Electronic Visit Verification Provider Policy Handbook


Section 1000, EVV Program

Revision 18-0; Effective November 1, 2018

 

 

1100 Program Introduction

Revision 18-0; Effective November 1, 2018

 

In 2011, the legislature recommended the use of Electronic Visit Verification (EVV) for various long-term care services and as a result, the Texas Health and Human Services Commission (HHSC) formerly known as the Department of Aging and Disability Services (DADS) initiated an EVV pilot program in certain regions across the state. In 2013, the legislature expanded their direction for HHSC to implement a statewide EVV program to include personal assistance services in the managed care programs, personal care services in acute care fee-for-service and community first choice. The HHSC EVV program became operational statewide in June 1, 2015.

This EVV Provider Policy Handbook (EVVPPH) provides EVV utilization standards and policy requirements for provider agencies who are contracted with HHSC and Managed Care Organizations (MCOs) to adhere to. Provider agencies are responsible for complying with all requirements pertaining to EVV in this handbook in addition to program requirements. While the EVVPPH has common requirements across HHSC and the MCOs, each of these entities may have other requirements for provider agencies according to their individual contracts. Provider agencies should contact their appropriate contracted entity with any questions on EVV requirements. The following contracted entities administer the EVV program:

 

Fee-for-Service (FFS)
HHSC

 

Managed Care Organizations (MCOs)
Aetna Better Health Cook Children's Health Plan
Amerigroup Driscoll Children's Health Plan
Blue Cross Blue Shield Molina
Children's Medical Center Health Plan Superior Health Plan
Cigna-Health Spring Texas Children's Health Plan
Community First Health United Health Group

 

1200 Program Overview

Revision 18-0; Effective November 1, 2018

 

EVV is a computer-based system that electronically verifies the occurrence of authorized personal attendant service visits by electronically documenting the precise time a service delivery visit begins and ends. The EVV program was implemented to replace paper-based attendant timesheets, which are difficult to monitor and regulate, with an electronic, verifiable clock-in and clock-out system.

In Texas, EVV is required for certain Medicaid funded home and community-based services provided through HHSC and MCOs. Texas Medicaid and Healthcare Partnership (TMHP), the Texas Medicaid claims administrator, and MCOs use electronic visit data from the EVV system, called an EVV visit transaction, during the Medicaid claims adjudication process to verify people who receive Medicaid receive services authorized for their care and to aid in the prevention of fraud, waste, and abuse. HHSC rules require the MCOs and TMHP to verify the existence of an EVV visit transaction prior to paying a claim for reimbursement. Claims not supported by an EVV transaction may be denied or subject to recoupment.

 

1300 Governing Rules

Revision 18-0; Effective November 1, 2018

 

EVV state and federal statutes and rules include:

A. Texas Government Code §531.024172
B. Human Resource Code, Section 161.086
C. Section 12006 of the 21st Century Cures Act (Cures Act)
D. TAC, Title, 1 Part 15, Chapter 354, Subchapter A, Division 11, Rule §354.1177(d)
E. TAC, Title 40, Part 1, Chapter 49, Subchapter C
F. TAC, Title, 40 Part 1, Chapter 68

Section 2000, Programs, Services and Billing

Revision 19-1; Effective November 15, 2019

 

2100 Programs, Services and Billing Codes

Revision 19-1; Effective November 15, 2019

 

The following Medicaid programs and services require a visit transaction for claim reimbursement:

STAR+PLUS STAR Kids STAR Health HHSC Fee-for-Service
  • Personal assistance services (PAS)
  • Personal care services (PCS)
  • Protective Supervision In-home respite services
  • Community First Choice (CFC)-PAS and Habilitation (HAB)
  • PCS
  • In-home respite services
  • Flexible family support services
  • CFC (PCS/HAB)
  • PCS
  • CFC (PAS/HAB)
  • Primary Home Care (PHP)-PAS
  • Community Attendant Services (CAS)-PAS
  • Family Care (FC)-PAS
  • Community Living Assistance and Support Services
    • In-home respite services; and
    • CFC (PAS/HAB)

EVV is optional for consumer directed services (CDS) and service responsibility option (SRO).

For more information regarding CDS options and SRO please refer to Appendix I: Consumer Directed Services Option and Service Responsibility Option.

 

EVV Billing Codes

Below is a list of billing codes for fee-for-service, STAR + PLUS, STAR Kids, and STAR Health programs and services subject to EVV:

 

2200 Resources and Communications

Revision 18-0; Effective November 1, 2018

 

Provider agencies can visit the EVV Training Resources webpage to find information on upcoming trainings, posted training documents and other important announcements. Providers are also encouraged to visit the GovDelivery webpage to sign up and receive HHSC-email alerts regarding EVV and other programs and services required to use EVV.

Providers who have contracts with HHSC are required to sign up for GovDelivery email alerts as outlined in TAC §49.302.

Each MCO has information on their health plan website regarding EVV.

Providers may also visit the Texas Medicaid & Healthcare Partnership (TMHP) website for information regarding EVV.

 

2300 Vendors

Revision 18-0; Effective November 1, 2018

 

EVV vendors include:

HHSC Approved EVV Vendors
DataLogic (Vesta) Software To get started with DataLogic visit their website at www.vestaevv.com.
MEDsys Software Solutions MEDsys contract is expiring on Nov. 6, 2018 and will no longer be an HHSC approved EVV vendor. Due to this contract expiration, MEDsys is not accepting new providers.

 

2400 New Providers

Revision 18-0; Effective November 1, 2018

 

Selecting an EVV Vendor

Fee-for-service provider agencies with new contracts must research and select an HHSC approved EVV vendor no later than 30 calendar days after the effective date of the contract. Provider agencies are only required to select and use one EVV vendor. Provider agencies should visit the EVV vendor’s website to learn more about the vendor’s electronic system or request a system demonstration. The EVV vendor is required to provide system training to provider agencies.

EVV vendors may offer additional software, such as a billing solution, for purchase. Provider agencies are not required to purchase any software or equipment under the HHSC EVV program.

Under the HHSC EVV program, EVV vendor(s) must provide a system allowing a provider agency to enter member information, provider information and service delivery schedules (scheduled or non-scheduled) either through an automated system or a manual system.

Managed care provider agencies:  

For more information on how to get started with EVV by selecting a HHSC approved EVV vendor please visit the “How do I get started with EVV?” section of the HHSC Electronic Visit Verification website.

 

EVV Grace Periods

New contracted fee-for-service provider agencies receive a three month grace period to train staff on how to use the EVV system before being subject to EVV compliance scores.

Provider agencies only receive a single grace period per contract. There is no additional grace period for a provider agency that transitions from one EVV vendor to another. The grace period for HHSC contracted providers ends the last day of the third calendar month after the effective date of the contract. Please see example in the table below:

Effective Day of the Contract EVV Grace Period
Jan. 1 Jan. 1 – Mar. 31
Mar. 1 Mar. 1 – May 31
Aug. 1 Aug. 1 – Oct. 31
Nov. 1 Nov. 1 – Jan. 31

Provider agencies should be using the EVV system during the grace period. Use paper timesheets only for back up purposes during the grace period.

Provider agencies may no longer use paper timesheets to document service delivery beginning on the first day of the fourth calendar month after the effective date of the contract date. If paper timesheets are used to document service delivery on or after this time visits may be subject to recoupment.

