4000 EVV System and Setup

Revision 22-2; Effective March 1, 2022

All program providers and FMSAs must implement and begin using EVV prior to submitting a claim for reimbursement for a service required to use EVV.

The program provider or FMSA must complete the following steps prior to using an EVV system.

Step 1: Select an EVV system (Refer to 4100 EVV System Selection)

  • EVV vendor system
  • EVV proprietary system

Step 2: Complete all EVV trainings (Refer to 4200 EVV Training):

  • EVV System
  • EVV Policy
  • EVV Portal

Step 3: Complete EVV system Onboarding

  • Manually enter or electronically import identification data (Refer to 4400 Data Collection)
  • Enter or verify member service authorizations (Refer to 4500 Service Authorizations)
  • Setup member schedules (if required) (Refer to 4600 Schedules)
  • Create the CDS employer profile for CDS employer credentials to the EVV system

4100 EVV System Selection

Revision 21-1; Effective November 1, 2021

State and federal law require program providers and FMSAs to use an EVV system for Medicaid services required to use EVV.

Program Providers and FMSAs must complete the following:

  • Select a single EVV system
  • Complete the EVV system training, EVV policy training and EVV Portal Trainings
  • Complete the EVV system onboarding process
  • Begin using the EVV system

Failure to use an EVV system to verify and document the occurrence of a service visit will result in the denial or recoupment of EVV claims by HHSC and MCOs.

Subcontracted providers must use the EVV system selected by the program provider directly contracted with HHSC or an MCO. CDS employers must use the EVV system selected by their FMSA.

There are two types of EVV systems:

  • EVV vendor systems from the state vendor pool
  • EVV proprietary systems purchased or developed by a program provider or FMSA

4110 EVV Vendor Systems

Revision 21-1; Effective November 1, 2021

An EVV vendor is an entity contracted with TMHP, the state's claims administrator. This vendor provides an HHSC-approved EVV system at no cost to the program provider, FMSA or CDS employer. An EVV vendor also provides EVV system training and support to its users. The program provider or FMSA may select one of the following EVV vendors available from the state vendor pool.

State Vendor Pool

EVV Vendor EVV Vendor System Name EVV Vendor Contact Information
DataLogic Software, Inc. Vesta EVV

Website: vestaevv.com/

Phone: 844-880-2400

First Data Government Solutions AuthentiCare EVV

Website: solutions.fiserv.com/authenticare-tx

Phone: 877-829-2002

EVV vendor responsibilities include, but are not limited to the following:

  • Adhering to all HHSC EVV vendor business rules for system operation
  • Following HHSC EVV Policy
  • Supporting multiple clock in and clock out methods required to use the EVV system
  • Providing EVV system training and technical support

4120 EVV Proprietary Systems

Revision 22-2; Effective March 1, 2022

An EVV proprietary system is an HHSC-approved EVV system that a program provider or FMSA may use instead of an EVV vendor system that:

  • Is purchased or developed by a program provider or an FMSA
  • Is used to exchange EVV data with the EVV Aggregator
  • Complies with HHSC EVV Policy as it relates to EVV Proprietary Systems
  • Complies with HHSC EVV Business Rules for Proprietary Systems
  • Complies with the requirements of Texas Government Code Section 531.024172 or its successors

An EVV PSO is a program provider or FMSA that uses an EVV proprietary system by completing the EVV Proprietary System Request Form to enter the PSO Onboarding Process.

A program provider or FMSA operates their own EVV proprietary system agrees to:

  • Forego use of one of the cost-free EVV systems provided by the state as part of the EVV vendor pool.
  • Assume full responsibility for the design, development, operation and performance of the EVV proprietary system.
  • Assume responsibility for all costs to develop, implement, operate and maintain the EVV proprietary system.
  • Ensure the accuracy of EVV data collected, stored and reported by the proprietary system. Take responsibility for the submission of EVV visit transactions to the EVV Aggregator.
  • Assume all liability and risk for the use of the EVV proprietary system.
  • Maintain all system data, backup data, and historical data to comply with and support all legal, regulatory and business needs.
  • Train all EVV proprietary system users, including state and MCO staff.
  • Provide system access to state staff, TMHP staff, MCO staff (if applicable) and other state and federal entities as required.
  • Take responsibility for the provision and management of HHSC-approved clock in and clock out methods and devices associated with the EVV proprietary system.

