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.
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.
Handbook Policies include:
- 1000 Electronic Visit Verification Policy Handbook Introduction
- 2000 EVV Stakeholders
- 3000 Programs and Services Required to Use EVV
- 4000 EVV System and Setup
- 5000 EVV Proprietary System
- 6000 EVV Visit Transaction
- 7000 Clock In and Clock Out Methods
- 8000 Visit Maintenance
- 9000 EVV Reason Code
- 10000 EVV Compliance Reviews
- 11000 Usage
- 12000 EVV Claims
- 13000 Reports
- 14000 Non-EVV Services
- 15000 Fraud Waste and Abuse
- 16000 EVV CDS Employer Policies
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.
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).
Texas Medicaid & Healthcare Partnership (TMHP) has selected two EVV vendors on behalf of the Health and Human Services Commission (HHSC): DataLogic Software, Inc. and First Data Government Solutions. 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 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.
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 Proprietary System An Electronic Visit Verification (EVV) proprietary system is an HHSC-approved EVV system that a program provider or Financial Management Services Agency (FMSA) may use instead of an EVV vendor system from the state vendor pool that:
- Is purchased or developed by a program provider or an FMSA.
- Is used to exchange EVV data with the EVV Aggregator.
- Complies with HHSC EVV Policy as it relates to EVV Proprietary Systems.
- Complies with HHSC EVV Business Rules for Proprietary Systems.
- Complies with the requirements of Texas Government Code Section 531.024172or its successors.
A Proprietary System Operator (PSO) is a program provider or FMSA that has received HHSC approval to use an EVV proprietary system.
Refer to the section 5000 EVV Proprietary System, for more information.
- EVV Training (Section 4200 of the EVV Policy Handbook)requires program providers, Financial Management Services Agencies, and Consumer Directed Services employers to complete all required training before using an EVV system, and then annually.
- EVV Training Requirements Checklists (PDF)provides more detailed information about these training requirements and how to complete them.
- EVV Policy Training Program providers, FMSAs and CDS employers can complete annual EVV policy training requirements in the EVV HHS Learning Portal.
- EVV Learning Portal Guide (PDF)provides instructions on creating an account on the HHS Learning Portal, including how to locate and enroll in EVV policy training courses.
- EVV Portal Training Program providers and FMSAs can access the TMHP Learning Management System to complete annual EVV Portal training requirements. Visit the TMHP EVV Training webpage for more information.
- EVV Vendor System Training Contact:
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.
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).
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 8060 EVV Visit Maintenance Unlock Request 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
- For program providers and FMSAs This document provides step-by-step instructions for program providers and Financial Management Services Agencies (FMSAs) to follow when completing a Visit Maintenance Unlock Request and includes common Visit Maintenance Unlock Request examples. Refer to 8060 Visit Maintenance Unlock Request in the EVV Policy Handbook for policy regarding this process.
- For Consumer Directed Services (CDS) Employers This document is for Consumer Directed Services (CDS) employers that selected Option 1 on Form 1722, Employer’s Electronic Visit Verification Responsibilities. It provides step-by-step instructions for CDS employers to follow when completing a Visit Maintenance Unlock Request and includes common Visit Maintenance Unlock Request examples. Refer to 8060 Visit Maintenance Unlock Request in the EVV Policy Handbook for policy regarding this process.
- EVV Visit Transaction Rejection Guide This guide assists program providers and FMSAs with identifying and taking the necessary steps to correct an EVV visit transaction rejection.
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.
For more information please refer to EVV Policy Handbook section 10000 EVV Compliance Reviews
10010 EVV Usage Reviews
10020 EVV Landline Phone Verification Review
10030 EVV Required Free Text Reviews
10040 HHSC EVV Informal Reviews and MCO Disputes
10050 Formal Appeal of Enforcement Actions
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.
EPH Website Complaints and Appeals https://www.elpasohealth.com/members/complaints-and-appeals/
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.
EVV@hhs.texas.gov for general complaints about EVV requirements.
HHSC Office of the Ombudsman for escalation of a complaint.
CDS employers can find the EVV Contact Information Guide for CDS Employers under resources on the EVV Consumer Directed Services Option webpage.