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Thomas Jefferson Active

  Date of Birth

04/17/1743

  Gender

Male

  Member ID

1234567

  Admission ID

87654321

  Contract Name

Life Care Payer

  Service Coordinator

John Doe

Calendar

Calendar
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Feb 29

T Completed Visit

Scheduled Time 08:00 PM - 09:00 PM

Visit Time - Incomplete confirmation of time and duty 08:00 PM - 09:00 PM

Billed (no time)

Claim submitted

Non-Skilled Visit
Provider: Northeast Home Services   Caregiver: Paul Allen

1

2

3

4

5

6

7

8

9

10

LS Linked or Mutual patients are not scheduled correctly Completed Visit

Schedule Time 02:00 PM - 03:00 PM

Visit Time - Confirmed 02:15 PM - 03:15 PM

Not Billed - 1 hr 0 min

Claim not submitted

IO 4:02 PM - 4:42 PM (Caller ID not available)

Skilled Visit
Provider: Northeast Home Services   Caregiver: Paul Allen

11

12

13

14

15

16

17

18

LS Missed Visit

Scheduled Time 01:00 PM - 02:00 PM

Missed Reason AR - Participant/family refused or unavailable

Non-Skilled Visit
Provider: Northeast Home Services   Caregiver: Paul Allen

19

20

21

22

23

Scheduled Time 08:00 AM - 09:00 AM

Non-Skilled Visit
Provider: Northeast Home Services   Caregiver not assigned

24

25

26   Member Discharge Date

27

28

29

30

31

April 1

2

3
Legend:   Not Authorized   Authorized   No Authorization Needed

2 Active Authorizations

View All (3)
Active Authorizations
Auth # From To Auth Type Provider Service Type Service Code
01/01/2020 01/01/2021 Entire Period Northeast Home Services
TIN: 1234567 		HHA HHA1
01/01/2020 01/01/2021 Daily Northeast Home Services
TIN: 1234567 		HHA HHA1

Provider Information

Add Placement

Authorization

Authorizations
Auth # From To Auth Type Provider Service Code Actions
01/01/2020 01/01/2021 Entire Period Northeast Home Services
TIN: 1234567 		HHA1
01/01/2020 01/01/2021 Daily Northeast Home Services
TIN: 1234567 		HHA1
01/01/2020 01/01/2021 Monthly Northeast Home Services
TIN: 1234567 		HHA1

Member Profile

General

EVV Required

Yes

HHA Providers

-

Member Team

-

Service Coordinator

-

EMPI

-

Medicaid Number

-

Nurse

-

Frequency

-

Mutual Case Withs

-

Source of Admission

-

Alerts

-

Address

Member Addresses
Address Type Notes Actions
12345 Fake St. Suite 403, Charlottesville, VA 12345 Home (Primary) This is a note View on Google Maps opens in new tab
12346 Fake St. Suite 403, Charlottesville, VA 12345 Community - View on Google Maps opens in new tab

Phone Number

Home Phone

123-456-7890

Phone 2

-

Phone 3

-

Emergency Contact

George Washington (Friend)

987-654-3210 (home)

987 Example Road, Charlottesville, VA 12345

Emergency Preparedness

Contract Priority Code

1

Contract TAL

TAL 1 - Non-Ambulatory

Special Requests

Preferred Gender

None

Requested Special Provider

Northeast Home Services

Primary Language

English

Secondary Language

-

Preferred Discipline

None

SSP22

Yes

Other

-

Insurance

Member Insurance
Insurance Primary Start Date Stop Date Policy Number
Blue Cross Blue Shield PA Yes 01/01/2020 12/31/2020 XYZ-12345
Medicare No 01/01/2020 12/31/2020 ABC-12345

Notes/Messages

Master Week

Visits

POC

Events

Add Authorization

Authorization #1234567

Total Units

3600.00

Allocated

0.00

Max Units for Period

40.00

Authorization

Authorization #

1324567

Authorization Type

Daily

From

01/01/2020

To

01/01/2021

Service Category

Home Health

Service Type

HHA

Service Code

HHA1

Service Code Type

Daily

Provider

Northeast Home Services

Diagnosis Code #1

123

Diagnosis Code #2

-

Diagnosis Code #3

-

Hours

Master Sat Sun Mon Tues Wed Thurs Fri
Hours 10.00 10.00 10.00 10.00 10.00 10.00 10.00 10.00
Start Time Any Any Any Any Any Any Any Any

Blackout Dates

No information provided.

