New Jersey Workflow

Overview

(Private pay is generally self-regulating within the confines of state law and regulatory processes. This article focuses on Medicaid billing in the state of New Jersey.)

NOTE: Customers transitioning from using the HHAX EVV system to the Ankota EVV system must enter the alternative HHAX caregiver IDs in the Ankota caregiver ID and caregiver code fields, or their caregivers will be rejected as duplicates and no visits will be accepted. All visits in the HHAX EVV system (including scheduled visits) must also be closed out, or the integration will be blocked.

In the state of New Jersey, there are some unique billing processes. Select Medicaid visits must be completed using electronic visit verification (EVV), and these verified visits are required to be sent to HHAeXchange (WellCare, Aetna, United Health Care Community Plan, and Fee-for-Service) or CareBridge (Horizon, Amerigroup) as appropriate. For Ankota users, in addition to regular EVV services, Ankota delivers appropriate visit data to HHAeXchange to ensure state requirements are met. The Merged Health Care Claim (837) can then be used to file non-EVV billing with the state. (CareBridge integration is not available at this time in New Jersey. See your Ankota specialist to discuss this integration.)

While Ankota supports customers during implementation, tax paperwork, registration with individual payers, and registration with clearinghouses are ultimately the organization's responsibility.

This article covers:

• Set-up (Client Eligibility Report, HHAX, CareBridge, Gainwell)
• Testing (HHAX, CareBridge)
• Pre-Billing
• Billing Management for Medicaid Visits (HHAX, State/Gainwell, CareBridge)
• Imported Response Files
• Remittance Advice Management (835s)
• Corrected Claims (HHAX, NJMISS)
• Further Details

Set-up

Client Eligibility Report

In New Jersey, a Business Associate Agreement is required to exchange 270s/271s with the state:

1. Contact Kellie Pushko at Kellie.Pushko@dhs.nj.gov
2. Request a BAA (business associate agreement) to send a 270/receive a 271
3. Once a BAA has been assigned, the State will notify Gainwell of approval and a Switch ID will be assigned; the testing phase then begins
4. Once testing is complete, the 270 can be uploaded to the state and the 271 retrieved. See the article on 270 downloads and 271 uploads for a full walkthrough.

HHAX Set-up

WellCare, Aetna, United Health Care Community Plan, and Fee-for-Service plans are sent to HHAeXchange. Ankota users in New Jersey under any of those plans providing the following services must register for HHAeXchange: PCA, Individual Supports (DDD), Community Based Supports (DDD), In-Home Respite (DDD and MLTSS), and Home Based Supportive Care (MLTSS).

All services requiring an in-home visit are subject to the EVV mandate, including self-directed services except for live-in caregivers (see the live-in exemption form). There is no planned end-date for the NJ EVV live-in exception as of 2025. Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation, but registration ensures HHAeXchange will accept the data and provide credentials and log-in.

To register with HHAeXchange, providers must fill out the Provider Portal questionnaire AND the Third Party Attestation. The following information is required:

• Provider name: YOUR COMPANY NAME
• Provider contact name and email address
• Provider Medicaid ID
• Provider Tax ID
• Vendor name: Ankota LLC
• Vendor address: 1 Franklin Street, Suite 360B, Boston, MA 02110
• Vendor contact name & information: Sharon Dodge, COO, sharon.dodge@ankota.com, 844-4-Ankota, extension 703

Contact: Questions about NJ EVV can be sent to mahs.evv@dhs.state.nj.us. Additional questions about HHAeXchange can be sent to NJSupport@hhaexchange.com or (866) 245-8337.

HHAeXchange will provide credentials in return. Send Ankota the following:

• HHAeXchange credentials
• Any HHAeXchange communications
• Provider Medicaid ID, Tax ID, and taxonomy codes

New Jersey collects the following information:

• Type of service
• Person Serviced
• Dates of Service
• Location of Service
• (Reason & Action codes if needed)
• Name of Caregiver
• Times of Service (start & end time)

Client data (must be entered in Ankota to successfully send data):

• Medicaid ID in the Medicaid ID field
• Medicaid ID in the Admission ID field in the authorization
• Other ID or same ID in the Client ID field
• Client address
• Primary diagnosis code (must be the diagnosis CODE, not the description, and must be the code assigned by the state, not a general valid diagnosis code)

Caregiver demographic data (must be entered in Ankota to successfully send data):

• First Name, Last Name
• DOB
• SSN
• ID & Matching Caregiver Code (do not skip UNLESS the caregiver should not be sent, e.g., the Ankota Support caregiver)
• If transitioning from HHAX (previously had caregivers in HHAX), use the HHAX ALTERNATE caregiver ID and place this in the Ankota caregiver ID and caregiver code fields
• Gender
• Type: 'Both', 'Skilled', or 'Non-Skilled' (under Roles); no other Role is allowed by HHAx
• Hire date
• Valid email and phone format (if entered)
• Valid Address (State and 5-digit ZIP required)
• Role: Skilled, Non-Skilled, or Skilled

Visit data cannot be sent until caregivers are successfully sent and received. Clients must also be on file with the state/HHAx per your payer. Per HHAx: "If you do not accept the [client] placements within a certain time frame they go to a pending queue... You do need to have someone check the system daily to accept new placements." Email HHAx if clients need to be re-set to pending. Clients must have active authorizations for their data to be accepted.

Not all visit types are required to go to HHAx. See the list of visits that should be sent to HHAx.

CareBridge Set-Up

CareBridge integration is not available at this time in New Jersey. Contact your Ankota specialist to add this integration.

