Electronic Visit Verification. (EVV). Provider shall cooperate with State requirements for electronic visit verification for personal care services and home health services, as applicable.
Electronic Visit Verification. (EVV). The MCOP shall utilize the ODM-established EVV system for the following services: Private Duty Nursing; State Plan Home Health Aide; State Plan Home Health Nursing; RN Assessment, Waiver Nursing; Waiver Personal Care Aide; and Waiver Home Care Attendant. The MCOP shall have foundational knowledge of the EVV system and processes to issue resolve as needed and direct providers, individuals receiving services, and direct care workers to ODM-provided resources to address questions/concerns. The MCOP shall inform providers of the use of the EVV data collection system and how the data will be utilized by the MCOP. The MCOP will use data collected from the EVV data collection system to validate all claim lines against EVV data (100% review) during the claim adjudication process. The MCOP shall inform providers on the outcome of the claim validation review for each claim line. The MCOP shall code their claims adjudication system to post Remittance Advice Remark Code (RARC) N363 defined as “Alert: in the near future we are implementing new policies/procedures that would affect this determination” on a claim that does not have an EVV visit match. The N363 will be reported on the 835 transaction to inform providers that while you’ve paid this claim, future claim payments may be impacted if the provider doesn’t make changes. Because N363 is an “Alert” per the definition and not a type of denial, no Claim Adjustment Reason Code (CARC) is needed to post to the claim. The N363 will also be reported on the encounter. However, since ODM uses the 837 transaction for encounter data, the N363 will have to be posted at the claim/header level. RARCs cannot be posted at the detail of an 837 transaction. The MCOP claim adjudication system shall be flexible to allow the ability of modifying or denying payment, as directed by XXX, for EVV claim lines during validation. Upon request, the MCOP shall submit a monthly report of all EVV related claim lines to ODM in the format specified by ODM. The MCOP shall review the monthly visit report provided by ODM to identify trends, provide outreach and education to providers, and identify potential fraud, waste, or abuse. Fraud, waste, and abuse is reported to ODM in accordance with Appendix I of this Agreement. The MCOP shall work collaboratively with the EVV vendor to establish connectivity, to conduct system testing, and to adhere to technical specifications until all scenarios are passed and the system is production ready. The MCOP...
Electronic Visit Verification. (EVV) – means an electronic system that verifies when service provision occurs by documenting six points of data; type of service performed, individual reviewing the service, date of service, location of service delivery, individual providing the service, and time the service begins and ends. EVV is referenced in subsection 5.2.
Electronic Visit Verification. (EVV). The MCOP shall utilize the ODM-established EVV system for the following services: Private Duty Nursing; State Plan Home Health Aide; State Plan Home Health Nursing; RN Assessment, Waiver Nursing; Waiver Personal Care Aide; Waiver Home Care Attendant. The MCOP will use data collected from the EVV data collection system data to validate all claims against EVV data (100% review) during the claim adjudication process. The MCOP shall inform providers of the use of the EVV data collection system and how the data will be utilized by the MCOP. The MCOP shall also provide assistance on utilization of the data collection system, as appropriate, to individuals receiving services, direct care workers, and providers. During the Pay and Post period of EVV, the MCOP shall submit a monthly report of all EVV related claims that would have denied as specified by ODM. Upon full implementation of EVV, the MCOP shall submit a monthly report of all EVV related denied claims as specified by ODM.
Electronic Visit Verification. Background EVV Requirement EVV Exemption for Live-in Providers EVV Implementation
Electronic Visit Verification. If Contracted Provider is a personal care aide, Contracted Provider shall comply with Health Plan’s electronic visit verification system requirements where applicable.