Attachments and Notes

Attachments

-

Notes

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Internal Notes

-

From To Auth Units Visit Units Allocated Units Left
01/11/2020 01/20/2020 40.00 7.00 7.00 43.00
01/01/2020 01/10/2020 40.00 5.00 5.00 45.00

February 29, 2020 Non-Skilled Visit

Thomas Jefferson

Admission ID

1234567

Assignment ID

010101

Phone Number

123-456-7890

Service Coordinator

-

Schedule

History

Schedule Time

8:00 PM - 9:00 PM

Service Code

HHA1

Caregiver

Paul Allen (123123)

POC

-

Bill at Zero $ Rate

No

Bill Type

Visit

Hold Visit for Billing

No

Duration

1 hour 0 min

Visit Information

History

Visit Start Time

8:00 PM 02/29/2020

Visit End Time

9:00 PM 02/29/2020

Missed Visit

No

Travel Time Request

-

New Reason

-

Action Taken

-

Uploaded Timesheet

-

Approve without POC

No

New Note

-

Audit

History

Verified By

Member

Verified Date

02/29/2020

Verified Time

9:30 PM

Supervisor

-

Duty Sheet

History

POC

0 (00:00)

Other

0 (00:00)

Total

0 (00:00)

Timesheet Required

No

Duties

-

Approve without POC

No

Caregiver Comments

-

Primary Bill

History

Payer

Life Care Payer

Service Code

PCA HH

Bill Type

Hourly

Service Hours

1:00

TT Hours

-

OT Hours

-

Billable Hours

1:00

Billable Units

-

Bill Rates

-

Total

-

Billed

-

Invoice #

-

Invoice Creation Date

-

Billing Hold

No

TRN #

-

Place Updated Visit on Hold

No

E-Billing Batch #

-

Authorization (Auto)

History

Authorization #

552

Authorized Units

1.00

Visit Schedule Units

1.00

Paul Allen Active

View Caregiver Profile

Caregiver Information

History

Caregiver Code

1030

Date of Birth

03/14/1980

Provider

Northeast Home Services

Discipline

PCA, HHA

Alt Caregiver Code

1040

Gender

Male

SSN

123-45-6789

Ethnicity

-

Initials

-

Time & Att. PIN

13579

NPI

-

Start Date

-

Employment Information

History

HHA/PCA Registry Number

-

Added/Checked Registry Date

-

Exclusion Lists Checked On

-

Employment Type

PCA, HHA

Rehire

No

Rehire Date

-

Contact Information

History

Address

1234 Fake St., Charlottesville, VA 12345

Home Phone

123-456-7890

Phone 2

-

Phone 3

-

Emergency Contact Information

History

Jennifer Allen (Spouse)

123-456-7899 (home)

1234 Fake St., Charlottesville, VA 12345

Robert Allen (Father)

123-456-7898 (home) | 123-456-7897 (mobile)

987 Example St., Charlottesville, VA 54321

Calendar Legend

  •   Not Authorized
  •   Authorized
  •   No Authorization Needed
  •   Completed
  •   Missed Visit
  •   Skilled Visit
  •   Provider Info
  •   Caregiver Info
  •   Scheduled Time
  •   Visit Time - Confirmed
  •   Visit Time - Incomplete confirmation of time and duty
  •   Member Discharge Date
  •   Agency Set Holiday
  • T  Temporary Indicator. If a user has manually adjusted the Schedule Time or Caregiver. This indicates a change was made to the visit manually, instead of via the Master Week.
  • LP  Linked Primary
  • LS  Linked Secondary
  • PM  Primary Mutual
  • SM  Secondary Mutual
  •   Linked or Mutual patients are not scheduled correctly