CCHP – Compliance Plan
Electronic Visit Verification
What is Electronic Visit Verification?
EVV is a telephone and computer-based system that electronically verifies service visits occur and documents the time service provision begins and ends.
The purpose of EVV is to verify individuals/members are receiving the services authorized for their support and for which the state/MCO is being billed. Provider agencies will use the time recorded in the EVV system to determine billable units/hours before requesting payment from the State or Managed Care Organization (MCO).
EVV is optional for individuals who have selected the Consumer Directed Services (CDS) option and the Service Responsibility Option (SRO).
Providers are required to validate service times using a selected EVV vendor system. For the most up-to-date information regarding the EVV timeline of implementation and compliance, please refer to the HHSC EVV news page.
The Grace Period for provider on-boarding, training, overall readiness and full compliance with the EVV system functionality will expire 30 days following HHSC notification of the compliance date.
CCHP will administer EVV compliance based on claims validation against submitted EVV transactional data. For EVV covered services, we will evaluate billed claims against verified visits (logged in the EVV system selected by the provider) which are transferred daily to CCHP.
After standard claim adjudication rules, we will execute an additional verification based on matching Provider ID, Member ID, dates of service, procedure codes, and billed units. If the EVV transactional units match the billed units, the claims will pay appropriately.
If there is no corresponding EVV transactional data, the claim is subject to denial.
If the billed units exceed the EVV validated transactional units, the claim is subject to denial or partial payment for units that were validated.
Vendor Compliance plan
CCHP – Compliance Plan
HHSC – Compliance Plan (External Link)
EVV Reason Codes
How does EVV work?
The EVV system electronically documents: the individual/member receiving services, the attendant providing services, the provider agency information, and the exact time the attendant begins and ends service delivery.
I do not have a home land line. Do I need to get one to continue my services?
No, EVV does not require individuals/members to get a home landline phone. If you do not have a home landline or you do not want your personal attendant to use your home landline, a small alternative device will be ordered and installed in your home for your personal attendant to use to clock in and out.
What is a small alternative device and how does it work?
A small alternative device is an alternative method for attendants to use to capture the date and start and stop time of a visit. When the attendant arrives and leaves your home, they write down a unique set of numbers displayed on the device. These numbers are referred to as values and documents the exact time your attendant begins and ends providing services to you. Your attendant calls these values into the EVV system to complete the service delivery record. Small alternative device values expire after seven (7) consecutive calendar days.
How do I get a small alternative device?
If you do not have a home landline or you do not want your attendant to use your home landline, you may request a small alternative device be installed in your home. Your provider agency will ask you to sign a Medicaid EVV Small Alternative Device Agreement Form. By signing this agreement, you agree the device will be installed in your home and must stay in the home at all times. You also agree that if the device is lost, stolen, removed from the home or you are no longer receiving services, you will contact the provider agency immediately.
There is no charge to receive a small alternative device.
How is the small alternative device installed in the home?
Each small alternative device is shipped with a zip tie (printed with the EVV vendor’s name on it) used to secure the device in your home. You can decide where you would like the device installed in your home. It should be installed in an area accessible to your attendants and to an object that is not easily removable from the home. Some suggested areas include: door knobs, closet rods or kitchen drawer/cabinet handles.
I don’t have a landline but I have a cell phone. Can my attendant use my personal cell phone to call the EVV system?
No. The use of the individual's/members personal cell phone is not allowed and your attendant should never ask to use your cell phone to call in and out.
Note: The only exception to cell phone use is if you are a Consumer Directed Services (CDS) employer. Please see the CDS FAQs for more information on cell phone use under the CDS option.
Can an individual/Member receive services in the community with EVV?
Yes. The use of EVV does not change the way and location in which services are delivered. Individuals /members will be allowed to receive services in accordance with their service plan and existing program rules.
What Providers must use EVV?
Star Kids (effective Nov. 1, 2016)
- Personal Care Services (PCS)
- In Home Respite Services provided by an attendant
- Flexible family support services
- CFC ( PAS/HAB)
General questions from Provider Agencies:
What is visit maintenance?
Visit maintenance allows designated staff in a provider agency to edit records of EVV visits by reviewing, modifying, and correcting visit information. If the EVV system cannot automatically verify an attendant’s visit, the visit information must be corrected in visit maintenance to accurately reflect the time worked and apply the most appropriate reason code to the visit.
How long do I have to complete visit maintenance?
Under the HHSC EVV initiative, provider agencies have 60 calendar days, from the date of the visit, to complete visit maintenance. Provider agencies must complete visit maintenance before submitting billing claims. After 60 days, the provider agency will not be allowed to make any corrections to a visit.
What are reason codes?
Reason codes explain the specific reason a change was made to the visit in the EVV system. 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 field.
What reason codes require “free text”?
Under the HHSC EVV initiative, there are seven (7) reason codes that require the provider agency to enter free text in the comment field. Listed below are the seven reason codes with the required documentation to be entered into the comment field. If free text is not entered when using any of these seven (7) reason codes, the visit is subject to recoupment by DADS contract managers.
**Please note all 25 reason codes allow provider agencies to enter notes in the free text comment field, however seven (7) reason codes require it.
