Provider Setup

HHAeXchange manages the initial linking of Payers and Providers. When a link has been established, information is exchanged between the Payer and Provider systems, including billing and service requirements set by the Payer using the Provider Setup function under Admin > Provider Setup.

In order to access Provider Setup in the new Payer Portal, Provider Setup and Search Provider permissions must be granted to the user via the Edit Roles page under Admin > User Management > Edit Roles > Admin.

Authorized users can add and delete Provider Serviced ZIP Codes under Admin > Provider Setup > Profile.

Provider Information page, Service ZIP Codes section, showing Add Serviced ZIP Code button (at right) and Remove function (from Actions menu below) highlighted

By clicking Add Serviced ZIP Code at right, authorized users can add one or more ZIP Codes (separated by commas) to a Provider at a time.

Add ZIP Code page, shown blank

By clicking the Ellipsis … in the Serviced ZIP Code’s Actions column and selecting Remove, authorized users can delete a Serviced ZIP Code from a Provider.

Confirm Deletion page

Authorized Payers can review and edit billing and service requirements for all linked Providers at any time. Follow the steps below to search, view, and edit Provider information.

  1. From the Admin menu, select Provider Setup.

  2. On the Search Provider page, use the search filters to locate a specific Provider or leave them blank to search for all Providers. Click Search.

    Provider page, Search Provider function shown blank

    National Provider Identifier has been added as a Provider search filter.

  3. From the search results, click the Provider name to access the Provider Info page.

  4. On the Provider Info page, Payers can view various Provider functions, described below.

    Provider Info page showing sample Provider settings With Edit button highlighted at right

    • Provider Export Code - Used by HHAeXchange for billing purposes.

    • Payment Terms - Provider payment terms.

    • Service Types Performed - Types of cases (HHA, RN, OT, etc.) the Provider can cover. The Provider can only accept placements for cases that match these values.

    • Provider Tier - Used to broadcast Placements. For more information, see the topic Provider Tier in Provider Setup.

    • Update Rates to 0 after [text] Days - Number of days a Provider must bill a confirmed Visit before the associated billing rate is set to 0.

    • Serviced ZIP Codes - List of the ZIP Codes included in the Provider's service area. Authorized users can add and delete Provider Serviced ZIP Codes

    • Active for New Placements - Indicates that the Provider is actively managing and accepting cases.

    • Bill Visits without POC Compliance - Allow Visits that do not meet the set POC requirements to be billed.

    • Allow Provider to Update Billing Rates - Allow the Provider to edit Service Code Rate information (rates, date ranges, and billing units). Changes are displayed in Payer Portal as well as in the Provider application. Required in states where Plan Code Rates are created and maintained by the Provider.

    • Can Change Invoice Export Flag - Allow the Provider to manually change the Invoice Export Flag from Yes to No on their invoiced Visits. If allowed, the Provider can update Visit information and resubmit claims without Payer consent or HHAeXchange Support.

    • Use Provider Taxonomy Code - Allow the Provider to set a unique Taxonomy Code using the Reference Table Management Service Code function.

    • Use Provider Revenue Code - Allow the Provider to set a unique Revenue Code using the Reference Table Management Service Code function.

    • Restrict Rebilling of Original Claims - Restrict the Provider from sending original claims on the Resubmit Claims page.

    • Apply Monthly Guardrail Limits to Authorizations - Enable Guardrails for the Provider. When enabled, all Entire Period Authorizations for a Guardrails-enabled Provider use Guardrails unless they are explicitly disabled at the Authorization level.

    • Allow Provider to Initiate Placements - Allow the Provider to create its own Patient (Member) Placement records rather than depending on the Payer to create them. Provider-created Placements can be viewed but not changed in the Payer Portal.

  5. To change Provider functions, click Edit at right. Click Save when changes are completed.

    Edit Provider Information page showing sample Provider settings and Save button highlighted below

Rates determine how much a Provider bills a Payer for a specific type of service.

Payers can set up multiple, unique rates for every linked Provider on the Provider Info page.

When a Service Code with Plan Codes assigned to it is selected for use by a Provider, unique billing rates can be created for each Plan Code assigned to the Service Code.