We want to take a moment to acknowledge the challenges many of you have experienced with the new clearinghouse system. We understand how important smooth and accurate billing processes are for your operations. The AFH Council is working closely with HCA and CHPS to address provider concerns with the new clearinghouse process and training. Below are updates to the issues raised by providers:

• NPI Field:
  We’ve learned that some AFHs are entering their API number in place of the NPI due to unclear guidance on how to obtain and use an NPI. CHPS has updated the account registration page to make registration clearer and easier for providers and has updated their training to help providers navigate the registration process more successfully. 

• Modifier Selection: There seems to be limited guidance on which of the four modifiers to choose, as well as confusion around using secondary IDs and qualifiers for those without an NPI. Providers will no longer be required to enter the modifier but will simply need to select the tier.

• Billing Calculations: We’ve received feedback on whether the system can automatically calculate totals based on unit counts to reduce errors. While HCA continues to work on this, they did clarify that once a provider puts in the start date and end date of services and selects the tier, the CHPS portal will calculate the total number of units and the billable amount. This will occur both on the spreadsheet and the direct data entry options.

• Billing & Payment: We’ve heard reports of claims showing as “accepted” in the clearinghouse but later being rejected or resulting in blank checks. We’ve asked HCA to help identify where the communication breakdown occurs between the clearinghouse and the MCOs. This issue is still pending.

• Provider Identification and Claim Matching:
  It was brought to our attention that there is uncertainty around how MCOs are matching claims to the correct adult family home location, given the absence of a designated field for the ProviderOne Number. The Council has clarified that the system does not require an AFH ProviderOne ID. CHPS identifies providers using their Tax ID (TIN), API/NPI, and the billing address entered when submitting claims. While the billing spreadsheet includes a field for the ProviderOne ID, it is not required, and there is no field for it in the direct data entry option.

Thank you to those who have taken the time to document and share these issues, your insights are invaluable in helping us advocate for better functionality and training. If you’re experiencing additional challenges or have examples to share, please reach out to us directly. Your feedback helps us continue improving the clearinghouse experience for all providers.