RC 130 – Disaster or Emergency
- Must document nature of the disaster or emergency
- Must document actual time in and/or time out (for example, 8am-12pm)
RC 305 – Malfunctioning Small Alternative Device and/or Invalid Small Alternative Device Value – Verified Services Were Delivered
- Must document actual time in and/or time out
RC 310 – Mobile Application Problems
- Must document nature of the problem
- Must document actual time in and/or time out
RC 900 – Attendant Failed to Call-In – Verified Services Were Delivered
RC 905 – Attendant Failed to Call-Out – Verified Services Were Delivered
- Must document actual time out
RC 910 – Attendant Failed to Call-In and Call-Out – Verified Services Were Delivered
- Must document actual time in
- Must document actual time out
RC 999 – Other
- Must provide an explanation as to why use of this code was required.
What if the attendant does not arrive at the scheduled time?
If the attendant arrives late, the attendant should still conduct the EVV call-in as usual. The EVV system will identify the exact time an attendant made the call. For this type of situation, necessary adjustments or notes related to the visit should be added by the system administrator as necessary.
What if the attendant forgets to call-in and call-out?
If the attendant forgets to call in or out or both, the provider agency would need to verify the visit occurred with the individual/member and complete visit maintenance to document the time the visit started and stopped in the EVV system and use a non-preferred reason code such as 900, 905 or 910 for the visit.
What is the state requiring for service delivery documentation when using an EVV system?
The HHSC EVV Initiative does not modify any rules or requirements related to the impacted programs. As such, providers will still be expected to comply with all service delivery documentation requirements outlined in existing program rules.
What will prevent an attendant from calling-in without being at the individual's/member’s home?
The provider agency is responsible for inputting the individual's/member’s home landline telephone number into the EVV system. After that number has been entered into the database, the EVV system will be able to determine if the call was made from the individual’s home landline number or from a different number. If the call was made from a different telephone number, the EVV system will flag the visit as needing additional system administrator attention via visit maintenance and non-preferred Reason Code 915, Wrong Phone Number, would have to be used.
Can an attendant use their personal cell phone to call in and out of the EVV system?
No. The attendant should never use their personal cell phone to call in and out of the EVV system. This could result in the use of a non-preferred reason code, Reason Code 915, Wrong Phone Number.
Can an attendant use their personal cell phone to call in the Small Alternative Device values?
Yes. An attendant may voluntarily use their personal cell phone to call in the SAD values into the EVV system.
What if the individual/member is in the hospital? According to program rules, if an individual/member is hospitalized, attendants are not to report for their scheduled shift.
Program rules related to hospital stays remain in effect with an EVV system. If an individual/member is in a hospital and attendants do not provide services in the individual's or member’s home, a visit would not be called into the EVV system. If a scheduled visit did not occur due to an allowable reason, the system administrator would note that rationale in the EVV system using preferred Reason Code 600, Service Suspension.
Are tasks required to be documented in the EVV system?
No. At this time, documentation of tasks is not required for EVV. However, provider agencies still are required to follow any program specific requirements related to documentation of tasks.
For STAR Kids in-home respite and flexible family support services, will you clarify that this is respite and flexible family support provided by the attendant and not registered nurses or licensed vocational nurses?
STAR Kids in-home respite and flexible family support services that are provided by registered nurses or licensed vocational nurses are not subject to EVV.
Will the individual's ability to define his/her service schedule and determine where he/she would like to receive services (e.g., individuals receiving services at school, while shopping, etc.) be limited by EVV?
No. The use of EVV does not change the way and location in which services are delivered. Individuals/members will still be allowed to receive services in accordance with their service plan and existing program rules. Providers will still be expected to ensure that services are delivered in accordance with program rules, regardless of the mandated EVV system. If a visit occurred in the community, Reason Code 105, Services provided outside the Home, would be the most appropriate reason code to use in these situations.
Does the attendant have to start and end services in the individual’s/member’s home to be able to clock-in and clock-out?
No. If the attendant needs to start or end services outside the home, the provider agency can use Reason Code 105, Service provided outside the Home, for the missing call- in and/or missing call-out. These services should be supported by the service plan and provided according to program policy.
Would an individual/member receiving services be able to have a split schedule? For example, an individual receives some services from one service provider in the morning and some additional services from a second service provider later in the day?
Yes. The use of EVV does not change the way in which services are delivered. Individuals and Members will still be allowed to receive services in accordance with existing program rules, service authorizations and individual service plans. Please contact your EVV vendors on how to set-up a split shift schedule in the EVV system.
What kind of telephone service is suitable for use with Electronic Visit Verification?
For purposes of the HHSC EVV initiative, an acceptable home landline telephone service, is defined as a phone line that is provided only at a single specified address (the individual’s/member’s home) and cannot be used away from that location without contacting a third party to transfer the service to a new specified location. These home landline telephone services may be provided through traditional copper cables, digital subscriber line (DSL), coaxial cable, fiber optic lines, and other transmission methods physically connected to the individual’s or member’s home.
IMPORTANT: Phone service provided over a cellular, satellite, or other mobile network is not acceptable. Portable alternative phone services that use voice over internet protocol (VoIP) (examples include Magic Jack and Vonage) are also not acceptable.
Who do I call if I have questions?
Cook Children’s Health Plan
HHSC general questions and complaints regarding an EVV vendor
Complaints regarding an MCO