ELECTRONIC VISIT VERIFICATION

Electronic Visit Verification

Electronic Visit Verification (EVV) is a computer-based system that electronically verifies the occurrence of authorized personal attendant service visits by electronically documenting the:

  • Member receiving services
  • Attendant providing services
  • Location of service delivery
  • Date of service delivery
  • Time the attendant begins and ends service delivery

The EVV program was implemented to replace paper-based attendant timesheets.

Texas requires EVV for certain Medicaid-funded home and community-based services provided through the Health and Human Services Commission (HHSC) and managed care organizations (MCOs)

Texas Medicaid & Healthcare Partnership (TMHP) is the Medicaid claims administrator for the state of Texas and is responsible for managing the EVV Aggregator, the claims matching process, and the EVV Portal. TMHP is also responsible for training program providers, financial management services agencies (FMSAs), managed care organizations (MCOs), and HHSC about the EVV Aggregator and the use of the EVV Portal. TMHP will provide technical assistance for all EVV Portal functions.

Electronic Visit Verification Policy Handbook link

The Electronic Visit Verification (EVV) Policy Handbook provides EVV standards and policy requirements that program providers and Financial Management Services Agencies (FMSAs) contracted with Texas Health and Human Services Commission (HHSC) and managed care organizations (MCOs) must follow. The EVV Policy Handbook also includes requirements for Consumer Directed Services (CDS) employers.

21st Century Cures Act

The 21st Century Cures Act, or Cures Act, is a federal law that passed in 2016 requiring states to implement EVV for Medicaid personal care services and home health care services that require an in-home visit. States that do not implement EVV will receive reduced federal Medicaid funding.  For more information on statues and rules please click on the following links.

Getting Started with EVV

The Texas Health and Human Services Commission (HHSC) published the following document to assist Financial Management Services Agencies (FMSAs), Consumer Directed Services (CDS) employers, Designated Representatives (DRs) and CDS employees in getting started with Electronic Visit Verification (EVV).

EVV Vendors

Texas Medicaid & Healthcare Partnership (TMHP) has selected an EVV vendor on behalf of the Health and Human Services Commission (HHSC): HHAeXchange.  All program providers and financial management services agencies (FMSAs), are required to select an EVV system to be in compliance with EVV state and federal law. It is important to note that CDS employers will use the EVV system selected by the FMSA.

Program providers or FMSAs may visit the TMHP EVV Vendors webpage to learn more about EVV vendor systems. HHSC EVV System and Set Up additional information on selecting a vendor.

A Proprietary System Operator (PSO) is a program provider or FMSA that has received HHSC approval to use an EVV proprietary system. An EVV proprietary system is an HHSC-approved EVV system that a program provider or Financial Management Services Agency (FMSA) may use instead of the state provided EVV system. Refer to the section 5000 EVV Proprietary System, for more information.

Program providers or FMSAs interested in using an EVV proprietary system, must visit the TMHP Proprietary System webpage to review the EVV PSO Onboarding Process and HHSC EVV Proprietary System Approval Process.

EVV Aggregator/EVV Portal

The Electronic Visit Verification (EVV) Aggregator is a centralized database that collects, validates, and stores statewide EVV visit data transmitted by an EVV system. The EVV Aggregator provides validated provider contract or enrollment data to EVV vendors, accepts or rejects confirmed EVV visit transactions using standardized validation edits and returns results to EVV vendors, and stores all accepted and rejected EVV visit transactions. The EVV Aggregator matches EVV claim line items to accepted EVV visit transactions in the EVV Aggregator and sends matching results to the appropriate payer for EVV claims processing.

The EVV Portal is an online system that allows users to perform searches and view reports associated with the EVV visit data in the EVV Aggregator.

EVV Aggregator/EVV Portal (graphic)

EVV Education/Training Resource Requirements

More information about EVV vendors and their systems is available on the TMHP EVV Vendors webpage.

EVV Reason Codes Program providers, Financial Management Services Agencies (FMSAs) and consumer directed services (CDS) employers must select the most appropriate EVV Reason Code Number(s), EVV Reason Code Description option (e.g., A, B, C, etc.), and enter any required free text when completing visit maintenance in the EVV system.

