EVV - Switching Payer To/From Medicaid and MCO

The following walks you through how to correct information in Barnestorm when a patient switches payer from/to straight Medicaid and an MCO.

Referral

Add the new payer to the referral (do NOT change any existing payers). You will discharge the old payer and place the new one as the primary payer.

IMPORTANT: It is critical to keep the discharged payer on the patient chart, since it is linked to previous billing, documentation, and EVV.

Here are detailed instructions on how to discharge an old payer and add a new payer:

Aide Care Plan

Stop the discharged aide plan with a stop date of the day you find out about the change.

IMPORTANT: This aide plan should NOT be changed or deleted! It should only be stopped.

Copy the aide plan. The new aide plan should have tomorrow's date as the start date.

Change the payer and job code on the new aide plan to the new payer & job code.

Authorization

Update the authorization screen with an entry for the new payer.

Do not edit, delete, or remove any existing entries.

Visits and Billing

If you like, you can correct the Sandata aggregator visits to no bill status for any that were sent.

Biller will need to correct the visits and schedules in Barnestorm so that they will be available for the new MCO, follow this process:

1. Go to Employee Activity and click on Fix Payer/Job Cd/Chart#.

2. Select the patient from the top left screen.

3. The discharged payer should show up under the patient on the left.

4. Select the from and through dates of the visits that need the payer changed.

5. Click the Find All Visits Like This.

6. Select the new payer on the right.

7. Select the correct Job Code from the list on the right. For most, it will match the payer code.

8. Click the And Change Them to This.

Use the Billing > HIPAA Transactions > HHAeXchange/CareBridge to send visits if the payer was switched to an MCO.