EVV Insanity
Managing multiple EVV aggregators and the task of validating shift data across various systems, along with reconciling billing, can be quite daunting. Paradigm simplifies this intricate process for you, effortlessly accommodating any number of systems or payers you work with.
Medicaid in
Pennsylvania
.
Electronic Visit Verification
EVV and home care Medicaid billing in Pennsylvania can be confusing; here’s what you need to know.
EVV Choice
Pennsylvania operates on an open model, allowing providers the flexibility to choose any Electronic Visit Verification (EVV) system they prefer.
EVV Aggregator
Depending on the payer, providers in Pennsylvania need to submit their EVV data to one of the three designated aggregators: HHA Exchange, Netsmart (Tellus), or Sandata.
Billing Process
Billing in Pennsylvania is executed electronically and submitted directly to payers. It's crucial that the claim data accurately match the EVV data to ensure smooth processing.
Rates
Pennsylvania's home care Medicaid rates are attractive, varying from $21 to $23 per hour. It's important to note that MCOs may contract at different rates, so examining all payer contracts is crucial.
Payers.
State Direct: PA Department of Health
Managed Care Organizations: AmeriHealth Caritas Pennsylvania, AmeriHealth Northeast, Geisinger Health Plan, Health Partners Plans, Highmark, Keystone First, UnitedHealthcare Community Plan of Pennsylvania, PA Health & Wellness, UPMC Health Plan, Aetna Better Health of Pennsylvania
Waiver Programs: Aging Waiver, Attendant Care Waiver, Community HealthChoices (formerly CommCare), Community Living, Consolidated Waiver, Consumer Recovery Investment Fund Program, Independence Waiver, OBRA Waiver, Options, Person/Family Directed Support Waiver, Act 150 (State Funded Program)
How Paradigm can Help.
Billing
Enrollments
Eligibility
EVV Management
Training
