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.