Managed care provider agencies:

 

2500 Data Element Requirements

Revision 18-0; Effective November 1, 2018

 

EVV Data Elements

The EVV system requires multiple data elements for electronic verification of the service delivery visit. Enter the following data elements (if applicable) accurately and completely in the EVV system to identify each Visit Data Category in this table.  

Visit Data Category Date Elements
The provider agency:
  • Taxpayer Identification Number (TIN)
  • National Provider Identifier (NPI) or
  • Atypical Provider Identifier (API)
  • Texas Provider Identifier (TPI) (only applicable in Fee for Service)
  • HHS Contract Number(s)
  • Provider Legal Name
  • Provider Address
  • Provider City
  • Provider ZIP Code
Type of service performed:
  • Service Authorization Information
  • Service Group
  • Service Code
  • HCPCS Code
  • Modifiers
The person receiving the service:
  • Last Name
  • First Name
  • Medicaid ID
  • DOB
  • Address, City & Zip Code
  • Landline Phone Number
  • Medicaid Eligibility Start & End
  • Payer
  • Payer Plan Code
  • MCO Service Delivery Area
  • Region (FFS)
  • EVV Client ID (assigned by EVV vendor)
The date and time of the service:
  • Date In
  • Date Out
  • Time In
  • Time Out
The location of service delivery:
  • GPS Coordinates
  • Caller ID
  • Token ID
The person providing the service:
  • Employee Last Name
  • Employee First Name
  • Phone Number
  • EVV Worker ID (assigned by the EVV vendor)
  • Employee Start Date (start date of employment with provider)
  • Employee End Date (end date of employment with provider)

Most data elements are entered once and automatically populate to each service visit. Provider agencies must ensure data elements entered into the EVV system are accurate and complete. Missing or incorrect data elements in the EVV system may result in rejected EVV visit transactions, denied or recouped claims, and inaccurate EVV standard reports.

 

Partial Visit Maintenance Lock Out

The EVV vendor provides a report listing data elements identified as incorrect which cannot be verified against eligibility data. Provider agencies that do not correct missing, incomplete or inaccurate data, will experience a partial lockout of the system. A partial system lockout will prevent agencies from completing visit maintenance until all missing or inaccurate data is corrected in the EVV system. Providers will retain limited system access until all identified data is corrected.

Section 3000, Electronic Verification Methods

Revision 18-0; Effective November 1, 2018

 

When an attendant provides authorized services to a person in the home or the community, the attendant must use one of three approved EVV time recording methods to clock in when services begin and clock out when services end. This section will describe each method available under the HHSC EVV program. The attendant should only use one method per person for clocking in and out. If the  person receives services in more than one location, the provider agency must work with the EVV vendor when choosing the most appropriate method the attendant can use at the different locations.  

When the attendant clocks-in and clocks-out of the system using one of these methods, the visit data is transmitted in real time to the provider agency to monitor and make adjustments as appropriate.

 

Home Landlines

How to use:

The provider agency must ensure the person’s home landline number is entered into the EVV system correctly. When the attendant uses the home landline, the EVV system will match the landline number used by the attendant to the number entered in the EVV system by the provider agency. If the numbers do not match, an exception will be flagged for this visit and cause the provider to perform visit maintenance.

Do not use cell phones to clock in and out of the EVV system unless the attendant is using the EVV mobile app.

Never use cell phones in place of a landline or when the SAD has not yet been installed in the home. The attendant should never ask or use the person’s cell phone to clock in out of the EVV system.

There are three exceptions to cell phone use:

The EVV vendor conducts monthly phone sampling of home landline numbers entered into the EVV system to verify that the number is a landline number and not a mobile phone number. If a mobile phone number is entered into the EVV system as a home landline, those visits are subject to recoupment by the payer.

The provider agency should order a small alternative device (SAD) if:

 

Allowable and Unallowable Landline Phone Types

Allowable phone types to clock in and out of the EVV system:

Unallowable phone types that cannot be used to clock in and out of the EVV system:

The EVV vendor will sample all landline numbers used to verify EVV visit transactions on a monthly basis, starting March 1, 2018. The EVV vendor will publish the results of their phone sampling for the previous month in the Landline Phone Sampling Report located under Standard Reports. Providers can use this report to monitor phone types being used to verify service delivery as well as multiple phone numbers used within the same month for the same person.

Please see Appendix V: EVV Policies to read the full Unallowable Phone Identification and Recoupment Policy and actions a provider agency must take when identifying an unallowable phone type.  

 

Small Alternative Device (SAD)

How to use:

SAD numeric codes expire after seven calendar days. Once the codes have expired, it is considered a failure to clock in and out of the EVV system.

A SAD is an HHSC approved device provided by the EVV vendor that displays a set of numbers used to document the time services begin and end. SADs are provided at no charge to the provider agency or person by the EVV vendor.

Upon determining that a person needs a SAD, the provider agency has 14 calendar days to order a SAD from the vendor. The vendor will give instructions on how to order a SAD electronically from the vendor’s EVV system. The EVV vendor has 10 business days to process and ship the device to the requesting provider agency. Depending on the shipping method, it may take additional days to deliver the order. If the person has selected the CDS option or the service responsibility option (SRO), the SAD will be mailed directly to the CDS employer.

 

Ordering a SAD Electronically

Effective May 1, 2018, provider agencies can order a SAD electronically through the EVV vendor system.

The new eSAD process will allow provider agencies to:

The EVV system will auto-populate the following information from the client record on the eSAD order request:  

 

Installation of the SAD

A provider agency representative or the attendant must place the SAD in the person’s home on or before the first service delivery date after receiving the device. The provider agency representative or attendant should ask the person where they would like the SAD placed in their home. The device should be in a location where it is accessible to the attendant at all times. The provider agency representative or attendant should explain to the person what the purpose of the SAD is and how the device works.  

 

Malfunctioning SADs

If the SAD is malfunctioning, the attendant must notify the provider agency immediately so a new device can be ordered.

Until the device is replaced, the provider agency must verify services were delivered and complete visit maintenance for those visits using the most appropriate reason code.

 

SAD Zip Ties

Under the HHSC EVV initiative, use of zip ties was required to install the device in the  person’s home. To streamline the SAD installation process HHSC and MCO representatives revised the zip tie policy to make the use of zip ties optional.

Effective June 1, 2018, provider agencies may choose if they want to utilize the EVV vendor zip tie when placing the device in the person’s home. If a person disagrees with the agency policy on installing a SAD with or without a zip tie, the provider agency must document the issue in the person’s case file, and use their preferred method.

The SAD must be in the home at all times. If the SAD does not remain in the home at all times, visits may be subject to recoupment and a Medicaid fraud referral may be made to the Office of Inspector General.
 

EVV Mobile Application

How to use:

The  EVV mobile app has been under pilot testing since May 2017 with one EVV vendor, DataLogic, and contains no protected health information (PHI) on the attendant’s phone. The estimated data usage of the EVV app is under two megabytes per month. It does not use minutes from the attendant's or assigned staff cell phone plan.

The EVV mobile app user requirements being piloted are:

 

EVV Mobile App User Liability

The provider agency and the attendant understand HHSC, EVV vendor(s), and payers are not liable for:

 

Graphical User Interface (GUI)

When the attendant does not use the EVV system, for allowable or unallowable reasons, and the provider agency is going to bill the payer for the visit, the agency must manually enter the visit pay hours into the EVV system. The visit method in and out is marked as Graphical User Interface (GUI). GUI entered visits should not be the norm but the exception. Payers will question an agency when they see frequent GUI visits.