Gainwell Set-up

Apply to Gainwell for a submitter ID (sometimes called a subscriber number) and password as soon as contracting with Ankota if non-EVV billing is required. EDI forms (101, 201, and possibly 801) must be filled out to obtain the ID. Wait time after submission is a minimum of 10-20 business days (often longer). To access these forms, go to njmmis.com, click Forms and Documents, then Submit Request. Scroll to the E section and select 101, 201, and if needed, 801.

These forms are typically required to be hard copies, physically mailed in. If already filed but the number is unknown, contact the EDI department at 609-588-6051 or email NJMMISproviderenrollment@gainwelltechnologies.com.

Emergency Card

Fill out the Emergency Card form for each Medicaid client per the state requirement.

Testing

HHAX Testing

No state testing processes are required for individual vendors at this time. (Ankota has completed required alt EVV testing.)

CareBridge Testing

N/A.

Pre-Billing

Successful billing starts at the beginning of the client's creation.

Caregiver Management

• Add caregivers as usual; new caregivers are exported at end of day (after initial launch)
• If caregiver failures appear in imported response files, correct the caregivers and re-send
• Do not send visits until caregivers are confirmed

Client Management

• Client Entry
• Setting Authorized Service for Clients (entering authorizations)
  • NOTE: In New Jersey, due to the location issue, authorize the CATEGORY, not the VISIT TYPE.
  • NOTE: Use the Assigned Caregivers feature to allow the caregiver to choose the correct visit type (EVV or NONEVV) at the start of the visit.
• Schedule Visits (Calendar-Based Scheduling, or Creating Visits from Patterns)

Visit Management

• Caregivers complete visits, or timesheets are entered manually through the office
• Visits are approved automatically or by the office
• Ensure visits are closed, then review and clear the Visit Approval Dashboard
• For HHAeXchange EVV visits:
  • Apply Action Codes as needed
  • Apply Reason Codes as needed

Prevention of Errors/Rejected Claims

• Watch warnings on the Action Center (missing auths, primary diagnosis codes, IDs, etc.) and address as needed
• Watch warnings on the Visit Approval Dashboard and address as needed
• Manage rejections

The Landing Dashboard highlights all necessary actions, including managing visits as needed.

Billing Management for Medicaid Visits

HHAeXchange Billing (EVV visits)

The following services require EVV management and are sent to HHAeXchange. Group homes, DDD Supported Living Services (24-hour service), and self-directed personal care services do not require EVV at this time.

Process:

1. Complete the pre-billing process above
2. Bill visits as usual in Ankota
3. Do not bill overlapping months; e.g., January and February visits should be in separate invoices
4. Separate EVV and non-EVV visits to avoid unnecessary rejections from the state
5. Visit data is exported to HHAx upon billing in Ankota
6. Read imported response files (see section below)
7. Manage corrections
8. Re-send visits as needed, usually via the Visit Approval Dashboard
9. Release billing in HHAx (see the training video on releasing billing in HHAx)

Once a visit is accepted in HHAx, any issue must be corrected in HHAx.

Friday 4pm is the weekly billing cutoff for billing through the state portal.

State/Gainwell Billing (NON-EVV visits)

1. Complete the pre-billing process above
2. Bill visits as usual in Ankota
3. Do not bill overlapping months
4. Separate EVV and non-EVV visits
5. Bill the state with the exported merged health care claim in the Gainwell portal (use the HIPAA-secure log-in; upload the file in the "upload" section)

CareBridge Billing

N/A.

Imported Response Files

Reading Response Files

After connection with HHAx, Ankota provides decoded, easy-to-read response files. See:

• HHAx Response Files (Overview)
• Accessing HHAx Response Files
• Reviewing HHAx Response Files

Correcting Visits (HHAx)

To correct visits rejected by HHAx, make corrections in Ankota and re-export the visit. See Managing Data Corrections for directions based on error type. Use the Approval Assistant to simplify the visit corrections process. Only use the Duration adjustments section if there are known, strict limitations on the allowed work duration for the selected visit type.

Remittance Advice Management (835s)

Remittance advice files (835s) may be provided in response to filing Medicaid claims — think of these as state receipts of payments. If provided, they can be uploaded to Ankota for automatic application of payments in the A/R records. Ankota does not provide 835s; if not received from the state, arrangements must be made to receive them. See:

• Process Remittance Advice (Upload 835 "receipts" received from MMIS into Ankota)
• Post Manual Payments
• Review Billing Reports (see also: Collections Report, Exceptions Report)

Corrected Claims

Generally, claims corrections are handled one of two ways:

1. Update the claims in Ankota and re-send
2. Update the claims in the location where they were sent

HHAX Claim Correction

To correct claims rejected in HHAeXchange:

1. Review the HHAeXchange response files
2. Correct the visits with errors as needed
3. Re-send visits from Ankota by the appropriate method:
   • Single visit export
   • Batch visit export (re-completing the affected invoice, which triggers delivery to HHAeXchange)

State/Gainwell Claim Correction

To correct claims rejected in the state portal:

1. Review the errors
2. Correct the visits with errors as needed
3. Re-export the 835 Merged Health Care Claim from Ankota
4. Upload the 835 in the state portal/via Gainwell

Further Details

Additional resources:

• The Ankota Training Overview, including videos
• Daily Adjustments
• Manual Visit Entry
• Private Pay Workflow

If placements are not accepted within a certain time frame, they go to a pending queue. Someone must check the system daily to accept new placements.