Prebilling Overview

Prebilling is one of the Exception pages in the HHAeXchange system. The Exception pages are automated auditing processes which ensure that visits with missing or incorrect information do not get invoiced and billed.

On the Prebilling page, visits are checked to ensure all validation requirements established by the Payer are met. If a visit does not meet all the validation requirements, it is held until the issue is manually corrected. Visits held on any of the exception pages cannot be processed for billing or payroll.

The Prebilling page automatically reviews all scheduled visits and those that do not meet the validation requirements set forth by the Payer are held here. Validation requirements vary from Contract to Contract. The following image provides a high-level view of the Prebilling Review process in HHAeXchange.

Key Terms and Definitions Closed

Term	Definition
Patient	Refers to the Member, Consumer, or Recipient. The Patient is the person receiving services.
Caregiver	Refers to the Aide, Homecare Aide, Homecare Worker, or Worker. The Caregiver is the person providing services.
Provider	Refers to the Agency or organization coordinating services.
Payer	Refers to the Managed Care Organization (MCO), Contract, or HHS. The Payer is the organization placing Patients with Providers.

Texas Key Terms and Definitions Closed

The following table cross references terms from HHAeXchange with the equivalent term in Texas Health and Human Services Commission (HHSC) Electronic Visit Verification (EVV) policy.

Terms marked with an asterisk can be configured in HHAeXchange via the HHAeXchange Support Team.

HHAeXchange Term	Texas Term	Definition
Billable Hours (Adjusted Hours)	Bill Hours	The EVV system calculates Bill Hours by subtracting the Bill Time In from Bill Time Out and rounding to the nearest quarter hour increment. Bill Hours represents the hours to be billed
Caregiver*	Service Provider or Consumer Directed Services (CDS) Employee	Service Provider: Person who provides an EVV service to a member and is employed by or contracted with a program provider. CDS Employee: Person who provides an EVV service to a member and is employed by a CDS employer.
Confirmed Visit	EVV Visit Transaction	Record generated by an EVV system that contains data elements for an EVV visit. Data elements include service authorization data, member data, service provider data, program provider or financial management services agency (FMSA) data, and EVV service delivery data.
--	Consumer Directed Services (CDS) Employer	Member or legally authorized representative (LAR) who chooses to participate in the CDS option and is responsible for hiring and retaining a service provider to deliver a Medicaid service.
Contract	Payer	Payers pay Medicaid claims, administer the EVV program and enforce EVV requirements. In Texas, the payers are HHSC and the Managed Care Organizations (MCOs).
Duty	Task	Activities of Daily Living that can be recorded as having been performed or refused during a visit.
EVV Call In	EVV Clock In	Date and time captured by HHAeXchange when the service provider/CDS employee uses an approved EVV method to document the beginning of service delivery.
EVV Call Out	EVV Clock Out	Date and time captured by HHAeXchange when the service provider/CDS employee uses an approved EVV method to document the end of service delivery.
Fixed Object (FOB)	Alternative Device	An HHSC-approved electronic device that allows a service provider or CDS employee to clock in and clock out of the EVV system from the member’s home.
IVR	Toll-free Number	Phone number service providers and CDS employees call to clock in and clock out with the landline and alternative device methods.
Manual Visit Confirmation	Manually Entered Visit	A visit transaction manually entered into the EVV system when the service provider or CDS employee fails to clock in or out of the EVV system or an HHSC-approved clock in or clock out method is not available.
Mobile Verification	Mobile Method	An HHSC-approved clock in and clock out method where the service provider or CDS employee uses the HHAeXchange-provided application, HHAeXchange+ Mobile App, to clock in and clock out of the EVV system during a service delivery visit.
New Reason	Reason Code	A Reason Code consists of a Reason Code Number and a Reason Code Description, and is used to indicate why the program provider, FMSA, or CDS employer is completing visit maintenance.
Office	Business Unit/Branch	A separate branch office, under the same or a different National Provider Identifier (NPI), associated with the same Provider Agency.
Passcode	Alternative Device Code	A code that is generated by the alternative device and identifies the precise date and time service delivery begins or ends.
Patient*	Member	Person eligible to receive Medicaid services requiring the use of EVV.
Plan Code	Managed Care Plan Code	Code to identify a specific payer/ managed care organization.
Provider/Agency*	Program Provider or Financial Management Services Agency (FMSA)	Program provider: Entity that contracts with HHSC or a managed care organization (MCO) to provide an EVV service. FMSA: Entity that contracts with HHSC or an MCO to provide financial management services to a CDS employer.
Representative	Designated Representative (DR)	A willing adult designated by the CDS employer to help meet or perform CDS employer responsibilities.
Scheduled Visit	Pending Visit	A visit that has been scheduled in the EVV system, but has not yet been performed.
Secondary Identifier	Atypical Provider Identifier (API)	Unique number assigned to a program provider or FMSA instead of a National Provider Identifier (NPI) number. The Centers for Medicare and Medicaid Services (CMS) defines atypical program providers as a program provider or FMSA that does not provide healthcare.
Service Code	Healthcare Common Procedure Coding System (HCPCS code)	A collection of codes that represent procedures and services provided to individuals, based on the American Medical Association’s Current Procedural Terminology (CPT).
Service Location or Visit Location	Service Delivery Location	Location where EVV-required services were provided.
Shift	Visit	Time elapsed between the time the service provider clocked in for service delivery using an HHSC-approved method and the time the service provider clocked out for service delivery using an HHSC-approved method.
UPR	---	Universal Patient Record (Linked Contract Patient)
Visit Start Time	Bill Time In	The time the service provider clocked in for service delivery using an HHSC-approved clock-in method. If the EVV clock in time is not captured by an approved clock in method, it must be entered in this field after the visit (visit maintenance) and a reason code is required. Format: HH:MM AM/PM.
Visit End Time	Bill Time Out	The time the service provider clocked-out for service delivery using an HHSC-approved clock in method. If the EVV clock out time is not captured by an approved clock out method, it must be entered in this field after the visit (visit maintenance) and a reason code is required. Format: HH:MM AM/PM.