Manage Patient Authorizations (Blended Services)

This topic provides instructions and best practices to manage both PA and PCA Patient authorizations in two different offices. Herein are two separate Workflows; one for Merged Patient Profiles and one for Un-Merged Patient Profiles, both addressing with the following common scenarios.

Scenario

Description

1

A Patient who currently receives PCA services would also need to be set up to receive PA services. Note: This applies to Providers set up with two offices.

2

Terminating PCA services for a Patient to begin PA services.

For this Workflow, the following is established:

  • The Patient is serviced by an Agency in HHAeXchange under the merged UPR linked Elderplan MJHS contract in their PCA office.

  • The Payer (Elderplan Team) creates a PA authorization and places it with the Agency’s PCA office.

  • Providers assign the Elderplan UPR Internal Contract to the PA authorization.

Patients’ PCA authorizations continue to be managed via the Elderplan MJHS Linked contract.

Complete the following steps to add the Elderplan Internal Contract.

  1. Go to Patient > Patient Search to locate the Patient. Select Contracts from the left navigation index to open the Patient Contracts page.

  2. On the Patient Contracts page, click the Add button.

    Adding a Contract to a Patient Profile

  3. The Contracts window opens. Complete the required fields.

    Entering a New Contract

    Field

    Description

    *Contract

    Select the applicable Contract (example: Elderplan MJHS Internal).

    *Service Start Date

    Enter or select the Service Start Date

    The remaining fields are optional. Enter/select if applicable.

  4. Click Save to add the Contract.

  5. Once saved, both Contracts (the UPR Linked Elderplan MJHS and the Internal).

    Internal Contract Added to Patient Profile

Once the Contract is created, an Authorization is needed. Complete the following steps to create an Authorization.

  1. Go to the Patient Profile and select Authorizations/Orders from the left navigation index.

  2. On the Authorizations page, under the Authorizations tab, click the Add button.

    Adding an Authorization

  3. The Authorization window opens. Complete the required fields.

    Creating an Authorization

    Field

    Description

    *Contract

    Select the Contract (for example, Elderplan MJHS Internal).

    *Discipline

    Select PA

    *Authorization Number

    Create an Authorization Number for the Internal contract.

    *From/To Dates

    Select/Enter the date range for the contract.

    All remaining fields are optional. Enter/Select if/as needed.

  4. Click Save.

    Once saved, both Authorizations (the UPR Linked Elderplan MJHS and the Elderplan MJHS Internal) appear on the Patient’s Authorizations page.

    Saved Authorizations on the Patient Profile

Now that the Internal Contract and an Authorization have been assigned to the Patient, adjust the Master Week under Patient > Masterweek to update visits from the UPR Linked Elderplan MJHS contract to the Elderplan MJHS Internal contract.

Patient Master Week

Once the process above is complete, the Agency continues to follow the normal steps to service the Patient in the HHAeXchange system using the Internal contract.

When invoicing for the Elderplan Internal contract, the Agency exports the claim file and uploads to the applicable contracted clearinghouse. This is the process followed prior to Elderplan’s Go Live of 12/6/2020 in HHAeXchange internal contract workflow.

For this Workflow, the following is established:

  • The Patient currently receives PCA services and would also like to receive PA services, under a separate Patient Profile.

  • Patients are not merged and are serviced by the Agency in HHAeXchange under a UPR Linked Elderplan MJHS contract in their PCA office.

  • The Payer (Elderplan Team) creates a PA authorization and places it with the Agency’s PCA office.

The Agency generates a Patient search, selecting the Elderplan Internal under the Contract field and Discharged under the Status field.

  • If the Patient appears with a DischargedStatus, then activate the Patient.

  • If the Patient does not exist under the Internal contract, then create a New Patient record as well as an Authorization.

In this case, the Agency follows their normal process to service the Patient in HHAeXchange for an Internal contract.

When invoicing for the Elderplan Internal contract, the Agency exports the claim file and uploads to the contracted clearinghouse. This is the process followed prior to Elderplan’s Go Live of 12/6/2020 in HHAeXchange internal contract workflow.