How to Avoid EVV Claim Mismatches (PDF)

HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (PDF)

Member

The member is a person receiving Medicaid services.  Members are responsible for:

  • Reviewing and signing the form EVV Responsibilities and Additional Information.
  • Notifying their FMSA if a CDS employee asks the member to clock in or clock out of the EVV system.

FORM 1718 EVV Responsibilities and Additional Information (MCO) is used by MCO service coordinators to inform Medicaid recipients of their requirements to comply with EVV (reference TAC §Section 354.4011).

Visit Maintenance Unlock Request (VMUR)

Program providers, FMSAs and CDS employers must complete all required visit maintenance, including entry of manual EVV visits, within 95 days from the date of service delivery. This is known as the visit maintenance time frame. HHSC may extend the visit maintenance time frame as needed.

Section 9000 EVV Visit Maintenance allows a program provider, FMSA and CDS employer the opportunity to correct data element(s) on an EVV visit transaction(s) after the visit maintenance time frame has expired.  The EVV system locks the EVV visit transaction and program providers, FMSAs or CDS employers may only complete visit maintenance if the payer approves a Visit Maintenance Unlock Request.

Payer Incorrect, Incomplete or Retroactive Authorization Approvals

The payer must approve the Visit Maintenance Unlock Request when:

The payer previously provided incorrect or incomplete information on the prior authorization for a member and the updated authorization requires updates to EVV visit transactions outside of the EVV visit maintenance time frame.

The payer submits a retroactive authorization for a member that will require the program provider, FMSA or CDS employer to resubmit an EVV visit transaction or EVV claim outside of the EVV visit maintenance time frame.

HHSC directs the payer to approve within the initial request time frame specified in this policy.

Program providers, FMSAs and CDS employers must follow the instructions on the EVV Visit Maintenance Unlock Request Process. Send request emails to EPH_EVV@elpasohealth.com email must include:

  • Contact name
  • Email address
  • Phone number

Requests that are not sent securely could result in a Health Insurance Portability and Accountability Act (HIPAA) violation and request will be denied.  If provider does not have secure email EPH will send email to allow Secure response.

EPH Provider Relations will respond via email to FMSA/CDS/EVV Vendor or PSO as required via policy for all approvals or denials.

VMUR Instructions/Job Aids and Templates

Compliance

HHSC and managed care organizations, the payers, conduct EVV compliance reviews to ensure program providers, Financial Management Services Agencies and Consumer Directed Services employers are in compliance with EVV requirements and policies.

Standards of Compliance: The three general areas evaluated for EVV compliance are: EVV usage, landline phone verification and required free text.

Recoupment Process: All El Paso Health’s outcome determination for contested overpayment claims will be notified to providers or FMSAs within 30 days of receipt of the appeal. Only identified claims where the decision of the appeal was found to be favorable to El Paso Health’s findings or claims that were not appealed will result in recoupment by El Paso Health. All claims appealed without complete supporting details or documentation will result in recoupment.

EVV El Paso Health Recoupment Policy El Paso Health has an updated Recoupment Policy to comply with the new requirements outlined in Senate Bill 1991. New EVV TAC Rules.

For more information please refer to EVV Policy Handbook section 11000 EVV Compliance Reviews

Compliance Job Aid for Program Providers and Financial Management Services Agencies This job aid provides guidance for program providers and Financial Management Services Agencies (FMSAs) on the standards for compliance, how to achieve and stay in compliance and the consequences of non-compliance.

Compliance Job Aid for Consumer Directed Services Employers This job aid provides guidance for Consumer Directed Services (CDS) employers on the standards for compliance, how to achieve and stay in compliance and the consequences of non-compliance.

Complaints

EPH Website Complaints and Appeals https://www.elpasohealth.com/members/complaints-and-appeals/

EVV@hhs.texas.gov for general complaints about EVV requirements.

HHSC Office of the Ombudsman for escalation of a complaint.

CDS employers who have complaints may contact:

CDS@hhs.texas.gov for complaints about a delay in payment from an FMSA or for general CDS program requirement complaints related to EVV.

CDS employers can find the EVV Contact Information Guide for CDS Employers under resources on the EVV Consumer Directed Services Option webpage.