Electronic Visit Verification

What is Electronic Visit Verification?

EVV is a computer-based system that electronically documents and verifies service delivery information, such as date, time, service type and location, for certain Medicaid service visits.

Programs Services Required to Use EVV

21st Century Cures Act Updates

To comply with federal law, HHSC is implementing the federal 21st Century Cures Act (Section 12006) in the following two phases:

  • Effective Jan. 1, 2021, EVV is required for Medicaid personal care services.
  • Effective Jan. 1, 2023, EVV will be required for Medicaid home health care services.
    • Note: Federal law allows states to request a one-year extension to Jan. 1, 2024.

States that do not implement EVV will receive reduced federal Medicaid funding.

Visit the 21st Cures Act webpage for additional information.

Compliance

Compliance Oversight Reviews monitor program providers contracted with HHSC and managed care organizations on the use of an EVV System to electronically document authorized service delivery visits. Program providers will be reviewed on a regular basis to ensure they are following EVV policy.

Historical Compliance Plans

EVV Consumer Directed Services Option

Policies

Proprietary Systems

Program providers and FMSAs may seek HHSC approval to use an EVV proprietary system instead of an EVV vendor system to comply with EVV requirements.

More information is on the HHSC EVV Proprietary Systems webpage.

Reason Codes

Program providers, FMSAs and CDS employers must select the most appropriate EVV Reason Code Number and Reason Code Description. When applicable, enter required free text.

Current HHSC EVV Reason Codes

Historical HHSC EVV Reason Codes

Resources

Contact Guides

Getting Started with EVV

The following guides are for getting started with Electronic Visit Verification:

Best Practices

Form 1718, Responsibilities and Additional Information (MCO)

Glossary of Terms

Benefits of Using the EVV Mobile Method

Historical EVV Alerts

Statutes and Rules

Service Bill Codes Table

The EVV Services Table below provides current billing codes and details for EVV-relevant services in Long-Term Care, Acute Care and Managed Care programs.

Program providers must use the appropriate Healthcare Common Procedure Coding System and modifier combinations to prevent EVV visit transaction rejections and EVV claim match denials.

Personal Care Services

Training

For additional information and resources, visit the HHSC EVV Training webpage.

Visit Maintenance Unlock Request

A Visit Maintenance Unlock Request allows a program provider, FMSA and CDS employer the opportunity to correct data element(s) on an EVV visit transaction(s) after the visit maintenance time frame has expired.

Program providers, FMSAs and CDS employers must follow the instructions on the Visit Maintenance Unlock Request (Excel) spreadsheet. Requests that are not sent securely could result in a Health Insurance Portability and Accountability Act (HIPAA) violation and the payer will deny the request.

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