Shift Care Guide

What is….

Shift Care (Nursing) vs. Shift Care (Home Health Aide)

Shift Care (Nursing) – Services provided by nurses functioning within their scope of practice delivering patient care as ordered by the provider and contained in the Plan of Treatment.

Shift Care (Home Health Aide) – Personal Care Services performed by a home health aide which include, but are not limited to, assisting the recipient with bathing and personal hygiene, ambulation and transfer, feeding and dressing.

Who is…

HHAeXchange (HHAeX) – We have partnered with HHAeX to offer Electronic Visit Verification (EVV)* and billing solutions at no cost to providers.

Sandata - Sandata provides homecare software solutions, best known for pioneering EVV systems used by Medicaid programs, managed care organizations, and home health agencies. DHS partnered with Sandata to develop an integrated EVV system.

*Electronic Visit Verification (EVV)

EVV was implemented due to Section 12006 of the Twenty First (21st) Century Cures Act (Cures Act) and the Centers for Medicare & Medicaid Services (CMS) requiring the utilization of Electronic Visit Verification System for all Personal Care Services by January 1, 2021, and all Home Health Care Services by January 1, 2023.  As a reminder, the Cures Act Mandate requires all visits to be timestamped via an electronic verification method utilizing EVV tools to record the member, caregiver, location of the service, date of the service, and the type of service performed.

Roles Defined:

Health Partners Plans/Jefferson Health Plans vs. HHAeXchange

Health Partners Plans/
Jefferson Health Plans

Health Partners Plans/Jefferson Health Plans manages member benefits, reviews authorization requests and processes claims for shift care.

Access our Provider Portal to:

  • Verify eligibility
  • Submit for Authorization/Start of Care
  • Obtain claim status or appeal a claim denial

HHAeX

HHAex manages claim submissions, tracks EVV data and serves as intake for all shift care related inquiries.

Access the HHAeX Portal to:

  • Document EVV
  • Submit a claim
  • Review EVV compliance reports
  • Submit all shift care related questions or inquiries

Authorization Requirements

Authorization is required for all shift care services. Our medical policy on Shift Nursing, Personal Care and Medical Daycare outlines the guidelines for obtaining an authorization.

Request Submissions

Requests for shift care should be submitted through the Provider Portal. Directions on submitting authorizations in the portal can also be found on the Provider Portal webpage.

Submission Timeframes

  • Providers have 5 business days from initial start of care to submit requests.
  • All ongoing home care requests are expected to be submitted before services are rendered.
  • We make every attempt to provide determinations as quickly as possible when all required documentation is received in a timely manner.

Mandated Documentation

Our mandated shift care letter of medical necessity and shift care form are located under the Additional Resources section below.

These templated resources were created to help streamline and make the submission of shift care requests easier for our providers.

Authorization Crossover to HHAeX

Before EVV can be captured through HHAeX, this approved authorization must be available in the HHAeX portal.

Approved authorizations are migrated from our system to HHAeX’s portal within 3 business days.

Health Partners Plans Medicaid
Determination Timeframes

  • 2 business days to render a determination for all standard pre-service requests
  • 30 calendar days to render a determination on all retrospective requests
  • 14 days to render a determination for all standard pre-service requests, OR
  • Extension timeframe is 14 days

Authorization Review Types

Select the appropriate “Review Type” when submitting an authorization request:

  • Initial – Select initial review type for any new requests or reauthorizations. This includes increases, starts of care, and decreases.
  • Concurrent – Concurrent review type for inpatient only and is not available for any outpatient authorization.
  • Retro/Post Service – Select retro/post service review type for any request that is being submitted after the requested dates have already occurred either completely or partially and prior auth was not requested.
  • Expedited - Select expedited if the request needs an urgent decision to prevent harm to the member. This should only be used for life-sustaining requests that, if not decisioned quickly, could cause harm to the member. This is NOT to be used when the request was submitted late.

Authorization Reconsiderations and Appeals

Reconsiderations

If an authorization is denied for missing information, the missing information must be submitted within 7 days of denial for reconsideration. On the 8th day, a formal appeal is required to overturn the determination.

Formal Appeals

Formal appeals must be completed by the member/head of household or the referring provider.