Section 4000, Visits

Revision 18-0; Effective November 1, 2018

 

 

4100 Visit Transactions

Revision 18-0; Effective November 1, 2018

 

An EVV visit transaction is a complete, verified, confirmed visit consisting of the date of service and the actual time service delivery begins and ends. An EVV visit transaction also consists of required data elements that identify and link the person to an attendant, an attendant to a provider agency, and a provider agency to a payer.

Each night the EVV vendor will export confirmed visits from the EVV system and send an EVV visit transaction file to the payer associated with the visits. The payer will accept or reject EVV transactions based on certain verification criteria such as NPI, TIN, Medicaid ID and date of service. If the payer rejects a visit, the EVV vendor will receive a rejection code from the payer and provide a failed to export and rejection report accessible by the provider agency. Agencies can use the report to identify visits that need to be corrected and re-exported to the payer. If the visit is more than 60 calendar days from the date of service, the provider agency must submit a request to the payer associated with the person to open visit maintenance.

HHSC and the MCOs will not pay a claim for reimbursement unless the payer has received a valid EVV visit transaction that matches the claim line item detail. The EVV visit transaction must match the date of service and correspond to the authorized services for which reimbursement is claimed.

Please see Appendix II: EVV Visit Transaction Flowchart for a diagram detailing the lifecycle of an EVV visit transaction.

 

4200 Visit Maintenance

Revision 18-0; Effective November 1, 2018

 

When the EVV system identities a difference between the planned schedule and what actually occurred, the system cannot auto-verify the visit and generates exception(s). The provider agency staff must clear exception(s) by correcting the visit information within the EVV system. This process is referred to as visit maintenance.

For a single visit, there may be more than one exception. Providers must save the most appropriate reason code(s) and enter any required free text in the comment field in order to explain and clear each exception before confirming the visit.

Examples of when exceptions can occur are when the attendant:

For more information regarding reason codes, please see Section 4400 Reason Codes and Appendix III: Reason Codes.

 

Visit Maintenance Timeframe

Provider agencies have 60 calendar days from the date of the visit to complete visit maintenance. After 60 days, the visit is locked and cannot be edited. The provider agency must contact HHSC or the appropriate MCO to request visit maintenance be opened in order to edit the visit record. Approval to open visit maintenance is at the discretion of the payer, HHSC or MCO.

 

Requests to Open Visit Maintenance

After 60 days, the visit is locked and cannot be edited. The provider agency must seek approval from their payer to open visit maintenance in order to make corrections to a visit. Opening visit maintenance allows provider agencies to make changes to certain data elements past 60 calendar days from the visit date and re-export corrected visits to the payer. Approvals and denials to open visit maintenance are at the payer’s discretion and are determined on a case-by-case basis. Requests are processed in the order they are received by the payer and may take up to two weeks to complete. There are no expedited requests.

Data elements that are not allowed to be changed through the open visit maintenance process include:

 

Visit Maintenance Request Process

To request the unlocking of visits after the 60 day window, provider agencies must complete the EVV Visit Maintenance Unlock Request spreadsheet, which can be requested by the payer or downloaded from the HHSC EVV website.   They must complete all fields with accurate information and the request must be sent securely via email to the payer. To increase the efficiency in which the payer can approve or deny the request to unlock visit maintenance the required subject line “Unlocking Visit Maintenance Request” must be included in the email. Requests not sent securely and with the required subject line missing, could result in a Health Insurance Portability and Accountability Act (HIPAA) violation and will be denied. The provider agency should provide an explanation of what needs to be changed and why. The agency should include any documentation to support the request.

Send requests for unlocking visit maintenance to the payer associated with the member in the EVV system. If the provider agency is requesting to make a change to the payer, the provider agency must submit the request to that payer stating that the member will be transferring to a new payer.  Only the current payer can view the visits associated with the member. If the payer determines additional information is needed, a request for more information will be sent to the provider agency. The provider agency must submit the information within three business days of the request back to the payer. If the information is not received within the allotted time, the request   will be denied.

Making corrections in the EVV system after 60 days will not change billing guideline requirements or any type of contract action (recoupments, settlement reviews, etc.) taken during the contract monitoring review. Provider agencies must follow instructions outlined in the contract monitoring exit conference.

The following are reasons for automatic denials to open visit maintenance:

If the request is denied due to one of the reasons listed above, the provider agency may resubmit the request correctly, however the resubmitted request will be considered a new request and will be worked in the order it was received.

The EVV vendor is notified by the payer and sends the request and spreadsheet if the visit maintenance request is approved. This lets the vendor know exactly what data elements are approved for change. The vendor only allows the provider agency to update data payor approved elements. If the request is denied, the payer will send an email to the provider agency with an explanation of denial.

 

Visit Maintenance and Billing Claims

Provider agencies must ensure service claims are supported by service delivery records that have been verified and confirmed in an EVV System. The provider agency must complete visit maintenance, prior to submitting a claim associated with the EVV transaction (visit record). Claims are subject to denial or recoupment if they are submitted before all required visit maintenance has been completed in the EVV System.

If visit maintenance is not completed on EVV transactions in the system or required data elements are not included within the system, the EVV transactions will not be exported to the appropriate payer by the EVV vendor. Claims not matched to an EVV transaction will be denied or recouped by the payer. It’s the provider agency’s responsibility to ensure all required data elements are correct and visit maintenance is completed prior to billing the claim to the appropriate payer.

If visit maintenance needs to be performed on an EVV transaction that has already been billed, and is within the required billing timeframes, the provider must:

Fee-for-Service Claim:

Managed Care Claim:

 

Rounding Rule

The EVV system applies rounding rules to actual hours by rounding the total hours worked to the next quarter hour, which is shown as the pay hours on an EVV transaction. Pay hours are adjustable and should match the hours billed on the claim. Provider agencies are required to bill in quarter-hour increments (0, 15, 30 or 45 minutes past the hour) per program rule and policy.

Within each quarter-hour increment, the EVV system rounds up to the next quarter-hour when the total actual time worked is 8 minutes or more, and rounds down to the previous quarter hour when the total actual time worked is 7 minutes or less.

Examples of rounding based on the rounding rules include:

NOTE: The system DOES NOT round each clock-in and clock-out time. The system only rounds the total duration of the actual hours worked.

MCO contracted provider agencies should contact their contracted MCOs for detailed information regarding each MCO’s rounding policies.

 

Visit Maintenance Reduction Solutions

The following EVV system solutions have been implemented to help reduce visit maintenance, increase auto-verified visits and provide more flexibility for clocking in and out. Visit maintenance reduction solutions are available to all provider agencies statewide.

 

Call Matching Window

The call matching window is set at 24 hours in the EVV system to match to a schedule. Any clock-in and clock-out between 12 a.m. and 11:59 p.m., on the same date of a scheduled visit, and no other exceptions are generated for the visit, the calls will auto-verify to the planned schedule. In order for the call matching window to link visits, the rounded pay hours must match the scheduled visit hours.

