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electronic visit verification

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If providers have not already started implementing EVV, providers are at risk of being out of compliance on January 1, 2024.

All claims and encounters for HHCS are subjected to EVV requirements for dates of service on or after January 1, 2024 and must have a corresponding EVV visit, or claims payment will be impacted. Manual editing compliance rates will also go into effect on January 1, 2024. Please reference the recently released bulletin “Electronic Visit Verification Requirements for Home Health Care Services in the Fee-for-Services Delivery and Managed Care Delivery Systems Bulleting, number 05-22-09, 07-22-03, 54-22-01, 59-22-01, 00-22-06.”

The Department of Human Services (DHS) will continue to monitor EVV data. If any systemic issues occur, DHS will communicate the issue and resolution via the Listserv and the website as soon as they can. Support volume is expected to increase now through the end of January 2024. Please be aware that response times may be longer than normal during this time.

As a reminder, available resources are on the DHS EVV website. There is also an FAQ page, which may answer a majority of your questions as well.

EVV ERROR STATUS CODES

Error Status Codes (ESC) are actively setting for all claims with services subject to EVV that are submitted through PROMISe for fee-for-service programs. EVV ESCs are currently setting in a pay and list status, so while claims continue to pay, the ESC still sets to educate the provider. Providers should be actively reviewing these ESCs to determine if their claims and EVV data are matching appropriately. The EVV Error Status Codes (ESC) published on the DHS EVV website outlines the conditions when claims would deny beginning with dates of service January 1, 2024, and after.

  • ESC 936 sets when “Duplicate Matching EVV HHCS Visits Found.” When two exact EVV records exist in the aggregator, the claim validation call does not know which record to match with, so it will set either ESC 926 or ESC 936 and deny. To correct this issue for alternate EVV users, the EVV record should contain “BillVisit” set to “False.” This will tell the aggregator to set the duplicate record to “Omit” so it is not considered during EVV validation against the aggregator. In addition, alternate EVV users should ensure when sending records for omission that they submit the same “VisitOtherID” that was assigned to the original record they wish to omit/remove.
  • ESC 937 sets when “HHCS Units Billed Exceed Units Verified in EVV.” Provider agencies should determine if the units on the claim detail line or the units found in the EVV record need to be corrected. PROMISe™ is not designed to cut back units on the claim for an EVV service if the allowed units on the claim are greater than the total units found in the Aggregator. Providers should make corrections as applicable and resubmit the claim, ensuring the units found in the EVV Aggregator are equal to or greater than the units submitted on the claim. While performing claims resolution analysis, providers are encouraged to review the rounding rules and/or the calculation rules, make corrections accordingly, and resubmit the claim.
    • Note:“Allowed” units on a claim detail line are not always equal to the exact units submitted on the claim because other edits/audits are performed before the units on the claim are validated against the units found in the EVV Aggregator record. Example: Fiscal year unit limitations or weekly unit limitations may “cutback” units submitted on a claim which would make the units on the claim less than what was submitted on the actual claim.
  • If ESC 938, “No Matching HHCS EVV Visit Found,” is setting, providers should complete the following steps to determine the cause of the error:
    • If the EVV record that is found in the Aggregator contains a mismatch between one or more data elements on the claim, review the EVV record in the Aggregator and manually validate if the data elements found in the Aggregator record(s) contains the appropriate values as specified in the Alternate EVV technical specifications found on the DHS EVV website. A frequently seen error is when the EVV record contains a 9-digit MA ID # instead of the 10-digit Recipient ID number (RID) that is contained on the claim. If you experience this issue, update your client/participant number from 9 to 10-digits in your source system that feeds the alternate EVV system records that are sent to the aggregator.
    • For 2:1 services specifically, the system is unable to determine which care worker visit to use when calculating units if the aggregator contains overlapping time for 3 or more care workers. This scenario will typically occur during shift changes. To resolve this issue, the provider should manually adjust the third care worker’s EVV visit to a time that does not overlap with the care worker’s time whose shift is ending. Due to this system limitation, a manual edit for this scenario is acceptable by DHS.

Providers experiencing issues should reach out to the appropriate contacts, which are included below, based on the issues they are experiencing.

For technical issues, such as DHS Sandata account assistance, Welcome Kit reissuance, account unlock issues either for DHS Aggregator or DHS Sandata EVV, and/or issues with the DHS Aggregator accepting file submissions, please contact: Provider Assistance Center (PAC) or 800-248-2152.

For issues related to HHAeXchange and CHC billing, please contact HHAeXchange and/or the appropriate CHC-MCO.

For general EVV program issues or requests to be added to the EVV Listserv, please contact the EVV Resource Account.