A Home Health Agency cannot appeal an authorization determination for services. There is no pathway for the home health agency to obtain appeal status.

The home health agency will only receive notification if the authorization determination is in some way altered.

Note: Reconsideration cannot occur if an appeal is already in process.

Electronic Visit Verification (EVV) through HHAeX

EVV Must Be Documented Through HHAeX

In alignment with CMS, we mandated the use of documenting EVV through HHAeX for all Personal Care Services by January 1, 2021, and all Home Health Care Services by January 1, 2023.

For on-demand webinars on how to document EVV, visit HHAeX’s Resources Library.

What Requires EVV? What Doesn’t Require EVV?

EVV is required for the following codes for Medicaid only:

G0156 (with applicable modifier)

G0151

G0152

G0153

G0155

G0299 (including supervisory visits for HHA)

G0300 (including supervisory visits for HHA)

T1000

T1002

T1003
EVV is not required for:

Our Medicare, Individual and Family Plans or CHIP lines of business

Well Baby and Well Mommy visits

Medical Daycare

Dietitian/Nutritionist Visits

Hospice

EVV Compliance Requirements

Beginning in January 2026, the Department will begin issuing EVV alerts to providers whose EVV manual entry* percentages exceed 15% for the previous quarter. Alerts issued in January 2026 will be based on the October – December 2025 quarter.

For managed care-enrolled providers, the Department will transmit a list of noncompliant providers to the appropriate managed care organizations (MCO) for awareness and MCO follow up.

When a provider who renders services in the managed care delivery system exceeds the 15% manual edit threshold for two consecutive quarters after the effective date of this bulletin, the MCO will initiate corrective action with the provider and submit documentation of those actions to the Department.

*What is a manual entry?

A manual entry is any manual change to EVV. Manual entries include manually adding a visit because the staff member did not clock in or clock out, adjusting the visit time or EVV time, or any adjustment made to a visit while it is in progress or after completion.

For the complete Medical Assistance Bulletin (MAB), see the Department of Human Services MAB2025082901.

Other EVV MABs can be found under the additional resources below.

For on-demand webinars and tools on how to improve EVV compliance, visit HHAeX’s Resources Library.

For more information on utilizing Sandata, visit DHS EVV Solution | Department of Human Services

EVV Best Practices

Reinforce internal EVV procedures.

  • Ensure all staff are thoroughly trained on correct EVV data entry at the point of service.
  • Ensure scheduled times are correct.
  • Provide key fobs to staff having issues using the app
  • Identify non-compliant staff and place them on an action plan. Proper entry at the time of service minimizes the need for manual edits and reduces compliance risk.

Utilize EVV Compliance Reports proactively. Regularly monitor your manual entry percentage using:

  • HHAeXchange Compliance Reports
  • Sandata Aggregator

Billing Requirements

EVV claims must be submitted through HHAeX.

Effective September 1, 2025, all Electronic Visit Verification (EVV) claims billed by Home Health/Shift Care providers for Health Partners Plans Medicaid members must be billed through HHAeX.

EVV claims submitted directly to Health Partners Plans Medicaid will be rejected, which will cause delays in claims processing and payments.

For on-demand webinars on how to bill within HHAeX portal, visit HHAeX’s Resources Library.

Billing Best Practices

✔ When billing, be sure to use the appropriate service code and modifier associated with the approved services. (see grid below). Approved services can be found on your authorization within our Provider Portal or the HHAeX portal, as well as in your determination letter.

Note: Medical Daycare must bill S codes if billing for skilled nursing in medical daycare regardless of service approved on authorization. (G0156 if billing for home health aide level of care in medical daycare.)

✔ When billing for multiple children, be sure to follow our claim payment policy on Pediatric Shift Care when Multiple Members in a Household are Receiving Care.

✔ Submit appropriate provider type and specialties based on DHS EVV requirements. Check DHS’ PROMISe system to confirm the appropriate provider type and specialty for submissions.

Home Care/Shift Care: Provider Type = 05 Specialty = 050

Private Duty Nursing: Provider Type = 05 Specialty = 051

✔ Document other insurance information in the HHAeX Secondary Screen, inclusive of non-covered information from the primary insurance.

✔ Always include the referring physician.

✔ Remember: members cannot be active with hospice and shift care or home care visits and shift care.