For example:

 

Optional Expanded Time for Auto-Verification

This optional solution extends the auto-verified timeframe by .25 rounded hours. If the rounded pay hours are equal to the scheduled hours plus .25 rounded hours (plus 22 minutes), and no other exceptions exist, the calls will auto-verify and log the rounded pay hours. Otherwise, visit maintenance is required.

 

Optional Automatic Downward Adjustment

This is an optional solution designed to automatically adjust pay hours downward to match the planned scheduled hours. This prevents issues with pay hours exceeding the weekly-authorized hours. This adjustment only applies to what the payer is billed and not what should be paid to the attendant. This optional feature is only available if the provider selects the Optional Expanded Time for Auto-Verification.

 

Optional Alert for Reaching Weekly Authorized Hours

This optional alert will notify the provider agency when the person’s authorized hours are close to being reached for the week. This feature will only work if the authorization hours are entered correctly into the EVV system.

Below are examples of the visit maintenance solutions with different options selected:

Example #1:  Planned Schedule 8 a.m. – 12 p.m.; 4 hours

Example #2: Planned Scheduled 1 – 3 p.m.; 2 hours

Important Note: Provider agencies must follow the persons authorized service plan. Although these solutions are available and add some flexibility, the needs of the member should always come first. For example, if a person needs their attendant to be at the home at the scheduled time of 8 a.m. to receive help getting out of bed, the attendant must be there on time. Document all situations that require documentation according to program policy or licensure requirements.

 

4300 Reason Codes

Revision 18-0; Effective November 1, 2018

 

A reason code is a standardized HHSC approved three-digit number and description that is used to explain the specific reason a change was made to an EVV visit record. When the EVV system identities a difference between the planned schedule and what actually occurred, the system cannot auto-verify the visit and generates exception(s). The provider agency staff must clear exception(s) by adding the most appropriate reason code(s).

Provider agencies must associate the most appropriate reason code with each change made to a visit and enter any required free text in the comment section. A single visit may have up to ten reason codes associated with it. Once a reason code is saved to a visit, it cannot be deleted.

There are two types of reason codes:

If a non-preferred reason code is saved to a visit the reason code cannot be removed and the entire visit will be considered non-preferred. The visit will remain as non-preferred even if additional preferred reason codes are saved. Use of non-preferred reason codes lowers the EVV provider compliance score.

Use the most appropriate reason code(s):

Some reason codes include the requirement to verify that services were delivered when the EVV system cannot due to missing clock-in or clock-out time. Provider agencies must follow program policies and procedures to verify services were delivered with the person and document required service delivery information for each visit as part of the visit maintenance process.

NOTE: EVV does not replace any contract, program or licensure requirements regarding service delivery or service delivery documentation.

 

Reason Code Free Text

Each reason code allows free text to be entered in the comments section of a visit. Several reason codes require free text. When the EVV system is a missing clock in time, a clock out time, or both, free text tells the payer what time the attendant actually started or stopped providing services.

If the provider agency uses one of the reason codes that requires free text and fails to enter the required free text in the comment field, the visit is subject to recoupment during contract monitoring.

The free text requirements are listed in bold on the HHSC Reason Code List.  The provider agency must add the appropriate required elements of free text as stated on the reason code list.

Example of Required Free Text:

 

Reason Code Usage Limitation

Some preferred reason codes have limited usage requirements. When the same preferred reason code is used for the same person over a consecutive time or there is a pattern of use of a certain preferred reason code, it may constitute misuse of a preferred reason code.

If the provider agency feels they need to use a reason code longer than 14 calendar days, due to a situation out of their control, they should document the reason why and reach out to the appropriate payer for additional guidance. The provider agency may be subject to the assessment of liquidated damages, corrective action plan or imposition of contract actions, and possibly referral for fraud, waste and abuse investigation when found to be misusing preferred reason codes.

For a complete list of reason codes, please see Appendix III - Reason Codes.

Section 5000, Reports

Revision 18-0; Effective November 1, 2018

 

The EVV vendor system has standard EVV reports that provider agencies and payers use to monitor EVV compliance. HHSC and the MCOs can review the same data as provider agencies when pulling standard reports from the EVV system. The following EVV standard reports are available in the EVV system:

Section 6000, Compliance Plan

Revision 18-0; Effective November 1, 2018

 

 

6100 Introduction

Revision 18-0; Effective November 1, 2018

 

The EVV Compliance Plan is a set of requirements that establishes a standard for EVV usage that must be adhered to by provider agencies. The purpose of the HHSC EVV Compliance Plan is to ensure required provider agencies use an approved EVV vendor system to document service delivery in the home or in the community.  

Effective April 1, 2016, HHSC and MCOs enforced EVV compliance. Regardless of the implementation date for the use of an EVV system, all Medicaid provider agencies required to use the EVV system will have their EVV visits reviewed for 90 percent compliance.

The Consumer Directed Services (CDS) option is exempt from the HHSC EVV Provider Compliance Plan.

Provider agencies must adhere to the requirements of the Texas Health and Human Services Electronic Visit Verification Provider Compliance Plan (PDF).

The EVV system allows  providers to pull standardized and ad hoc reports to analyze their own EVV compliance.

There are three main EVV compliance plan reports used for measuring compliance:

The EVV provider compliance plan score is a percentage that indicates how often billable visits are auto-verified, verified-preferred or verified-non-preferred.  

Visits Auto-Verified – The number of visits that have no exceptions and which no visit maintenance was required.

Visits Verified Preferred – The number of visits that have exceptions verified through visit maintenance using only preferred reason codes.

Visit Verified Non-Preferred – The number of visits that have exceptions verified through visit maintenance using at least one non-preferred reason code.

The compliance plan score is calculated by:

  1. Adding the number of visits auto-verified to the number of visits verified preferred for a particular time period.
  2. Dividing that sum by the total number of visits verified for that same  time period.
  3. Rounding the resulting number to the nearest whole percent.

EVV Initiative Provider Compliance Plan Score = (visits auto-verified + visits verified preferred) ÷ (total visits verified) rounded to the nearest whole percent

Compliance is measured quarterly, effective April 1, 2016, according to the following schedule:

 

EVV Compliance Review Schedule – Fee-for-Service

Fee-for-Service contracts are assigned to Groups 1, 2 or 3 for EVV compliance reviews according to the last digit of the contract number. The table below indicates the compliance reporting cycle for each of the three groups of Fee-for-Service contracts. 

Last Digit of Contract Number Group to Which Contract Assigned Compliance Review Months The Months During Which Compliance Reports be Reviewed
Zero
Three
Six
Nine
1 April, May, June September
July, August, September December
October, November, December March
January, February, March June

One
Four
Seven

2 May, June, July October
August, September, October January
November, December, January April
February, March, April July

Two
Five
Eight

3 June, July, August November
September, October, November February
December, January, February May
March, April, May August

NOTE: There is only one EVV compliance plan for providers to follow. Failure to achieve and maintain a provider compliance score of at least 90 percent for each review period may result in the assessment of liquidated damages, the imposition of contract actions (including contract terminations), a corrective action plan process and possibly a referral for a fraud, waste and abuse investigation.

 

6200 Compliance Enforcement

Revision 18-0; Effective November 1, 2018

 

The provider agency may be subject to the assessment of liquidated damages for each day in the review period the compliance plan score falls below 90 percent. A day on which this occurs is referred to as a “day below program expectations threshold.”

Liquidated damages are assessed at a rate of $3 per visit verified – non-preferred on a day below program expectations threshold.