Refer to 5000 EVV Proprietary System for more information.

4130 Select an EVV System

Revision 22-2; Effective March 1, 2022

EVV Vendor Selection

To select an EVV vendor from the state vendor pool, the program provider or FMSA, signature authority and, the agency's appointed EVV system administrator, must complete, sign and date the EVV Provider Onboarding Form located on the EVV vendor's website.

The program provider or FMSA must submit an accurate and completed form directly to the selected EVV vendor. There is no charge to the program provider or FMSA to use an EVV vendor system from the state vendor pool.

EVV vendors may offer other software such as billing solutions for a fee. HHSC does not require program providers or FMSAs to buy any software when selecting an EVV vendor system.

HHSC encourages program providers and FMSAs to research all EVV vendors before they select one. For example, program providers and FMSAs should learn about the vendor clock in and clock out methods, visit maintenance process and training options.

To aid in the selection of an EVV vendor, the program provider or FMSA may visit the TMHP EVV Vendors webpage to learn more about the EVV vendor systems in the state vendor pool.

EVV Proprietary System Selection

To elect the use of an EVV proprietary system, the program provider or FMSA, signature authority and the agency's appointed EVV System Administrator, must visit the TMHP Proprietary System webpage to review the EVV PSO Onboarding Process and HHSC EVV Proprietary System Approval Process.

Interested program providers or FMSAs must submit the PSO Request Packet to enter the EVV PSO Onboarding Process which includes:

  • An EVV Proprietary System Request Form
  • PSO Detailed Questionnaire (DQ)
  • TMHP Interface Access Request

A program provider or FMSA must complete the EVV PSO Onboarding Process and receive written approval from HHSC to use an EVV proprietary system to comply with HHSC EVV requirements.

EVV System Administrator

The program provider or FMSA must appoint a person to serve as the EVV System Administrator for the agency. This person will administer access to the EVV system for agency personnel and ensure that the program provider or FMSA enters all necessary data into the system for EVV visit collection to begin.

The EVV System Administrator will assign user account access for agency staff. The user accounts may include subcontracted, or third party, personnel as necessary to complete visit maintenance tasks. Only designated staff with appropriate security credentials may add or update the program provider or FMSA EVV user accounts. The EVV System Administrator must ensure that users of the agency's EVV system follow HIPAA laws and appropriate security protocols.
Contact TMHP at EVV@tmhp.com for questions regarding EVV system selection.

4200 EVV Training

Revision 22-2; Effective March 1, 2022

The HHSC EVV Training Policy requires program providers, FMSAs and CDS employers or any staff who performs EVV system operations to complete all required EVV training:

  • Prior to using either an EVV vendor system or an EVV proprietary system
  • Yearly thereafter

If the program provider or FMSA does not take the following EVV training, it may result in the payer taking contract and enforcement action:

  • EVV System
  • EVV Policy
  • EVV Portal

If the CDS employer does not take EVV system and EVV policy trainings, the following may result:

  • CDS employee(s) may experience a delay in payment or inaccurate payments if the EVV system is not used correctly.
  • An FMSA may require the CDS employer to complete a corrective action plan (CAP).

The CDS employer must take EVV system and EVV policy trainings to:

  • Gain a basic understanding of EVV requirements.
  • Train the CDS employee on the approved clock in and clock out methods.

The EVV vendor or EVV PSO will not grant access to the EVV system until the program provider, FMSA or CDS employer has completed EVV system training. An EVV PSO is a program provider or an FMSA who has selected to use their own EVV proprietary system.

The payers may request proof of completed trainings. Do not submit proof of training completion to HHSC, an MCO or TMHP unless requested.

Proof of completed trainings must include the:

  • Name of the training
  • Name of the person completing the training
  • Date of the training

Program providers, FMSAs and CDS employers can review the EVV Training Requirements Checklists found on the EVV webpage for more information.

The EVV vendor, HHSC, MCOs and TMHP may offer EVV trainings in different delivery methods, such as but not limited to:

  • Computer-based training (CBT)
  • Instructor-led training (ILT)
  • Webinars

Contact your EVV vendor, HHSC, MCO or TMHP for details on specific training delivery methods.

