© Copyright 2017 Homecare Software Solutions, LLC One Court Square 44th Floor Long Island City, NY 11101

Phone: (718) 407-4633 • Fax: (718) 679-9273

HHAeXchange

Patient Management Process Guide The Patient Profile

© Copyright 2017 Homecare Software Solutions, LLC One Court Square 44th Floor Long Island City, NY 11101

Phone: (718) 407-4633 • Fax: (718) 679-9273

Table of Contents Overview ............................................................................................................................... 1

Patient Setup ........................................................................................................................ 1

New Patient .............................................................................................................................................. 2

The Patient Profile ................................................................................................................. 4

The General Page ...................................................................................................................................... 4

The Profile Page ........................................................................................................................................ 5

The Authorization Page ............................................................................................................................. 5

The Insurance Page ................................................................................................................................... 6

The Special Requests Page ........................................................................................................................ 6

The Master Week Page ............................................................................................................................. 7

The Calendar Page .................................................................................................................................... 7

The Visits Page .......................................................................................................................................... 8

The POC Page ............................................................................................................................................ 8

Patient Statuses .................................................................................................................... 9

Patient Status Meanings ........................................................................................................................... 9

Waiting .................................................................................................................................................. 9

Pending ................................................................................................................................................. 9

Active ..................................................................................................................................................... 9

On Hold ................................................................................................................................................. 9

Hospitalized ......................................................................................................................................... 10

Discharged .......................................................................................................................................... 10

Update Patient Status ............................................................................................................................. 10

The Payer System

Patient Management Process Guide Page | 1 The Patient Profile Overview Proprietary & Confidential

Overview Patient records contain all pertinent medical and authorization information associated with a Patient’s case. These records may be imported from external systems or entered directly into HHAeXchange’s Payer platform. Once a completed Patient record is saved, it may be sent to a Provider so service can begin. This process guide will review how to manage Patients in the Payer system. This includes:

• Manual entry of new Patients

• Navigating the Patient Profile

• Patient Statuses Please note that this guide assumes users are entering new Patients and managing their information directly in HHAeXchange. It will not cover the process of importing Patient records from external systems. Any questions, comments, or concerns pertaining to the contents of this document should be directed to HHAeXchange Customer Support. Note: Please review the definitions below to understand the terms used in the HHAeXchange Systems:

• Patient: You may know the Patient as the Member, Consumer, or Recipient. The Patient is the person receiving services.

• Caregiver: You may know the Caregiver as the Aide, Homecare Aide, Homecare Worker, or Worker. The Caregiver is the person providing services.

• Vendor: You may know the Vendor as the Provider or Agency. The Vendor is the organization coordinating services.

• Payer: You may know the Payer as the Contract, HHS, MCO, or State. The Payer is the organization placing Patients with Vendors.

The Payer System

Patient Management Process Guide Page | 2 The Patient Profile Patient Setup Proprietary & Confidential

Patient Setup HHAeXchange classifies any individual who receives service as a “Patient”, regardless of the type of service they receive (non-skilled vs. skilled). The following section will cover entering new Patients, managing their information, and broadcasting their records to Providers.

New Patient

The New Patient function is used to generate a Profile for Patients. Creating a new Profile consists of entering demographic and emergency contact information. Please note that only the fields marked by a red asterisk are required. To create a New Patient, please complete the following:

1. Navigate to Patient > New Patient

2. Enter values for the following required fields:

• First / Last Name: The Patients full name.

• Gender: The Patient’s gender.

• DOB: The Patient’s date of birth.

• Admission ID: The identification number associated with the Patient’s case

• Team: Assign the Patient to a Team. The selected team will determine which users may access the Patient’s Profile.

New Patient Demographics

Note: The fields listed in Step 2 are the only ones required to create a new Patient Profile. HHAeXchange suggestion, however, that this page be filled out as thoroughly as possible.

3. Complete the following fields as thoroughly as possible if the Patient will be utilizing EVV:

• Street 1: The Patient’s street Address.

• City: The city the Patient lives in.

• Zip: The Patient’s Zip code.

• Home Phone: The Patient’s primary phone number. The system will authenticate EVV for this Patient based off this phone number.

• Phone 2/3: A second and third phone number associated with the Patient. EVV sent from one of these numbers will be caught on the Call Dashboard. They may, however, be linked to the Visit from there.

The Payer System

Patient Management Process Guide Page | 3 The Patient Profile Patient Setup Proprietary & Confidential

New Patient Address

4. Complete the following fields if the Patient has emergency contacts:

• Name: Full name of the emergency contact.

• Relationship: The contacts relationship with the Patient.

• Address: The address of the contact.

• Phone 1/2: The phone numbers used to reach the contact. Note: Two emergency contacts may be entered for a Patient:

New Patient Emergency Contact

5. Click to create a Patient Profile. 6. Every new Patient will have an initial status of Waiting. The Waiting status signifies that the

Patient’s case has not been sent out as a Placement.

Patient Status: Waiting

The Payer System

Patient Management Process Guide Page | 4 The Patient Profile The Patient Profile Proprietary & Confidential

The Patient Profile The Patient Profile consists 9 separate pages which are used to manage the Patient’s scheduling requirements, their Plan of Care, their demographic information, and so on. When a Patient is accepted by a Provider, their Profile becomes Active. Once a Patient becomes Active, it is important to regularly check their Profile to manage communications, maintain demographic information, update Authorizations, review scheduled/confirmed Visits, and so on. The following section will provide a high-level review of the pages in the Patient Profile, accessible using the Index (pictured to the right). When appropriate, links will be included below to provide supplementary information on certain functionality/features.