Liquidated damages are subject to a minimum assessment of $10 to a maximum of $500 per day below program expectations threshold.

An example of calculations of liquidated damages for a non-compliant quarter is shown in the table below:

Day **Daily
Compliance Score %
# of Non-Preferred
Visits within a non-
compliant quarter
Calculation Assessed
Liquidated
Damage
5/1 89% 2 2 x $3 = $6 $10
5/6 80% 10 10 x $3 = $30 $30
6/5 75% 15 15 x $3 = $45 $45
6/8 52% 198 198 x $3 = $594 $500
Total: $585
** less than 90% is a Day Below Program Expectations Threshold

 

Managed Care Contracted Providers:

Please refer to the MCO for information on enforcement actions taken when a provider agency falls below the EVV minimum compliance score.

 

Informal Reviews

A provider agency may request an informal review if the provider agency seeks to demonstrate that the quarterly compliance score was due to a failure of the EVV System. The informal review request must:

A request for an informal review that does not meet the above requirements will not be granted. The payer will notify the provider agency in writing of the results of the informal review. The payer's response will determine if the findings were substantiated, unsubstantiated or reduced based on the assessed corrective action plan and possibly liquidated damages. Provider agencies that request an informal review may still request a formal administrative appeal.

 

Administrative Appeal- Right to State Office of Administrative Hearings Appeal (HHSC Only)

Provider agencies have the right to request a formal appeal if the EVV compliance plan review results in liquidated damages. In accordance with Title 1 Texas Administrative Code (TAC), Section 357.484, Request for a Hearing, the request must be in writing, in the form of a petition or letter, and must state the basis of the appeal of the action. In addition, a legible copy of the notice must accompany the request.

In addition to providing a written appeal request to HHSC, the request and notice must be received at the following address within 15 calendar days of the provider agency’s receipt of the notice:

Texas Health and Human Services Commission
Attn: Director of Appeals
PO Box 149030 (MC- W-613)
Austin, Texas 78714-9030

 

Administrative Appeal – MCOs Only

Provider agencies may contact their respective MCOs for information about their EVV administrative appeal processes.

Section 7000, Training

Revision 18-0; Effective November 1, 2018

 

 

Provider agencies receive EVV program training from HHSC and MCOs, which includes but is not limited to:

NOTE: Access additional training resources online at the EVV Training Resources webpage.

Provider Agencies are responsible for training their staff on the use of EVV which includes but is not limited to:

Provider agencies receive training on the EVV system from the vendor, which includes but is not limited to:

All applicable provider agencies, including financial management services agencies (FMSAs), must contact the EVV vendor to set up EVV system onboarding and training no later than 30 calendar days after the effective date of the contract.

The HHSC approved EVV vendor is:

DataLogic (Vesta)
1501 South 77 Sunshine Strip
Harlingen, TX 78550
Email: info@vestaevv.com
Website: www.vestaevv.com
Training: training@vestaevv.com
Phone: 844-880-2400
Fax: 956-412-1464

Section 8000, Education

Revision 18-0; Effective November 1, 2018

 

 

8100 Introduction

Revision 18-0; Effective November 1, 2018

 

The purpose of EVV is to verify members are receiving the services authorized for their care and for which HHSC and the MCOs are being billed.

The person has rights and responsibilities that must be followed when receiving services required to use EVV.

 

Rights

The person has the right:

 

Responsibilities

The person:

 

8200 Special Situations

Revision 18-0; Effective November 1, 2018

 

Services in the Community

The person is allowed to receive services outside the home in accordance with their service plan and existing program rules. EVV does not change the method and location in which services are delivered.

 

Companion Cases

When two or more people receive services from the same attendant in the same home, the attendant must use the EVV system to clock-in and clock-out for each person.

EXAMPLE:  Attendant Smith provides services to Bob Jones from 8 – 11 a.m., and to Mary Jones, from 11 am – 1 pm.

 

Suspended Eligibility or Authorization

If the provider agency voluntarily chooses to continue providing services when Medicaid eligibility or service authorization has been suspended for a person then those services must be completely and accurately documented in the EVV system, including completing visit maintenance within 60 calendar days of the date of service. The provider agency cannot bill the services until the eligibility or authorization is reinstated.

EXAMPLE:  Ms. Thompson has lost her Medicaid eligibility due to failure to submit documentation on time, but the provider agency has voluntarily chosen to continue providing services in anticipation of Ms. Thompson’s eligibility being reinstated retroactively.  

IMPORTANT: If the Medicaid eligibility or service authorization is not reinstated retroactively, the provider agency will not be reimbursed for those visits. Provider agencies are not required to provide services to members who do not have Medicaid eligibility or a current service authorization.

Section 9000, Fraud, Waste and Abuse

Revision 20-1; Effective October 21, 2020

 

 

If HHSC or an MCO determines that a provider agency is not compliant with the EVV policy and procedures, it could result in a referral for a fraud, waste and abuse investigation.

If you are made aware of, or suspect situations that may be Medicaid fraud, waste or abuse please report it to the HHSC Inspector General online or by calling their toll-free fraud hotline at 800-436-6184.

 

9100 Contract Information

Revision 20-1; Effective October 21, 2020

 

The table below provides contact information for HHSC approved EVV vendors, payers and managed care organizations.

HHSC-Approved EVV Vendors
DataLogic (Vesta)
Website: www.vestaevv.com
Email: info@vestaevv.com
Training: training@vestaevv.com
Phone: 844-880-2400
Fax: 956-412-1464
First Data Government Solutions (AuthentiCare)
Website: solutions.fiserv.com/authenticare-tx
Email: AuthentiCareTXSupport@firstdata.com
Phone: 877-829-2002
Fax: 402-991-9340

 

Payers
Health and Human Services Commission (HHSC)
Email: electronic_visit_verification@hhsc.state.tx.us
Managed care policy questions email: managed_care_initiatives@hhsc.state.tx.us
Texas Medicaid & Healthcare Partnership (TMHP)
Website: www.tmhp.com/topics/evv
Phone: 800-925-9126, Option 5
Email: EVV@tmhp.com

 

Managed Care Organizations Payers
Aetna Better Health
Website: www.aetnabetterhealth.com/texas/providers/
Phone: 844-787-5437 Choose option 6
Email: evvmailbox@aetna.com
Amerigroup
Website: providers.amerigroup.com/Pages/starplus.aspx
Phone: 800-454-3730
Email: TXEVVSupport@amerigroup.com
Blue Cross Blue Shield
Website: www.bcbstx.com/provider/medicaid/index.html
Phone: 877-784-6802
Email: bcbstx_evv_questions@bcbstx.com
Children’s Medical Center Health Plan
Website: www.childrensmedicalcenterhealthplan.com/home/providers/Information/electronic-visit-verifications
Phone: 800-947-4969
Email: cmchpevv@childrens.com
Cigna-Health Spring
Website: www.cigna.com/starplus/health-care-professionals/evv/
Phone: 877-653-0331
Email: providerrelationscentral@healthspring.com
Community First Health Plans
Website: www.cfhp.com/
Phone: 855-607-7827
Email: cfhpevv@cfhp.com
Cook Children’s Health Plan
Website: www.cookchp.org/English/Providers/visit-verification/Pages/default.aspx
Phone: 800-964-2247
Email: CCHPEVV@cookchildrens.org
Driscoll Children’s Health Plan
Website: driscollhealthplan.com
Phone: 877-324-7543
Email: evvquestions@dchstx.org
Molina Healthcare of Texas
Website: www.molinahealthcare.com/en-US/Pages/home.aspx
Phone: 866-449-6849
Email: mhtxevv@molinahealthcare.com
Superior Health Plan
Website: www.superiorhealthplan.com/for-providers/provider-resources/
Phone: 877-391-5921
Email: SHP_.EVV@superiorhealthplan.com
Texas Children’s Health Plan
Website: www.texaschildrenshealthplan.org/for-providers/provider-resources/evv
Phone: 800-731-8527
Email: EVVGroup@texaschildrens.org
United Healthcare
Website: www.uhcprovider.com/en/health-plans-by-state/texas-health-plans/tx-comm-plan-home/tx-cp-evv.html
Phone: 888-887-9003
Email: uhc_evv@uhc.com