4210 EVV Training Requirements for Program Providers

Revision 21-1; Effective November 1, 2021

Program providers must complete the required EVV training shown in the table below.

EVV system users are staff who have access to the EVV system, perform EVV system operations and visit maintenance in the EVV vendor system or EVV proprietary system. EVV portal users are staff who have access to the EVV portal, conduct visit or claim searches and generate reports. Billing staff are staff who submit Medicaid claims for an EVV-required service.

Program Providers

EVV Training Requirement Taken By Provided By
EVV System Training EVV system users EVV vendor or EVV PSO
EVV Portal Training
  • EVV portal users
  • Billing staff
TMHP
EVV Policy Training
  • EVV system users
  • EVV portal users
  • Billing staff
Payer (HHSC or MCO)

Program providers must keep up-to-date training records for their staff.

Program providers who have received written approval from HHSC to use an EVV proprietary system must train all users on the proper use of the EVV proprietary system, to include clock in and clock out methods.

4220 EVV Training Requirements for FMSAs

Revision 22-2; Effective March 1, 2022

FMSA staff must complete the required EVV training shown in the table below.

EVV system users are staff who have access to the EVV system, perform EVV system operations and complete visit maintenance in the EVV vendor system or EVV proprietary system. EVV Portal users are staff who have access to the EVV Portal, conduct visit or claim searches and generate reports. Billing staff are staff who submit Medicaid claims for an EVV-required service.

FMSAs

EVV Training Requirement Taken By Provided By
EVV System Training
  • FMSA EVV system users
EVV vendor or EVV PSO
EVV Portal Training
  • FMSA EVV Portal users
  • FMSA billing staff
TMHP
EVV Policy Training
  • FMSA EVV system users
  • FMSA EVV Portal users
  • FMSA billing staff
Payer (HHSC or MCO)

FMSAs must keep up-to-date training records for their staff. FMSAs may request training records from their CDS employers.

4230 EVV Training Requirements for CDS Employers

Revision 22-2; Effective March 1, 2022

CDS employers complete applicable required EVV training. If the CDS employer has a designated representative (DR), the DR completes the required EVV training based on the option selected by the CDS employer. This information is shown in the table below.

CDS employers must train their CDS employees on the clock in and clock out methods with assistance from the EVV vendor or the EVV PSO.

See details in table below for:

  • CDS employer training based on delegation of visit maintenance on Form 1722, CDS Employer's Selection for Electronic Visit Verification Responsibilities.  
    • If a CDS employer switches their option by completing a new Form 1722, CDS Employer's Selection for Electronic Visit Verification Responsibilities, they must take the proper training for that option, before being granted greater access to the EVV system by an EVV vendor, their FMSA or an EVV PSO.

Note: HHSC policy training is available in Spanish or English.

If the CDS employer selected:

Form 1722 Options EVV Training Requirement Provided By
Option 1: The CDS employer agrees to complete all visit maintenance and approve their employee's time worked in the EVV system.
  • Full EVV system training
  • Includes clock in and clock out methods
EVV vendor or EVV PSO (FMSA)
  • EVV policy training
Payer (HHSC or MCO) or FMSA
Option 2: The CDS employer elects to have their FMSA complete all visit maintenance on their behalf. However, the CDS employer will approve their employee's time worked in the EVV system.
  • Full EVV system training
  • Includes clock in and clock out methods
EVV vendor or EVV PSO (FMSA)
  • EVV policy training
Payer (HHSC or MCO) or FMSA
Option 3: The CDS employer elects to have their FMSA complete all visit maintenance on their behalf. The FMSA will confirm the employee's time worked in the EVV system based on approval documentation from the CDS employer.
  • Overview of EVV system training. Covers key elements of the EVV system training.
  • Includes clock in and clock out methods
EVV vendor or EVV PSO (FMSA)
  • EVV policy training
Payer (HHSC or MCO) or FMSA

The CDS employer must keep up-to-date training records of their training completions and provide training records to their FMSA, HHSC or their MCO, if requested.

Note: EVV policy trainings may vary if your payer is an MCO. Please check with your MCO if you have questions on EVV policy trainings and requirements.

