Pennsylvania adult day centers must connect the service they provide with the authorization, actual attendance, and claim submitted. The UPMC Adult Day Services HHAeXchange transition changes where affected providers manage those steps. New UPMC authorizations began moving to the HHAeXchange Home Care Portal in September 2026, followed by the new billing workflow. This guide explains the dates, setup steps, attendance rules, and claim checks administrators need to know.
UPMC Adult Day Services HHAeXchange: What Changed in 2026?
Quick answer: UPMC moved Adult Day Services billing and authorizations from the HHAeXchange Non-Homecare Portal workflow to the Home Care Portal. Centers must record each member's actual in/out times and confirm visits before billing. Electronic Visit Verification (EVV) is not required for this specific Adult Day Services workflow. The official HHAeXchange Getting Started Guide provides the transition instructions.
- August 13, 2026: UPMC and HHAeXchange held a provider information session.
- September 1, 2026: New UPMC Adult Day Services authorizations began appearing in the Home Care Portal.
- Late September to early October 2026: Providers on typical monthly billing cycles began using the new process for September dates of service.
This change applies specifically to UPMC Adult Day Services, not every Community HealthChoices payer or UPMC service line. Centers working with multiple plans should keep each payer's process distinct. The Pennsylvania Community HealthChoices information center has the official provider resources. For general state-specific center documentation, see our Pennsylvania adult day software page.
UPMC Adult Day Services Home Care Portal: Six Setup Steps
The official six-step sequence begins with account access and ends with billing. Assign an owner to each step so that missing permissions or authorizations are discovered before the first claim batch.
- 1. Verify access: Existing Home Care Portal users can retain their credentials. Non-Homecare-only providers must complete the provider onboarding questionnaire.
- 2. Confirm settings: Check admin and user roles, Tax ID, National Provider Identifier (NPI), and office details.
- 3. Configure staff: Add applicable Primary Staff and Enhanced Adult Day Nurse profiles. HHAeXchange permits a generic "staff" profile for a visit.
- 4. Review members: Verify UPMC Adult Day Services authorizations, service dates, codes, approved duration, and any limits against each member record.
- 5. Schedule and confirm visits: Choose the authorized service, enter actual arrival/departure times, assign staff, and confirm each visit.
- 6. Prepare claims: Review confirmed visits, applicable half-day/full-day rules, and the claim batch before submission.
Providers with recurring weekly attendance can use the portal's Master Week feature. Keep a short exception log for missing member authorizations, staff assignments, or mismatched visit times, and resolve each issue with the appropriate payer or portal support team. Our adult day care authorization tracking guide covers the broader process without repeating this UPMC-specific transition.
UPMC Adult Day Services Attendance Requirements and EVV
UPMC requires the time each member actually entered and left the center to be recorded in the new portal before the service can be billed. The official FAQ does not specify a separate universal same-day cutoff. Importantly, an expected schedule is not proof of attendance, and entering visit times does not automatically create a claim.
Does UPMC Adult Day Services require EVV? No. HHAeXchange expressly says EVV is not required for this service. Nevertheless, providers must enter start and end times, associate a staff profile, and confirm the visit for claim generation. Do not apply this service-specific exemption to other Medicaid-funded services.
As an operational safeguard, preserve the center's original check-in/check-out record and an understandable history of corrections. This is recommended recordkeeping rather than an extra UPMC portal requirement. Adult day care attendance software can support time-stamped arrival, departure, and correction records, but it does not replace HHAeXchange visit confirmation.
UPMC Adult Day Services Billing 2026: Claim Review
The updated workflow separates attendance entry, visit confirmation, and claim generation. The UPMC Adult Day Services Provider FAQ confirms that a visit must be created and confirmed with start and end times before a claim can be generated. It also says UPMC supplies the diagnosis code automatically during the affected HHAeXchange billing process.
The UPMC provider guide identifies these applicable Adult Day Living service-code variants:
| Service code | Description in UPMC guide |
|---|---|
| S5102 | Adult Day Living Services |
| S5102:U3 / S5102:U4 | Adult Day Living Services Enhanced |
| S5102:U5 | Adult Day Living Services Enhanced (Half Day) |
The guide states that providers bill one unit per date of service, based on the authorized half-day or whole-day arrangement. Never infer the billing category from elapsed hours alone. Verify the current authorization, relevant duration rules, service code, member identity, staff assignment, and confirmed-visit status. Our adult day care billing units article explains general attendance-to-unit reconciliation separately.
Example: Reconcile One Member-Day Before Billing
Suppose a fictional participant attends on October 7, 2026, from 9:05 a.m. to 2:55 p.m. The billing team checks those times against the participant's UPMC authorization, service code, assigned staff profile, and confirmed portal visit. The team should not automatically treat the recorded duration as a full day: the payer's applicable half-day/full-day requirements govern. If any record disagrees, resolve the difference before generating the claim.
Third-Party Software and Adult Day Genie
HHAeXchange instructs centers using third-party systems to discuss the V5 integration specification with their vendor; the official guide advises allowing at least two weeks for setup. An attendance export or an 837P claim file is not proof of a working Home Care Portal integration. Ask your vendor what has been implemented, tested, and confirmed for the UPMC workflow.
Adult Day Genie provides consent-based face or manual check-in, time-stamped attendance, append-only correction history, and exports. Its Medicaid billing software supports self-serve 837P preparation from attendance records. These features help centers check the documentation behind a service day, but a direct Adult Day Genie–HHAeXchange integration has not been verified. Continue using the payer-required portal process.
Frequently Asked Questions
Who needs to use the new UPMC Home Care Portal?
The 2026 transition applies to providers delivering UPMC Adult Day Services. It does not automatically affect other Pennsylvania managed care organizations or unrelated UPMC service lines.
Do I need a new HHAeXchange login?
Not if your organization already has Home Care Portal access. Providers using only the Non-Homecare Portal need to complete the onboarding questionnaire to obtain access.
Does entering attendance automatically create a UPMC claim?
No. HHAeXchange requires the visit to be created and confirmed with start and end times before the claim can be generated.
Does UPMC Adult Day Services require EVV?
No. The official transition guide says EVV is not required for this specific service. Actual member in/out times and visit confirmation are still required before billing.
Can my existing software send visits to HHAeXchange?
A compatible third-party system may use the HHAeXchange V5 integration specification, but the vendor must verify and implement it. A direct Adult Day Genie integration has not been confirmed.
Keep the Attendance Record Behind Every Claim
A payer portal change is easier to manage when the center can verify each participant's attendance and correct discrepancies without recreating paper logs. Adult Day Genie helps teams keep that source record organized. Book a 15-minute Adult Day Genie walkthrough to see attendance, correction history, and reporting, and confirm any separate integration requirements with your vendor.
Last reviewed: October 15, 2026. For current policy and authorization questions, confirm with UPMC; for portal procedures, use the latest HHAeXchange guidance.