Appendices

Appendix I: Consumer Directed Services Option

Revision 18-0; Effective November 1, 2018

 

EVV is optional for a person who chooses the consumer directed services (CDS) option. CDS employers may choose how they want to use the EVV system.

The three participation options are:

  • Phone and computer (full participation)
  • Phone only (partial participation)
  • No EVV participation

CDS employers must document their EVV participation choice on Form 1722, Employer's Selection for Electronic Visit Verification, and send the completed form to their financial management services agency.

For more information regarding the CDS option and getting started please visit the following links:

HHSC EVV Consumer Directed Services Option
HHS Consumer Directed Services - Main Page

 

Consumer Directed Services Governing Rules

EVV state and federal statutes and rules include:  

Appendix II: Transaction Flow Chart

Revision 18-0; Effective November 1, 2018

 

The diagram below details the lifecycle of an EVV visit transaction from the time a provider agency first schedules a visit in the EVV vendor system to the time the payer accepts the visit transaction.

EVV Visit Transaction Flow Chart

Appendix III: Reason Codes

Revision 18-0; Effective November 1, 2018

 

A reason code is a standardized HHSC-approved three-digit number and description used during visit maintenance to explain the specific reason a change was made to an EVV visit record. There are preferred reason codes and non-preferred reason codes.

  • Preferred reason codes indicate situations that are acceptable variations in the proper use of the EVV system.
  • Non-preferred reason codes indicate situations where there was a failure to use the EVV system properly.

Each time a change is made within the EVV system, a reason code must be entered.

HHSC Reason Code Category Numbers Definition
Preferred Variation 100-199 These preferred reason codes reflect situations that are acceptable variations in the proper use of the EVV system.
Small Alternative Device 200-299 These preferred reason codes are related to small alternative devices.
Technical Issue 300-399 These preferred reason codes reflect situations where technical problems prevented the proper use of the EVV system.
Phone Not Accessible 400-499 These preferred reason codes reflect situations where a person’s home landline could not be used by the attendant or nurse.
Special Service Situation 500-599 These preferred reason codes reflect acceptable special situations or special services that require visit maintenance in an EVV system.
Suspension/Reinstatement 600-699 These preferred reason codes are related to service suspensions and reinstatements.
Billing 700-799 These preferred reason codes are related to acceptable adjustments in visit maintenance required for billing and administrative purposes.
Non-Preferred 900-999 These reason codes are non-preferred and generally indicate a failure to use the EVV system properly.

 

The following table contains all current HHSC reason codes.