For billing issues, such as why EVV ESCs are setting, what the EVV ESCs mean, and questions about what is in the Aggregator, please contact the following program office claims:

ODP Claims Resolution Section 1-866-386-8880,
Email
Hours of operation: Monday – Friday, 8:30 am –12:00 pm and 1:00 pm – 3:30 pm
OLTL Provider Call Center 1-800-932-0939

Hours of operation: Monday – Thursday, 9:00 am – 12:00 pm and 1:00 pm – 4:00 pm
OMAP Provider Inquiry Line 1-800-537-8862, choose option 2, then

option 6, then option 1

Hours of operation: Monday-Friday, 8:00 – 12:00 pm and 12:30 pm – 4:30 pm

 

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The Electronic Visit Verification (EVV) public meeting originally scheduled for Friday, March 18, 2022, has been rescheduled to Friday, April 8, 2022, from 1:00 pm–2:00 pm. Topics include updates related to DHS’s implementation of EVV.

Please register using this registration link. After registering, you will receive a confirmation email containing information about joining the webinar.

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Many agencies and providers have successfully participated in the DHS Sandata EVV training. These providers are successfully using the DHS Sandata EVV system during the PA-DHS soft-launch period. As a reminder, the soft-launch period is scheduled to end Dec 31, 2019.

While Pennsylvania is seeking a Good Faith Effort Exemption (GFE) from the Centers for Medicare and Medicaid Services (CMS) to extend the soft launch period, it has not yet been approved. If your agency is one of the few that still needs to complete Sandata EVV training to get your DHS Sandata EVV credentials, it is not too late!

Online self-paced training is still available 24/7 and can be accessed here. To receive your agency credentials, at least one provider representative must complete training.

The first person in your agency who enrolled and completes training will receive an emailed Welcome Kit with your agency’s credentials.

Welcome Kits: Presently, Welcome Kits are distributed within two business days after the completion of training. Due to the holidays, any agency completing training on or after December 20, 2019, will not be guaranteed a Welcome Kit by January 1, 2020.

If your agency has competed training and did not receive a Welcome Kit, please contact PAC at 800-248-2152 or via email.

Questions?

For questions on whether a provider or services are included in the EVV mandate, contact Provider Enrollment:

  • ODP Provider Enrollment: 866-565-9435 or email
  • OLTL Provider Enrollment: 800-932-0939 option 1

For DHS Sandata EVV application questions, call 800-248-2152 or email. Submit EVV program questions here. For ALT-EVV Certification, call 855-705-2407 or email.

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As a reminder, section 12006 of the 21st Century Cures Act requires all states to implement the use of EVV for Medicaid-funded personal care and home health care services. EVV must be implemented for personal care services by January 1, 2020, and for home health care services by January 1, 2023.

OLTL waiver services included in the initial implementation of EVV:

  • Personal Assistance Services (Agency and Participant-Directed Model)
  • Participant-Directed Community Supports
  • Respite (unlicensed settings only)

As part of the soft launch period, claims submitted to PROMISeTM for services subjected to EVV will be validated against EVV visits submitted through the Department of Human Services (DHS) Sandata system or DHS Aggregator. During claims processing in PROMISeTM, EVV validation against the DHS Aggregator will continue to be performed and EVV Error Service Codes (ESCs) will set without impacting claim payment. The ESCs for EVV will become active on December 13, 2019, for claims submissions with dates of service on or after November 1, 2019. Providers are expected to review when the EVV edit(s) set and actively make corrections either to the data stored in the DHS Aggregator or the claim itself to ensure errors do not repeat.

Please see this chart of EVV-specific ESCs for reference. If you have questions about EVV, please refer to the Frequently Asked Questions document on the DHS EVV website or contact the EVV Resource Account.

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ODP Announcement 19-150 is to inform stakeholders that Pennsylvania will formally request a Good Faith Effort (GFE) Exemption from CMS to delay the implementation of the electronic visit verification (EVV) mandate. More time is needed in order to allow providers to fully prepare for EVV. ODP has heard from many providers who are using Alternate EVV systems and have been working with Sandata to certify their systems for integration with the DHS Aggregator. Since the time for certification is taking longer than originally projected, the Department is seeking an extension to allow additional time for these systems to go through the necessary testing with Sandata and become integrated to feed EVV data to the DHS Aggregator.

The Department is seeking a GFE to extend the soft launch period and to delay the denial of payments. The timeframe between system launch and the EVV mandate is referred to as the soft launch. The soft launch is an opportunity to:

  • Test and interface Alternate EVV systems
  • Familiarize providers with EVV prior to claims integration. Claims will continue to pay and EVV errors will appear on remittance advice.
  • Inform policy and system development
  • Help the Department identify and develop supplemental training materials
  • Facilitate EVV participation by caregivers and members

If approved by CMS, the GFE will allow the Department to extend the soft launch period and implement a tiered compliance structure before the denial of payments. EVV system implementation, training, and vendor interfacing will proceed on the current project schedule. Since the exemption has not yet been approved, providers are still required to begin using EVV by January 1, 2020. Provider participation will produce valuable data for system modification and policy development.

