Submit all managed care claims for EVV-relevant services delivered through the consumer directed services option or service responsibility option in the STAR Health, STAR Kids, STAR+PLUS, and STAR+PLUS Medicaid-Medicare Plan programs to Texas Medicaid & Healthcare Partnership by Oct. 1. This is for the EVV claims matching process to occur. This information is for Cures Act program providers and FMSAs required to use Electronic Visit Verification by Jan. 1, 2021.
- Submit EVV claims with a date of service on or after Oct. 1 to TMHP. They will be denied or rejected if they are submitted directly to a managed care organization.
- Refer to How to Setup Managed Care EVV Claims Submission to TMHP to prepare for submitting EVV claims to TMHP.
- The process of setting up claims submission can take up to three weeks to complete. Program providers and financial management services agencies should begin the process as soon as possible to be ready by Oct. 1.
EVV Practice Period
From July 1, through Nov. 30, program providers and FMSAs impacted by the Cures Act can practice using the EVV system, EVV Portal, and submitting EVV claims to TMHP for EVV claims matching.
- During the practice period, EVV claims for services included in the Cures Act EVV expansion will not be denied for a mismatch.
- Refer to the article titled Cures Act EVV: The EVV Practice Period Begins July 1, posted on May 22, for more information about the practice period.
EVV Claim Denials for Mismatches Begin
Beginning Dec. 1:
- Capture all service visits for an EVV-required service in the EVV system.
- Claims that don’t have a matching EVV visit transaction in the EVV Portal will be denied.