4240 Training Requirements for Service Providers and CDS Employees

Revision 22-2; Effective March 1, 2022

Service providers and CDS employees must complete the required EVV training shown in the table below.

The EVV vendor or EVV PSO will provide materials and resources.

Service Providers and CDS Employees:

EVV Training Requirement Provided By
Clock In and Clock Out Methods Program Provider or CDS Employer

The CDS employer must keep up-to-date training records of service provider and CDS employee training completions by using Form 1732, Management and Training of Service Provider. Form 1732 should be provided to the FMSA.

4250 EVV Training Registration

Revision 21-1; Effective November 1, 2021

To register for EVV training:

  • EVV System: Visit your EVV vendor website or contact your EVV PSO (FMSA).
  • EVV Policy: Visit the HHSC or MCO EVV webpage.
  • EVV Portal Training: Visit the TMHP website

For questions related to training, contact:

Topic Contact
EVV Policy
  • HHSC EVV Operations at EVV@hhs.texas.gov
  • Your MCO (refer to EVV Contact Guides found in Resources section on HHSC EVV webpage)
EVV Portal
EVV vendor or EVV PSO System
  • Your EVV vendor or EVV PSO (FMSA)

4300 Credentialing

Revision 21-1; Effective November 1, 2021

The FMSA is responsible for creating credentials (username and temporary password) for the CDS employer and the CDS employee.

For the CDS Employer

The credentials will be sent by the EVV system or the FMSA to the CDS employer based on the email account the FMSA entered in the EVV system. If a member is not the CDS employer, the FMSA will include the CDS employer's name in the member profile and provide credentials to the CDS employer. If the member also has a DR, both the CDS employer and the DR will have their own unique credentials.

The CDS employer uses the credentials to log in to the EVV system. After the CDS employer logs in to the EVV system, the temporary password can be changed, and a new unique password can be created.

The FMSA can only see the CDS employer's username and email address in the EVV system. However, both the FMSA and the CDS employer can change the password.

There are two common reasons why a CDS employer has not received their credentials, and therefore must contact their FMSA.

  • The FMSA has not created credentials for the CDS employer
  • The information entered by the FMSA was incorrect
    • The FMSA can correct the email address and resend credentials to the CDS employer

For the CDS Employee

The FMSA or the CDS employer provides the credentials to the CDS employee.

Contact your EVV vendor to determine if the FMSA or the CDS employer will provide the CDS employee credentials.

Program Providers

The program provider is responsible for creating credentials such as username and temporary password, for all program provider staff including service providers.

4400 Data Collection

Revision 22-2; Effective March 1, 2022

In alignment with Texas Government Code Section 531.024172 and federal requirements, the EVV system must allow for verification of the following critical data elements relating to the delivery of Medicaid services:

  • Type of service provided
  • Name of the recipient who had the service
  • Date and times the provider began and ended the service delivery visit
  • Location, including the address and geolocation, where the service was provided
  • Name of the person who provided the service
  • Other information the commission determines is necessary to ensure the accurate adjudication of Medicaid claims

HHSC categorizes critical data elements as:

  • Identification data
  • Visit data

Identification Data

Before using the EVV system, the program provider or FMSA must enter or import the following identification data into the EVV system:

  • Type of service provided (service authorization data).
  • Name of the recipient who had the service (member data).
  • Name of the person who provided the service (service provider data).
  • Other information HHSC determines is necessary to ensure the accurate adjudication of Medicaid claims (program provider, FMSA or CDS employer information).

Program providers and FMSAs must manually enter or electronically import identification data during the EVV system onboarding process, or after the onboarding process for new members.

Once the program provider or FMSA has completed the entry of all identification data, the service provider or CDS employee may begin to use the EVV system.

Program providers and FMSAs must maintain the identification data as needed.

The program provider or FMSA is solely responsible for maintaining accurate and up-to-date data within the EVV system. This includes information managed or maintained by a third party or subcontractor. If the program provider or FMSA identifies data errors, they must act to resolve the inaccuracy.

Visit Data

When the service provider clocks in and clocks out of the EVV system, the system captures the following visit data:

  • Type of service provided (service authorization data).
  • Name of the recipient who had the service (member data).
  • Date and times the provider began and ended the service delivery visit.
  • Location, including the address and geolocation, where the service was provided.
  • Name of the person who provided the service (service provider data).