The General Page

The General page is split in four sections: General, Vendor Information, Status History, and Notes.

• The General section allows Payers to assign Patients a Nurse, Coordinator, a Team, and designate a Source of Admission. Users may also specify whether Providers may use EVV to confirm Visits for the Patient, and if the Patient has a Mutual Case With another Patient.

• The Vendor Information section is used to send Placements and track which Providers are currently providing service for the Patient. For more information on Placements, please see the Patient Placement Process Guide.

• The Status History section maintains a record of any status changes the Patient undergoes. Please review the Patient Statuses section of this document for further information.

• The Notes section is used to review and send messages, or Notes, within HHAeXchange to Providers. For more information on this functionality, please see the Communications Process Guide.

The General Page

The Payer System

Patient Management Process Guide Page | 5 The Patient Profile The Patient Profile Proprietary & Confidential

The Profile Page

The Profile page is used to maintain Patient Demographic information, their Address, Emergency Contacts, and Emergency Preparedness information. Payers may also review Emergency Preparedness information setup by any Provider the Patient has been placed with.

The Profile Page

The Authorization Page

The Authorization Page is used to manage Authorizations for the Patient. For information on setting up and managing Authorizations, please see the Patient Placement and Case Management Process Guides.

The Authorization Page

The Payer System

Patient Management Process Guide Page | 6 The Patient Profile The Patient Profile Proprietary & Confidential

The Insurance Page

The Insurance page is used to enter a record of the Patient’s insurance plan. At least one insurance record must be entered for each Patient in order to send them as a Placement to provides. For further information on Insurance, please see the Patient Placement Process Guide.

The Insurance Page

The Special Requests Page

Special Requests are non-mandatory Patient preferences for scheduling. Special Requests include preferences such as Preferred (Caregiver) Gender, the Patient’s Primary Language, and custom values setup by the Payer. Providers may review these preferences and schedule a Caregiver accordingly.

The Special Requests Page

The Payer System

Patient Management Process Guide Page | 7 The Patient Profile The Patient Profile Proprietary & Confidential

The Master Week Page

This page allows Payers to review the Master Week setup by the Provider for the Patient. A Master Week is a reoccurring weekly schedule. Payers may not edit or create a Master Week for the Patient.

The Master Week Page

The Calendar Page

The Calendar page may be used to review scheduled and confirmed Visits for the Patient. Payers may not edit any information on this page, but they may enter Notes for specific Visits to easily communicate with Providers. For further information on the Calendar page, please see the Case Management Process Guides.

The Calendar Page

The Payer System

Patient Management Process Guide Page | 8 The Patient Profile The Patient Profile Proprietary & Confidential

The Visits Page

The Visits page provides an alternative means to review scheduled and confirmed Visits for the Patient. Payers may search for Visits based on a date range, the Provider scheduling the Visit, and their billed status. Further information on the Visits page may be found in the Case Management Process Guides.

The Visits Page

The POC Page

The POC page is used to set up a Plan of Care for the Patient. Payers may enter multiple Plans of Care if required. For further information on the Patient POC, please see the Patient Placement Process Guide.

The POC Page

The Payer System

Patient Management Process Guide Page | 9 The Patient Profile Patient Statuses Proprietary & Confidential

Patient Statuses The Patient Status indicates the state of the Patient’s case. When a Patient is initially entered in the system, the Status signifies whether they have placed with a Provider. Once they have been placed, Payers can manually update the Status to restrict scheduling or end the placement outright.

Patient Status Meanings

Waiting

When a Patient is first entered, the system will assign them a status of Waiting. This signifies that the Patient Profile has been saved successfully, but has not yet been sent to a Provider as a Placement.

Patient Record not yet Sent: Waiting Status

Pending

When a Patient is sent to a Provider as a Placement, their status will update to Pending. This signifies that the Provider has received the Placement, but has not yet accepted or denied the case.

Patient Record Sent, not Accepted: Pending Status

Active

If a Provider accepts the Placement, the Patient will now be considered Active. The Active status indicates that the Patient is receiving service.

Patient Record Sent and Accepted: Active Status

On Hold

When a Patient is placed On Hold, the Provider may no longer schedule Visits for them. Additionally, any scheduled services that fall beyond the date in which the Patient is placed On Hold will be deleted. If the Patient has an active Master Week, the system will stop it from rolling over as well. A Patient with an On Hold Status may become Active again.

On Hold Status

The Payer System

Patient Management Process Guide Page | 10 The Patient Profile Patient Statuses Proprietary & Confidential

Hospitalized

The Hospitalized Status signifies the Patient is in the hospital. Updating a Patient’s Status to Hospitalized will automatically discharge them from the Provider, meaning the Provider may no longer service them.

Hospitalized Status

Discharged

The Discharged Status signifies that the Patient will no longer be receiving service from the Provider. The Patient’s Profile will not, however, be deleted, as the Payer may send the Patient as a new Placement. In this case, the system will reactive the existing Profile instead of creating a new one.

Discharged Status

Update Patient Status

Payers manually update a Patient’s Status to On Hold, Hospitalized, and Discharged by navigating to the Patient’s General Page and selecting :

General Page, Update Status

To update the Status, select the Date of the change and the Status to apply. Please note that a Patient may only be Discharged if they are already Hospitalized.

Select Status