CPT Code Service Description Modifiers Age/Staffing Criteria
G0156 Home Care HHA U8 Members 21 years old and older
G0156
 Shift Care HHA and HHA U7 Members under 21 when agency staff is staffing
G0156 Shift Care HHA U7, SC When parent/legal guardian/adoptive parent is staffing
G0156
 Shift Care HHA U7, TT When 2 or more patients to 1 agency HHA at the same time (regardless of insurance provider)
G0156 Shift Care HHA U7, TT, SC When parent/legal guardian/adoptive parent is staffing 2 or more patients at the same time (regardless of insurance provider)
T1002 Shift Care Skilled Nursing TT When 2 or more patients are staffed by 1 RN at the same time
T1003 Shift Care Skilled Nursing TT When 2 or more patients are staffed by 1 LPN at the same time
T1002 Shift Care Nursing Care None When RN is servicing only 1 member
T1003 Shift Care Nursing Care None When LPN is servicing only 1 member
All other EVV codes
 Other EVV Services None required --

Post-Payment Audits

We may conduct post-payment audits to ensure payments made to our providers comply with applicable policies, regulations, billing standards and contractual obligations.

While there is no time limitation for requesting reimbursement of overpayments from providers receiving State or Federal Funds, we follow the same recovery time period guidelines for non-fraud related claims as are adopted by DHS: two years from the date of payment notice.

The most common reasons for recovery during audits are missing referring provider information and errors in EVV data.

To prevent potential recoveries, make sure to follow the recommended guidelines and best practices described in the billing and EVV sections above.

Claim Reconsiderations

A provider can request a reconsideration determination for a claim that they believe was paid incorrectly or denied inappropriately, whether the result of a provider billing error or a Health Plan processing error.

  • Providers should request the reconsideration of a claim using the Provider Portal.
  • All claims reconsideration requests must be received within 180 calendar days from the date of the Explanation of Payment (EOP) advising of the adjudication decision.
  • For claim reconsideration appeals, submit all documentation to support the appeal (e.g. primary EOP, Denial and Exhaustion Letters) in the provider portal.

Directions on submitting a claims reconsideration appeal through the provider portal can be found on our Provider Portal webpage.

Pediatric Shift Care Nursing Services Incentive Program

Home care agencies are eligible for two incentive opportunities, each paying a per-member, per-year (PMPY) amount based on their results compared to annual benchmarks.

  • Home care agencies that improve their missed shift rate will be eligible to earn a per-member, per-year incentive payment based on their rate of improvement.
  • Home care agencies with optimal overall missed shift care rates will be eligible to earn an additional per-member, per-year payment based on their overall rate.
  • To qualify for any payout, home care agencies must have at least 10 members in their denominator.

Agencies eligible for this incentive plan will receive outreach to review overall performance.

Who To Contact…

Contact HHAeX if:
  • after receiving a fax of approval, the authorization is not loaded in HHAeX, OR the placement is not loaded in HHAeX.
  • any authorization information is incorrect in HHAeX (i.e. units, codes, and/or dates).
  • a member needs to be removed from your agency in HHAeX.
  • confirmation of approval dates, level of care, and/or hours is needed.
  • any EVV issues arise.

All above inquiries can be submitted through the message tool in the HHAeX HHAeX Portal or directed to your dedicated HHAeX representative.

HHAeX Portal Inquiries

Complete HHAeX's contact form.

Contact Health Partners Plans/Jefferson Health Plans to:
  • follow up on new authorization, reauthorization or pended authorization requests by reaching out to Utilization Management at 1-866-500-4571.
  • refer patients to our Care Coordination team. Call our Provider Services Helpline at 1-888-991-9023 or email us at ClinicalConnections@jeffersonhealthplans.com.
  • check claim status and submit claim appeals. Claim status and appeal submissions must be submitted through our Provider Portal.
    • For directions on how to check claims status or submit an appeal, visit the Provider Portal.
    • Note that claim appeal processing may take up to 45 days.

Health Partners Plans/Jefferson Health Plans Portal Inquiries

For registration questions/concerns and user role updates, contact hpconnect@jeffersonhealthplans.com.

For technical issues, password resets and locked accounts, contact the HealthTrio Helpdesk at connect@healthtrio.com or 1-877-814-9909.