Number HHSC Reason Code (RC) – Effective 07/01/2017 Instructions and Examples of Use Category
100 Schedule Variation Select RC 100 when the attendant or assigned staff provides more or fewer hours of service than scheduled or provides services at a different time of day than scheduled, as requested by the person. Document all situations that require documentation according to program policy. This reason code cannot be used when an attendant or assigned staff fails to clock in, out or both, unless the appropriate non-preferred reason code (RC 900, 905 or 910) is also saved to visit. Misuse of this preferred reason code may result in contract action(s). Preferred Variation
105 Services Provided Outside the Home – Supported By Service Plan Select RC 105 when the attendant or assigned staff cannot clock in, out or both because some or all of the scheduled services were provided outside of the home in accordance with program policy. This is a preferred reason code. Preferred Variation
110 Fill-in for Regular Attendant or Assigned Staff Select RC 110 when someone other than the scheduled attendant or assigned staff provides services. This is a preferred reason code. Preferred Variation
115 Individual/Member Agreed or Requested Attendant or Assigned Staff Not Work Schedule Select RC 115 when the attendant or assigned staff does not work and the person was:
  • contacted and agreed; or
  • contacted the agency and requested the attendant or assigned staff not work.
Record all situations requiring documentation according to program policy. This is a preferred reason code.
Preferred Variation
120 Invalid Attendant or Assigned Staff or Individual/Member ID Entered – Verified Services Were Delivered Select RC 120 when an attendant or assigned staff in accurately or incompletely enters either their employee ID, the member’s EVV ID or both into the EVV system. This is a preferred reason code. Preferred Variation
121 Attendant or Assigned Staff - No Call and No Show (NEW) Select RC 121 when there is a planned schedule entered in the EVV system and the attendant or assigned staff failed to report to work and did not inform the provider agency until after the missed scheduled visit. Document all situations requiring documentation according to program policy. This is a preferred reason code. Preferred Variation
125 Multiple Calls For One Visit Select RC 125 when an attendant or assigned staff makes multiple calls for a single scheduled visit. Do not use RC 125 if technical issues with the phone prevent the attendant or assigned staff from calling in. Use RC 300 for technical problems with the phone. This is a preferred reason code. Preferred Variation
130 Disaster or Emergency Select RC 130 when an attendant or assigned staff is unable to provide all or part of the scheduled services to a person due to a natural disaster or other emergency (e.g., EMS must be called). Free text is required in the comment field; the provider must document the nature of the disaster or emergency and the actual time service delivery begins and ends in the comment field. This is a preferred reason code. Preferred Variation
135 Confirm Visits with No Schedule (NEW) Select RC 135 when the attendant or assigned staff provides services, as requested by the member, but there was no schedule in the EVV system. Document all situations that require documentation according to program policy. This is a preferred reason code. Preferred Variation
200 Small Alternative Device Has Been Ordered – (Initial or Replacement Order) Select RC 200 when a small alternative device has been ordered, but the provider has not yet received the device. Misuse of this preferred reason code may result in contract action(s). Small Alternative Device (or landline)
205 Small Alternative Device Pending Installation Select RC 205 when a small alternative device has been received by the provider, but the provider has not yet installed the device in the member’s home. Use of RC 205 for the same person more than 14 calendar days may constitute misuse of this preferred reason code. Small Alternative Device (or landline)
210 Missing Small Alternative Device Select RC 210 when the small alternative device cannot be located in the person's home. If the small alternative device is not located within 14 calendar days, the provider agency must request a replacement. This is a preferred reason code. Small Alternative Device (or landline)
215 Reversal of Call In/Out Times (New) Select RC 215 when an attendant or assigned staff reverses either a call in for a call out or a call out for a call in. This is preferred reason code. Small Alternative Device (or landline)
300 Phone Lines Not Working – Attendant or Assigned Staff Not Able to Call – Verified Services Were Delivered Select RC 300 when call in or call out is not possible due to technical problems with landline. Report continuous vendor system issues to the EVV vendor. Please notify payer(s) within 48 hours of unresolved vendor system issues. This is a preferred reason code. Technical Issue
305 Malfunctioning Small Alternative Device or Invalid Small Alternative Device Numeric Codes – Verified Services Were Delivered Select RC 305 when a small alternative device malfunctions or provides invalid numeric codes. The provider must document the actual time service delivery begins, ends or both. If the EVV system is missing the start or end time of a visit, the provider must document the missing time in the Free Text. If RC 305 is used for the same person over more than 14 calendar days, a replacement small alternative device should be ordered. This is a preferred reason code. Technical Issue
310 Malfunctioning Mobile Application Select RC 310 when the EVV mobile application malfunctions and prevents an attendant or assigned staff from documenting the time service delivery begins or ends or both in the EVV system. The provider must document the nature of the problem with the mobile application and the actual time service delivery begins, ends or both using free text in the comment field. This is a preferred reason code. Technical Issue
400 Individual or Member Does Not Have Home Phone – Verified Services Were Delivered Select RC 400 when a person does not have a home landline and requires the use of a small alternative device, but they haven’t requested one. Provider has 14 calendar days to submit a completed order for a small alternative device to the EVV vendor after learning a person requires a small alternative device. Use of RC 400 for the same person more than 14 calendar days may constitute misuse of this preferred reason code. This is a preferred reason code. Phone Not Accessible
405 Phone Unavailable – Verified Services Were Delivered Select RC 405 when the attendant or assigned staff cannot use the phone to call-in or call-out because the phone is in use when the service provision begins or ends (e.g., the person is on the phone with their doctor). Use of RC 405 for the same person for more than 14 calendar days may constitute misuse of this preferred reason code. If this becomes routine, a small alternative device should be ordered. This is a preferred reason code. Phone Not Accessible
410 Individual or Member Refused Attendant or Assigned Staff Use of Phone – Verified Services Were Delivered Select RC 410 when an attendant or assigned staff cannot use the phone to call in or call out of the EVV system because the person refuses to allow the attendant or assigned staff to use the phone (e.g., the person does not trust the fill-in attendant or assigned staff). Use of RC 410 for the same person over more than 14 calendar days may constitute misuse of this preferred reason code. Order a small alternative device if this becomes a routine issue. This is a preferred reason code. Phone Not Accessible
500 In-Home Respite Services Select RC 500 when unscheduled in-home respite services are provided. This is a preferred reason code. Special Service Situation
505 Consumer Directed Services (CDS) Employer Time Correction People self-directing their services using the CDS option who need to correct an EVV entry can select RC 505. CDS employers or Financial Management Services Agencies (FMSAs) can also use RC 505. This is a preferred reason code. Special Service Situation
600 Service Suspension Select RC 600 when the provider has suspended the individual or member’s services per program policy (e.g., the person is in the hospital or temporarily in a nursing facility). Document all situations requiring documentation according to program policy. This is a preferred reason code. Suspension/ Reinstatement
700 Downward Adjustment to Billed Hours Select RC 700 when adjusting the time billed downward to offset rounding. Each visit is rounded to the nearest quarter hour (0, 15, 30 or 45 minutes past the hour) based on the total actual hours. Because of the rounding rules, providers must sometimes round hours down, causing an exception that must be cleared. MCO-contracted provider agencies should contact their contracted MCOs for detailed information regarding MCO rounding policy. Misuse of this preferred reason code may result in contract action(s). Free text is not required. This is a preferred reason code. Billing
900 Attendant or Assigned Staff Failed to Call In – Verified Services Were Delivered Select RC 900 when an attendant or assigned staff fails to use the EVV system to call in. Free text is required in the comment field to document the actual “call in” time. This is a non-preferred reason code. Non-Preferred
905 Attendant or Assigned Staff Failed to Call Out – Verified Services Were Delivered Select RC 905 when an attendant or assigned staff fails to use the EVV system to call out. Free text is required in the comment field to document the actual “call out” time. This is a non-preferred reason code. Non-Preferred
910 Attendant or Assigned Staff Failed to Call In and Out – Verified Services Were Delivered Select RC 910 when an attendant or assigned staff fails to use the EVV system to call in and call out. Free text is required in the comment field; the provider must record the actual time service delivery begins and ends in the comment field. This is a non-preferred reason code. Non-Preferred
915 Wrong Phone Number – Verified Services Were Delivered Select RC 915 when calls for a visit are from a number that is not recognized by the EVV system. This is a non-preferred reason code. Non-Preferred
999 Other Select RC 999 when a provider must address an EVV system exception that cannot be addressed using any of the other reason codes. Free text is required in the comment field explaining why this code was required. This is a non-preferred reason code. Non-Preferred

Download current and historical HHSC reason codes online at HHSC EVV Reason Codes.

Appendix IV: Provider Compliance Document

Revision 18-0; Effective November 1, 2018

 

Provider agencies must adhere to the requirements of the Texas Health and Human Services Electronic Visit Verification Provider Compliance Plan (PDF).

Failure to achieve and maintain an EVV provider compliance score of at least 90 percent per review period may result in the assessment of liquidated damages, the imposition of contract actions (including contract terminations), a corrective action plan process and possibly a referral for a fraud, waste and abuse investigation.

Appendix V: Policies

Revision 18-0; Effective November 1, 2018

 

EVV Unallowable Phone Identification and Recoupment Policy

Effective Aug. 1, 2018, the Texas Health and Human Services Commission or the applicable Managed Care Organization and provider agency must adhere to the following revised policy.

 

Unallowable Phone Identification Written Notice:

  • HHSC or the MCO must notify the provider agency in writing via email and mail when they have identified a phone number originating from an unallowable phone type.
  • The written notification to the provider must include, at a minimum, the following information:
    • Phone number identified
    • Phone type
    • Dates the phone number was used to clock in, out or both
    • Attendant associated with the EVV check in or out
    • Individual’s first and last name
    • Individual’s Medicaid number
    • Date HHSC or MCO identified the phone number associated with the device
    • List of supporting documentation the provider can submit to validate the identified unallowable phone number(s) is not a mobile phone or a cellular-enabled device or tablet
    • HHSC or MCO contact information
    • HHSC or the MCO must provide the provider agency a copy of the EVV Vendor Phone Sampling Report or other phone sampling reports used to identify the unallowable phone type

 

Identified Wireless Only Phone Carriers

The following cell phone carriers have been identified as providing wireless service only:

  • Boost Mobile
  • Cricket Wireless
  • Straight Talk
  • T-Mobile
  • Metro PCS
  • Virgin Mobile

 If the Phone Sampling Report identifies one of the wireless phone carriers listed above, or any other wireless only phone carrier, the provider must select one of the following actions within twenty business days from the date of receipt of the written notice.

  • Participate in the EVV Mobile Application Pilot
  • Request a small alternative device

 

Identified Wireless and Landline Phone Carriers

If the Phone Sampling Report identifies a phone carrier that provides wireless and landline services, such as AT&T, the provider agency must take one of the following actions within twenty business days from the date of receipt of the written notice:

  • Participate in the GPS Mobile Application Pilot
  • Request a SAD
  • Submit supporting documentation showing the identified unallowable phone number(s) is not a mobile phone or cellular-enabled device or tablet

HHSC or the MCO will review all supporting documentation submitted within the required timeframe and provide written notice of a decision. If the supporting documentation submitted by the provider cannot verify the unallowable phone number as an allowable phone type, the visit(s) identified in the written notice are subject to recoupment. Supporting documentation may include, but is not limited to:

  • Internet search sites such as White Pages, Free Carrier Look-up Service, Reverse Phone Check
  • Documentation from the phone company

If the provider agency does not receive the SAD(s) within ten business days from requesting a SAD using the e-SAD ordering process, the provider agency should immediately notify the payer identified on the written notice and HHSC EVV operations staff.