Please visit the DHS EVV website to view the ODP EVV technical guidance, public meeting notices, training resources, and Frequently Asked Questions (FAQs).

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Office of Developmental Programs (ODP) Communication 19-020 is intended to provide current information to external stakeholders regarding the Electronic Visit Verification (EVV) Federal mandate established by the 21st Century Cures Act. This is also to request that you complete a DHS survey to help inform their EVV system development and implementation.

EVV is a technology solution which electronically verifies that home and community-based services are delivered to the individuals needing those services. EVV includes multiple technologies, such as telephonic, mobile, and web portal verification inputs. The 21st Century Cures Act requires that all state Medicaid agencies implement an EVV solution to manage their personal care services by January 1, 2020, and home health care services by January 1, 2023.

As a reminder, the EVV system must collect and verify:

  1. Type of service performed;
  2. Individual receiving the service;
  3. Individual providing the service;
  4. Date of the service;
  5. Location of service delivery; and
  6. Time the service begins and ends.

DHS is working with DXC and Sandata to develop an EVV system that will integrate with their existing Medicaid Management Information System (MMIS), PROMISe™. However, Pennsylvania is using an open EVV system model and providers may use their own EVV vendor/system, as long as it captures the six required items and is able to submit EVV data into the state’s system. Third party EVV systems will need to meet Sandata’s technical specifications and DHS’ Addendum, both of which will be made available once finalized. Providers serving participants covered under one of the Community HealthChoices Managed Care Organizations (CHC-MCOs) will be able to use the MCO’s EVV system, HHAeXchange. If a provider participating in CHC already has their own internal EVV system, they must work with the CHC-MCO to ensure their system is able to send information to HHAeXchange. For participant-directed programs in the Office of Long-Term Living (OLTL) waivers, the vendor fiscal agent Public Partnerships LLC (PPL) will be utilizing their EVV system, Time4Care, to satisfy EVV requirements.

DHS is developing the state EVV system with a full go-live date of August or September 2019, with a soft implementation of the system and outreach and training beginning this spring through the fall. DHS is also asking that you complete a quick survey to help inform EVV system development and implementation by March 8, 2019. You can access the survey directly at this link.

DHS will continue to provide you with guidance and updates as they move through this process. Updated information will be sent to you and will also be included on the DHS website. Questions or comments can be submitted to the EVV resource account email.

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(From OLTL)

EVV Implementation Update

The 21st Century Cures Act requires implementation of electronic visit verification (EVV) by January 1, 2019 for personal care services (PCS).  On July 30, 2018, the President signed a law delaying penalties for implementation to January 1, 2020 for PCS.  The requirement for implementation of EVV for home health services by January 1, 2023 has not changed.

This delay will allow Pennsylvania an opportunity to extend implementation activities and training, to make sure that providers are fully ready for the implementation of EVV.  The tentative plan for Pennsylvania’s implementation of EVV is:

  • January 2019 – PA guidance will be distributed
  • Spring 2019 – provider training will be offered with phased-in system use
  • Summer 2019 – full implementation of system

As shared previously, we will utilize an open system for EVV.  This means that providers who already have an EVV system will be able to submit information to the state’s EVV vendor.  The Department of Human Services is using the existing PROMISe™ fiscal agent contract with DXC for EVV.

Providers who do not have their own EVV will be able to utilize the Department’s system for compliance.

For Office of Long-Term Living waivers, including Agency and Participant-Directed Services, PCS includes:

  • Personal Assistance Services
  • Respite (unlicensed settings only)

Additional information will be shared when it becomes available.  You may also look for information on our website at http://dhs.pa.gov/provider/billinginformation/electronicvisitverification/index.htm.  For further questions regarding EVV, please email [email protected].

A listserv has been established for ongoing updates on the CHC program. It is titled OLTL-COMMUNITY-HEALTHCHOICES, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

Please share this email with other members of your organization as appropriate. Also, it is imperative that you notify the Office of Long-Term Living for changes that would affect your provider file, such as addresses and telephone numbers. Mail to/pay to addresses, email addresses, and phone numbers may be updated electronically through ePEAP, which can be accessed through the PROMISe™ provider portal. For any other provider file changes please notify the Bureau of Quality and Provider Management Enrollment and Certification Section at 1-800-932-0939 Option #1.

To ensure you receive email communications distributed from the Office of Long-Term Living, please visit the ListServ Archives page at http://listserv.dpw.state.pa.us to update or register your email address.

NOTICE: This confidential message/attachment contains information intended for a specific individual(s) and purpose. Any inappropriate use, distribution or copying is strictly prohibited. If received in error, notify the sender and immediately delete the message.

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