Missing or incorrect identification data and visit data in the EVV system results in:

  • Rejected EVV visit transactions
  • Denied or recouped EVV claims
  • Inaccurate EVV standard reports

4410 Data Collection Overview Diagram

Revision 21-1; Effective November 1, 2021

The EVV system:

  • Electronically captures and verifies critical data elements to confirm service delivery.
  • Validates identification data against data received from the Texas Medicaid system.
  • Sends a complete, accurate and validated EVV visit transaction to the EVV Aggregator for use in the EVV claims matching process.

Contact your payer for questions about the data elements.

Contact your EVV vendor or EVV PSO for questions about entering data into the EVV system.

4500 Service Authorizations

Revision 22-2; Effective March 1, 2022

The HHSC EVV Service Authorization Policy requires program providers and FMSAs to enter and maintain the most current service authorization in the EVV system for each member receiving services required to use EVV.

The payers must authorize the program provider or FMSA to deliver services to a member. An authorization is documentation for the services a member is eligible to receive.

A program provider or FMSA may receive authorization documentation for member services through the:

  • Service authorization
  • Prior authorization
  • Individual plan of care (IPC)
  • Individual service plan (ISP)
  • Community care service notification

The EVV system refers to authorization documentation as a service authorization.

Information from the service authorization must include at least the following when applicable:

  • Payer
  • Provider (National Provider Identifier (NPI), Atypical Provider Identifier (API), Texas Identification Number (TIN), Texas Provider Identifier (TPI)
  • Member Medicaid ID
  • Service group, service code or HCPCS and Modifier
  • Authorization start date
  • Authorization end date

The EVV system will electronically retrieve the most recent service authorization from TMHP for the following HHSC programs:

  • Community Living Assistance and Support Services (CLASS) Waiver
  • Deaf Blind Multiple Disabilities (DBMD) Waiver
  • Home and Community-based Services (HCS) Waiver
  • Texas Home Living (TxHmL) Waiver
  • Personal Care Services (PCS)
  • Primary Home Care (PHC)
  • Family Care (FC)
  • Community Attendant Services (CAS)
  • Youth Empowerment Service (YES) Waiver

The EVV vendor or an EVV PSO will instruct program providers and FMSAs on the entry of service authorizations into the EVV system.

Program providers and FMSAs must enter service authorizations manually into the EVV system for the following HHSC and managed care programs:

  • Home and Community-based Services - Adult Mental Health (HCBS-AMH)
  • STAR Kids
  • STAR Kids Medically Dependent Children's Program (MDCP)
  • STAR+PLUS
  • STAR+PLUS Home and Community Based Services (HCBS)
  • STAR+PLUS Medicare-Medicaid Plan (MMP)
  • STAR Health
  • STAR Health MDCP

The program provider or FMSA may manually enter service authorization changes and updates into the EVV system at any time.

Failure to enter the most current service authorization issued by the payer into the EVV system may result in the need for visit maintenance or the payer may deny or recoup related claims.

Program providers and FMSAs must confirm all electronically received service authorization information in the EVV system to ensure the accuracy for each member.

Contact your payer with questions about service authorization requirements.

4600 Schedules

Revision 21-1; Effective November 1, 2021

EVV systems do not require schedules.

Program and payer requirements for following a service delivery schedule, service delivery requirements and using schedules in the EVV system vary. Program providers, FMSAs and CDS employers must follow their program and payer schedule and service delivery requirements or EVV claims may be recouped.

The EVV vendor or EVV PSO will provide instructions on how the EVV system will verify EVV visits with or without schedules.

Contact your payer with questions about schedule requirements.

4700 EVV System Transfer

Revision 21-1; Effective November 1, 2021

This policy provides guidance on transferring from one EVV system to another EVV system and includes the transfer to or from an EVV proprietary system.

A program provider or FMSA may:

  • Transfer from one EVV vendor system to another EVV vendor system within the state vendor pool.
  • Transfer from an EVV vendor system to an EVV proprietary system.
  • Transfer from an EVV proprietary system to an EVV vendor system.
  • Transfer from one EVV proprietary system to another EVV proprietary system.