Electronic Visit Verification. The HMO shall implement Electronic Visit Verification (EVV) for designated service codes by the deadlines established by the Department. The HMO will use data collected from the EVV system to validate claims pertaining to affected service codes against approved authorizations during the HMO’s claims adjudication process. Encounters without a valid EVV record may be excluded in future rate-setting development. Prior to implementation, the HMO shall outline expectations for contracted providers regarding the use of the EVV data collection system within subcontracts and/or provider manuals. The HMO shall also provide assistance and support to both DHS and the contracted EVV vendor for training, outreach, and utilization of the data collection system, as requested. As part of EVV implementation, the HMO is required to submit accurate, complete, and timely data. Failure to comply with EVV implementation, as part of the federal 21st Century CURES Act may result in a corrective action plan and/or the application of remedies for violation, breach, or non-performance of the contract under Article XIV, C.
Electronic Visit Verification. (EVV)
a. The Contractor shall develop or purchase and implement an electronic visit verification system to monitor member receipt and utilization of personal care services including at a minimum, personal care assistance, home based supportive care and in-home respite. This includes all applicable self-directed personal care services.
b. The Contractor shall oversee its selected EVV vendor to ensure the EVV system operates in compliance with this Contract, with policies and protocols established by DMAHS, and with the requirements of the 21st Century Cures Act. The 21st Century Cures Act requires electronic (not manual) verification of the type of service performed, the individual receiving the service, the date of the service, location of service delivery, the individual providing the service, and time the service begins and ends. The Contractor shall notify DMAHS within five (5) business days of the identification of any issue affecting EVV system operation which impacts the Contractor’s performance of this Contract, including actions that will be taken by the Contractor to resolve the issue and the specific timeframes within which such actions shall be completed.
c. At a minimum, recredentialing of providers shall include verification of continued licensure and/or certification (as applicable); compliance with policies and procedures identified during credentialing, including background checks and training requirements, use of the EVV; and compliance with the HCBS Settings Rule detailed in 42 C.F.R. § 441.301(c)(4)-(5).
d. The Contractor shall monitor all manual confirmations and take action to eliminate manual confirmations to ensure compliance with 21st Century Cures Act EVV system requirements by January 1, 2022.
i. Contractor shall pay claims for visits recorded in an EVV system which may require manual intervention.
ii. The Contractor shall utilize an exceptions process as specified by DMAHS for visits recorded manually and outside the EVV system.
e. The Contractor shall generate reports and conduct audits according to DMAHS specification to ensure members are receiving necessary services. The Contractor shall take appropriate remedial action against providers and workers who repeatedly fail to use the EVV system as required.
f. The Contractor shall select its own electronic visit verification vendor, as applicable, and shall ensure, in the development of its EVV system, the following minimal functionality:
i. The ability to effectively connect wit...
Electronic Visit Verification. (EVV) – A system established to enhance program efficiencies and quality assurance for various in-home and community-based care services administered by EOHHS and the managed care organizations. EVV is an in- home visit scheduling, tracking and billing system that uses telephony-based technology and GPS tracking to capture time and service information about home and community- based service visits. EVV is intended to employ controls within the delivery of home and community-based services to ensure quality of care, program efficiency and quality assurance for various in home and community-based services.
Electronic Visit Verification. 4.2.1. HCPF shall implement and administer the EVV program.
4.2.2. HCPF shall develop a live-in caregiver attestation form for provider use.
4.2.3. HCPF shall provide to DPHE a monthly report of providers billing for live-in caregivers. This report shall include the provider service name, provider service address, provider Medicaid ID and NPI names of the providers that are listed in the CDPHE licensing system.
4.2.4. DPHE shall review provider files to ensure appropriate live-in caregiver documentation is present when claims indicating live-in statute are billed.
4.2.4.1. DPHE shall review a representative sample of member files, including differing roles and responsibilities, where live-in documentation should be present.
4.2.4.2. If documentation is incorrect or not present, DPHE will cite the provider and refer to HCPF.
4.2.4.2.1. DPHE shall perform live-in caregiver documentation review at time of certification or site visit. Providers not scheduled for site visit shall be reviewed at least a minimum of every three years.
4.2.4.3. Provider types and services requiring live-in caregiver document review include:
