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 shall also collaborate with the EVV vendor to implement any system updates or changes as necessary. MCOPs must show a 1% monthly average increase in EVV claims matching by June 30, 2024, and a 3% average monthly increase in claims matching by June 30, 2025. ODM will use the July 1, 2022 – April 30, 2023 time period as the baseline for meeting these requirements.
Appears in 3 contracts
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
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 appropriate 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 The MCOP shall submit a monthly report of all EVV related claim lines to ODM. Additionally, those lines that would have denied because they are not supported by EVV visits as specified by ODM shall be identified 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 shall also collaborate with the EVV vendor to implement any system updates or changes as necessary. MCOPs must show a 1% monthly average increase in EVV claims matching by June 30, 2024, and a 3% average monthly increase in claims matching by June 30, 2025. ODM will use the July 1, 2022 – April 30, 2023 time period as the baseline for meeting these requirementsreport.
Appears in 2 contracts
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
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 appropriate 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 XXXODM, for EVV claim lines during validation. Upon request, the The MCOP shall submit a monthly report of all EVV related claim lines to ODM. Additionally, those lines that would have denied because they are not supported by EVV visits as specified by ODM shall be identified 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 shall also collaborate with the EVV vendor to implement any system updates or changes as necessary. MCOPs must show a 1% monthly average increase in EVV claims matching by June 30, 2024, and a 3% average monthly increase in claims matching by June 30, 2025. ODM will use the July 1, 2022 – April 30, 2023 time period as the baseline for meeting these requirementsreport.
Appears in 2 contracts
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
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 shall also collaborate with the EVV vendor to implement any system updates or changes as necessary. MCOPs must show a 1% monthly average increase in EVV claims matching by June 30, 2024, and a 3% average monthly increase in claims matching by June 30, 2025. ODM will use the July 1, 2022 – April 30, 2023 time period as the baseline for meeting these requirements.
Appears in 1 contract
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