Program providers and FMSAs that have not selected an EVV system must follow 4100 EVV System Selection.

4710 Transferring EVV Systems

Revision 22-2; Effective March 1, 2022

Refer to the EVV System Transfer Process and the TMHP EVV Data Transfer Reference Guide for more information.

Program providers and FMSAs who wish to transfer to an EVV vendor in the state vendor pool must request a transfer at least 120 days before the desired Go-Live date. The transfer may occur before the 120 days if the program provider or FMSA and the EVV vendors agree on an earlier date.

The 120-day transfer time frame allows for:

  • Training on the new EVV system.
  • Transfer and verification of identification and visit data elements.
  • Completion of all import tasks necessary to begin using the new EVV system.

The Go-Live date is the date the program provider or FMSA begins using the selected EVV system.

Program providers and FMSAs must still:

  • Use their old EVV system until they have successfully transferred to the new EVV system.
  • Document all visits for dates of service before the Go-Live date of the new EVV system in the old EVV system.
  • Document all visits for dates of service on or after the Go-Live date of the new EVV system in the new EVV system.

Program providers, FMSAs and CDS employers must complete visit maintenance in the same EVV system in which the EVV visit transaction was created.

The program provider or FMSA must collect and return all alternative devices supplied by the old EVV vendor after the Go-Live date with the new EVV system.

FMSAs must notify CDS employers 60 days in advance of the planned Go-Live date to allow time for retraining CDS employers and their CDS employees on the new EVV system.

Program providers and FMSAs who wish to transfer to an EVV proprietary system must submit the PSO Request Packet and complete the EVV PSO Onboarding Process. Refer to 5000 EVV Proprietary System for more information.

4720 How to Transfer to an EVV Vendor in the State Vendor Pool

Revision 22-2; Effective March 1, 2022

If transferring to a vendor in the state vendor pool, the:

  • Program provider or FMSA will select "transfer" on the EVV Provider Onboarding Form and submit to the new EVV vendor.
  • New EVV vendor will contact the signature authority or the EVV System Administrator within five business days of receipt to confirm the request to transfer and acknowledge receipt.
  • Current EVV vendor will contact the program provider or FMSA to discuss the transfer request and agree upon a date to transfer data to the new EVV vendor.
  • Current EVV vendor will communicate the date to transfer data to the new EVV vendor and TMHP.
  • New EVV vendor must import data within five business days of receipt on behalf of the program provider and FMSA.
  • New EVV vendor will notify the program provider or FMSA and TMHP within five business days of completing the data transfer.
  • New EVV vendor will provide further onboarding and EVV system training instructions.
    • All required EVV system trainings must be completed prior to any EVV system user receiving access to the EVV system.

Program providers or FMSAs who transfer to a new EVV vendor system:

  • Must follow 4100 EVV System Selection.
  • Will not receive a grace period and will be subject to all EVV policies, including those related to compliance and enforcement.
  • May have EVV claims denied or recouped if there are no matching accepted EVV visit transactions in the EVV Aggregator.

4730 How to Transfer to an EVV Proprietary System

Revision 22-2; Effective March 1, 2022

If transferring to an EVV proprietary system:

  • The program provider or FMSA submits a PSO Request Packet which includes: 
    • an EVV Proprietary System Request Form
    • PSO DQ
    • TMHP Interface Access Request directly to TMHP
  • TMHP will notify the current EVV vendor once the PSO enters Operational Readiness Review (ORR).
  • The transfer only occurs after:
    • HHSC provides written approval of the EVV proprietary system
    • The program provider, FMSA or Signature Authority signs the Certification Form
    • HHSC agrees on a Go-Live date.

Program providers or FMSAs who transfer to an EVV proprietary system:

  • Must provide training on the EVV proprietary system and must ensure EVV system training is complete prior to any EVV system user receiving access to the EVV proprietary system. Refer to 5000 EVV Proprietary System for more information.
  • Will not receive a grace period and will be subject to all EVV policies, including those related to compliance and enforcement.
  • May have EVV claims denied or recouped if there are no matching accepted EVV visit transactions in the EVV Aggregator.

Contact the selected EVV vendor or email TMHP for questions about the EVV system transfer.