup.

If any of the information is incorrect, reach out to the HHAeXchange Support Team for assistance.

To set up your EDI vendor integration for the first time:

1. Add any team members who need access to HHAeXchange. The video below provides information on how to do that.

    

   User Management

   10 min.

2. Complete and submit the Third-Party Electronic Visit Verification (EVV) Attestation form. This can be found on your Provider Info Center page.

3. A ticket will be automatically created to set up your integration. Check your email and respond to any questions and/or requests from the team.

4. Testing may be required, depending on your vendor. This action is completed on the Vendor's side. If you do not require testing, continue with step 6.

5. Once your Vendor has completed the process (and testing, if applicable), open a new ticket to the HHAeXchange Support Team saying saying that your vendor has completed setup. Select Data & Integration for the ticket Category and 3rd Party Vendor Integration New for the Sub Category. Make sure to include your 3rd Party Vendor name (not your Payor), your Tax ID, and your Agency Name. The HHAeXchange Support Team will respond with your Production Credentials.

6. Contact your Vendor to find out how to send over Visits to HHAeXchange.

To set up your EDI vendor integration for the first time:

1. Add any team members who need access to HHAeXchange. The video below provides information on how to do that.

    

   User Management

   10 min.

2. Send your vendor the EDI Code Table for your state, the Homecare V5 Flat File Import Layout, and the Configuration and Requirements Tables for your state (if applicable). These topics contain important information to ensure your vendor sends the correct data to HHAeXchange.

3. Open a ticket to the HHAeXchange Support Team asking to set up your EDI integration. Select Data & Integration for the ticket Category and 3rd Party Vendor Integration New for the Sub Category. Make sure to include your 3rd Party Vendor name (not your Payor), your Tax ID, and your Agency Name. Check your email and respond to any questions and/or requests from the team.

4. Testing may be required, depending on your vendor. This action is completed on the Vendor's side. Please note that some vendors have already tested with us and will not require testing.

5. Create your SFTP account within HHAeXchange. For more information, see SFTP Setup.

6. Contact your Vendor to find out how to send over Visits to HHAeXchange.

An important part of making sure your EDI setup runs successfully is monitoring any rejected visits that come through.

To monitor rejections:

• For API Users: Visit Statuses are only visible from your Vendor's side. Contact your Vendor for more information.

• For V5 Flat File Users: In your HHAeXchange portal, go to Admin > EDI Tool to view rejections. For a comprehensive list of rejection reasons and how to solve them, see Homecare Common EDI Import Failures.

Billing in HHAeXchange has four stages:

1. Prebilling: Visits are checked to ensure all payer validation requirements are met. If you encounter prebilling holds as an EDI provider, make corrections in your EVV system and re-import the data. All import rejections need to be corrected and imported. For more information, see Review Billing on the Prebilling Page

   If your Visit is holding in Prebilling for any reason related to incorrect data being sent — such as incorrect codes or missing invoice numbers — reach out to your vendor to correct the information, and have them resubmit the data.

2. Invoicing: Visits are invoiced with the necessary export information for your payer. Invoice generation is automatic if all required data elements are imported. Refer to your state specifications for details.

3. Billing Review: Visits are checked against the Payer’s export requirements. If you encounter holds during this stage, correct the data in your EVV system and re-import it. For more information, see Billing Review.

4. e-Billing: Once Visits are cleared of holds, they are automatically batched and exported to the Payer or clearinghouse.

In the event that you need to rebill a claim, see Rebill - Claims Resubmission.

Make sure to track the status of your claims to see whether they have been accepted, denied, or are pending, to work for a timely follow-up and accurate reimbursement.

For more information, see View Claims Status.