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Horizon EVV Integration OverviewOct 23rd, 2020Horizon BCBSNJ – Government Programs1This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission
ObjectivesOverview Description of 21st Century Cures Act RequirementsClassification of Providers Impacted.Codes that require EVV ValidationPathways for EVV Providers to communicate EVV Data.Data Flow and No Wrong Door PolicyEVV Survey completion due October 2, 20202This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission2
Scope of Impacted Providers The 21st Century Cures Act mandates that, States require use of ElectronicVisit Verification (EVV) for Medicaid-funded Personal Care Services (PCS) andHome Health Services (HHCS) for in-home visits by a provider. Providers include home health agencies, personal care service agencies,home based supportive care and respite provides. Providers are required to implement EVV for PCS by 01/01/2021 and forHHCS by 01/01/23. The Cures Act requires the following data be contained for personal careservices: Date of service; location of service; individual providing service;type of service; individual receiving service; and time the service begins andends. HNJH’s current program supports EVV data but also relays data forcare plan compliance, collaboration on HEDIS care gaps and care plancompliance.3This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission3
Codes Requiring EVVServicePersonal Care Assistance 15MUnit of Service15 MinutesProcedure CodeT1019Personal Care Assistance Group15 MinutesT1019 HQPersonal Care Assistance PDPer DiemT1020Personal Care Assistance (Self Directed) Individual15 MinutesT1019 SEPersonal Care Assistance (Self Directed) Individual Agency15 MinutesT1019 SE UIPersonal Care Assistance Group (Self Directed) Group15 MinutesS5125 SE HQPersonal Care Assistance (Self Directed) Group Agency15 MinutesS5125 SE U3MLTSS Home Based Supportive Care15 MinutesS5130MLTSS Home Based Supportive Care - Self Directed15 minutesS5130 HQMLTSS In Home RespiteDDD Individual SupportsDDD Individual SupportsDDD Individual SupportsDDD In Home RespiteDDD In Home Respite15 Minutes15 minutes15 minutes15 minutes15 minutes15 IU8DDD Community Based Supports15 minutesH2021HIDDD Community Based Supports15 minutesH2021HI22DDD Community Based Supports15 minutesH2021HI524This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission4
Data TransmissionEVV data will flow from the provider to the state’s aggregator “HHA”. The state hasadopted a “no wrong door policy” in which data is forwarded to the State’s identifiedaggregator, HHA: Data may be sent using the following options: Directly by providers using HHA software Indirectly through EVV and aggregation software that may be provided byan MCO (e.g. CareBridge/Sinq). Any other alternative software capable of collecting and transmitting data toHHA in accordance with the required format specifications; includingindependent software providers or software developed internally orindependently by the provider. Your independent software provider mustwork through data transmission and integration with HHA.Your EVV software provider will need to work with HHA to set up data transmission:Please contact: edisupport@hhaexchange.comData will be aggregated by HHA for all MCOs and pushed back to MCOs via a dailyupdate. H5This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission5
EVV Survey Requested In cooperation with the New Jersey DMHAS, all MCOs sent out arequest to participating providers to complete a survey regardinghow providers will collect and implement data transmission to thestate’s aggregator HHA.The survey requests information about the software platform you willbe using to collect and transmit data to HHA.Providers only need to complete the survey once, even though theymay have received requests as a participating provider in multipleMCOs.The initial request was sent out by MCOs to participating providersin their network in mid-September and completion was requested byOctober 2, 2020.If you have not yet completed the questionnaire, please do so assoon as possible by accessing the questionnaire athttp://hhaexchange.com/njdmahs-evv/6This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission6
CareBridge EVV SolutionCareBridge EVV is a completely free solution that aims to streamline your currentprocesses through: Caregiver Mobile App – Easy to record information Provider Portal – Manage authorization, scheduling, billingProviders use 4 core functions: Authorization Management Schedule Appointments Visit Management Bill for ServicesMultiple methods for Caregiver check-in and check-out Downloadable mobile application (iOS & Android) Interactive Voice Response (IVR)7This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission7
HHA Webinars HHAeXchange Provider Info Session: DSs3iT6y6jdQrOZ9w6A Dates: Monday, October 26th at 10:00AM;Tuesday, October 27th at 2:00PM; Thursday,October 29th at 11:00AM NJ Provider EDI Session (3rd Party EVVIntegration): Gz o1SWeHCT2UfBdobg Date: Wednesday, October 28th at 12:00PM8This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission8
Horizon EVV ProgramNameSubject MatterEmailPhoneStephen FitchQuestion related to HNJHwith respect to the EVVProgramstephen fitch@horizonblue.com(862) 241-5996Matthew TipplesQuestions related to Sinqor Carebridge Softwareplatforms.mtipples@sinq.io(630) 596 67219This Document is Proprietary and Confidential – Do Not Print or Distribute Without Permission9
4 This Document is Proprietary and Confidential -Do Not Print or Distribute Without Permission Codes Requiring EVV Service Unit of Service Procedure Code Personal Care Assistance_15M 15 Minutes T1019 Personal Care Assistance Group 15 Minutes T1019_HQ Personal Care Assistance_PD Per Diem T1020 Personal Care Assistance (Self Directed) Individual 15 Minutes T1019_SE
