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Authorization Creation Changes for Personal Care Services (PCS)/Private Duty Nursing (PDN) services

Date: 09/23/24

Sunshine Health is changing how hourly Personal Care Services (PCS) and Private Duty Nursing (PDN) services are authorized and communicated via HHAeXchange, our electronic visit verification portal.

These changes will take effect on October 21, 2024.

Our goal is to eliminate early consumption of authorized hours and ensure our members receive the services they need without interruption. This will also enhance our PDN/PCS staffing options.

What’s Changing

  • Authorized hours will be entered on individual service lines by month.
    • Providers will still be able to request authorization spans of up to 180 days
    • Each line in HHAX will reflect the units available for the corresponding month; units will vary based on the days in the month and hours approved
  • PDN hours will be authorized as a bundled code under procedure code S9123 for both Registered Nurse (RN) and Licensed Practical Nurse (LPN) levels of care.
    • Providers will no longer see a line built for each code reflecting hours approved
    • Providers will have the flexibility to ensure patients are staffed by the appropriate clinician
    • Providers will be able to select the appropriate code in HHAX per shift

Note: These changes will not impact provider authorization requests or billing claims.

Resources for Home Health Providers

Resources for Home Health Providers is Sunshine Health’s online resource dedicated to helping Home Health providers resolve any issues they may have.

Learn How to Use the HHAeXchange Portal

It takes less than 5 minutes to create an HHAeXchange account. These step-by-step instructions and videos will help you create an account and learn how to use the portal.

Questions

If you have any questions, please call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Our Provider Engagement staff can also answer questions. Visit the Find Your Account Manager tool to find who supports your specialty and region. Keep up with the latest Sunshine Health provider updates by reviewing and bookmarking Provider News.

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