Common use of Electronic Visit Verification Clause in Contracts

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.