The provider agency will be in compliance with no further action necessary when:

  • verification can be provided from the EVV vendor that the attendant is using the GPS mobile application; or
  • verification can be provided from the EVV vendor that a SAD has been requested within twenty business days from the date of the written notice; or
  • the provider receives written notification from HHSC or MCO that the supporting documentation submitted confirmed the unallowable phone number as an allowable phone type

Provider Agency Fails to Take Action:

If the provider agency fails to use the GPS mobile application, request a SAD or submit supporting documentation to HHSC or the MCO within twenty business days from the date of the written notice, HHSC or the MCO may take compliance or contract action against the provider agency including recoupment of the visit(s) identified in the written notice.  

If an unallowable phone number had been previously identified and confirmed to be unallowable, and was used later for EVV visits after the provider received written notification, those visits may be subject to recoupment.

Allowable Phone Types:

  • Wired phone connected to a phone jack in the wall
  • Cable internet provider (e.g., Time Warner, Comcast, AT&T, etc.)
  • Non-Fixed Voice over Internet Protocol (VoIP) (e.g., Portable alternative phone services that use VoIP, including but not limited to MagicJack, or Vonage)
  • Fixed VoIP

Unallowable Phone Types:

  • Mobile phone
  • Cellular-enabled device or tablet

How is an unallowable phone type identified?

DataLogic (Vesta) will sample all numbers used to verify EVV visit records on a monthly basis, starting March 1, 2018. DataLogic will publish the results of their phone sampling for the previous month in the Phone Sampling Report located under Standard Reports.

Providers can use this report to monitor phone types being used to verify service delivery as well as multiple phone numbers used within the same month for the same member.  

If you require assistance in locating or generating the Phone Sampling Report, please call Vesta EVV Customer Support at 844-880-2400.

 

Small Alternative Device Zip Tie Policy

Effective June 1, 2018, each provider agency must continue to place or install the SAD in the person’s home but may choose whether or not to utilize the HHSC approved EVV Vendor zip tie.

Provider agencies must work with the person to determine the best method for placing the SAD in the home. If a person disagrees with the agency policy on installing a SAD with or without a zip tie, the provider agency must document the issue in the person’s case file, and use the person’s preferred method.

The SAD must be in the home at all times. If the SAD does not remain in the home at all times, visits may be subject to recoupment and a Medicaid Fraud referral may be made to the Office of Inspector General.

Appendix VI: Alerts Historical Timeline

Revision 18-0; Effective November 1, 2018

 

The following alerts have been published by HHSC EVV. To receive EVV alerts sign-up with GovDelivery.

 

2018

Alerts for the current year are available in the News & Alerts section on the HHS EVV website.

2017

Alerts for 2017 can be found here.

2016

Alerts for 2016 can be found here.

2015

Alerts for 2015 can be found here.

2014

Alerts for 2014 can be found here.

Forms

ES = Spanish version available.

Form Title  
1718 Electronic Visit Verification (EVV) Rights and Responsibilities Managed Care Organization ES
1722 Employer's Selection for Electronic Visit Verification (EVV)  
1723 Electronic Visit Verification (EVV) Request for Employer Phone Number(s)  

Glossary

Revision 18-0; Effective November 1, 2018

 

Electronic Visit Verification (EVV) — Electronic documentation and verification of service delivery through an HHSC-approved EVV System.

EVV System — EVV system electronically verifies when service visits occur and the precise time of the beginning and ending of the service. It is computer-based.

EVV Visit Transaction — A complete, verified visit consisting of the date of service, the time service delivery begins and ends, and other required data elements that identify and link the person to an attendant, an attendant to a provider agency and a provider agency to a payer.

Exceptions — Visits that do not auto verify and require the use of one of more reason codes to clear in the EVV system.

HHSC EVV Provider Compliance Plan — A set of requirements that establish a standard for EVV usage. They must be adhered to by provider agencies under the HHSC EVV initiative.

HHSC EVV Provider Compliance Plan Grace Period — A timeframe during which provider agencies must use an EVV system and may, for billing support purposes only, use paper timesheets as backup documentation. Provider agencies that are in a grace period are not subject to liquidated damages, contract actions, or corrective action plan requirements for failing to achieve a compliance plan score of at least 90 percent. However, claims may still be subject to denial or recoupment.

HHSC EVV Provider Compliance Plan Review Period — A time-period that occurs at least once within a calendar year or more frequently as determined by the payer. It consists of three consecutive calendar months prior to the review month.

Liquidated Damages (LDs) — The amount of compensation for damages an injured party can collect in the event of a specific breach of contract, as agreed to by the parties during the formation of a contract.

Payer — Texas Health and Human Services or Managed Care Organization.

Non-Preferred Reason Code — Indicates situations where there was a failure to use the EVV system properly.

Preferred Reason Code — Indicates situations that are acceptable variations in the proper use of the EVV system.

Provider/Provider Agency — Service providers that are under contract and are providing Medicaid covered services subject to EVV.

Reason Code — A standardized, HHSC approved three-digit number and description used during visit maintenance to explain the specific reason for a change made to an EVV visit record.

Visit Maintenance — The process by which provider agencies can make adjustments in an EVV System to electronically document service delivery visit information as required by HHSC and the MCOs.

Visits Verified — The number of visits that have no exceptions or for which all exceptions have been resolved through visit maintenance in the EVV System. Verified visits are eligible for billing. Visits verified = number of visits auto-verified + number of visits verified preferred + number of visits verified non-preferred.

Visits Auto-Verified — Visits that matched the planned schedule and have no exceptions.

Visit Maintenance Partial Lockout — The inability of a provider to complete visit maintenance in the EVV system due to required data elements not entered or entered incorrectly.

Visits Verified Preferred — Verified visits with exceptions that were confirmed through visit maintenance using only preferred reason codes.

Visits Verified Non-Preferred — Visits with exceptions that were verified through visit maintenance using at least one non-preferred reason code.

Revisions

20-1, Changes to Section 9000

Revision Notice 20-1; Effective October 21, 2020

 

The following change(s) were made:

Section Title Change
9100 Contract Information Updates vendor, payer and MCO information.

19-1, Changes to Section 2000

Revision Notice 19-1; Effective November 15, 2019

 

The following change(s) were made:

Section Title Change
2100 Programs, Services and Billing Codes Updates EVV billing codes.

18-0, New Handbook

Revision Notice 18-0; Effective November 1, 2018

 

The Electronic Visit Verification Provider Policy Handbook supports the EVV program, a computer-based system that electronically verifies the occurrence of authorized personal attendant service visits by electronically documenting the precise time a service delivery visit begins and ends.

Contact Us

For technical or accessibility issues with this handbook, email: Editorial_Services@hhsc.state.tx.us

For questions about Electronic Visit Vertification Provider Policy Handbook, please email: electronic_visit_verification@hhsc.state.tx.us.