An official State of Texas website.
Revision 22-4; Effective Sept. 1, 2022
Program providers, FMSAs and CDS employers are required to use an EVV system and meet the minimum EVV Usage Score.
Payers will monitor the number of manually entered EVV visit transactions and the number of rejected EVV visit transactions to ensure the minimum EVV Usage Score is met for the state fiscal year quarter.
Refer to 10000 EVV Compliance Reviews for more information.
A manually entered EVV visit transaction is an EVV visit that is manually entered into the EVV system when a service provider or CDS employee fails to use the EVV system to clock in when service delivery begins, clock out when service delivery ends, or both.
Refer to 7000 Clock In and Clock Out Methods for more information.
A rejected EVV visit transaction is an EVV visit transaction that is exported from an EVV system to the EVV Aggregator but is not accepted by the EVV Aggregator.
11010 EVV Usage Score
Revision 22-4; Effective Sept. 1, 2022
Program Providers
Program providers must achieve and maintain a minimum EVV Usage Score of 80% rounded to the nearest whole percentage, each state fiscal year quarter, unless noted by HHSC.
Program providers below the EVV Usage Score will be reviewed. Payers may choose to review all program providers or a sample of program providers that did not meet the minimum EVV Usage Score.
Score Calculations
The EVV Usage Score for a program provider equals the Manual EVV Visit Transaction Score plus the Rejected EVV Visit Transaction Score.
The Manual EVV Visit Transaction Score equals the number of total electronic (non-manual) visit transactions divided by the total number of accepted visit transactions by the EVV Aggregator and then multiplied by 60 percent.
The Rejected EVV Visit Transaction Score equals the number of non-rejected visit transactions divided by the total number of exported visit transactions sent to the EVV Aggregator and then multiplied by 40 percent.
Non-rejected visit transactions are the number of visit transaction submission attempts that were not rejected.
FMSAs
FMSAs must achieve and maintain a minimum EVV Usage score of 80% rounded to the nearest whole percentage, each state fiscal year quarter, unless noted by HHSC.
FMSAs below the EVV Usage Score will be reviewed. Payers may choose to review all FMSAs or a sample of FMSAs that did not meet the minimum EVV Usage Score.
Score Calculations
The EVV Usage Score, for an FMSA, equals the Rejected EVV Visit Transaction Score.
The Rejected EVV Visit Transaction Score equals the number of non-rejected visit transactions divided by the total number of exported visit transactions sent to the EVV Aggregator.
Non-rejected visit transactions are the number of visit transaction submission attempts that were not rejected.
CDS Employers
CDS Employers must achieve and maintain a minimum EVV Usage Score of 80% rounded to the nearest whole percentage, each state fiscal year quarter, unless noted by HHSC. See table below for CDS employer EVV Usage Score requirements based on service delivery dates.
CDS employers below the EVV Usage Score will be reviewed. Payers may choose to review all CDS employers or a sample of CDS employers that did not meet the minimum EVV Usage Score.
| Fiscal Year (FY) | Quarter (Q) | Service Delivery Dates | EVV Usage Score |
|---|---|---|---|
| FY 23 | Q1 | 9/1/2022 – 11/30/2022 | 40% |
| FY 23 | Q2 | 12/01/2022 – 2/28/2023 | 60% |
| FY 23 | Q3 | 3/1/2023 – ongoing | 80% |
Score Calculations
The EVV Usage Score, for a CDS employer, equals the Manual EVV Visit Transaction Score.
The Manual EVV Visit Transaction Score equals the number of total electronic (non-manual) visit transactions divided by the total number of accepted visit transactions by the EVV Aggregator.
11020 Manual EVV Visit Transaction Score
Revision 22-4; Effective Sept. 1, 2022
The Manual EVV Visit Transaction Score:
- Excludes manual EVV visit transactions with zero bill hours
- Includes manual EVV visit transactions accepted by the EVV Aggregator
- Only counts a manual EVV visit transaction one time
- When an EVV visit transaction is manually entered into the EVV system or an EVV visit transaction is missing a clock in or a clock out time which must be manually entered into the EVV system, the EVV visit transaction counts against the Manual EVV Visit Transaction Score once.
Refer to 7000 Clock In and Clock Out Methods for more information.
11030 Rejected EVV Visit Transaction Score
Revision 22-4; Effective Sept. 1, 2022
When an EVV visit transaction is sent to the EVV Aggregator and does not pass all EVV visit transaction validations, the EVV visit transaction is rejected and sent back to the EVV system. This is to notify the program provider, FMSA or CDS employer visit maintenance is required.
Each time a visit transaction is rejected by the EVV Aggregator, it counts against the Rejected EVV Visit Transaction Score. This is true for EVV visits which are exported from an EVV system and rejected by the EVV Aggregator multiple times.
For example:
- On Monday a program provider submits an EVV visit transaction to the EVV Aggregator, and the EVV visit transaction is rejected.
- On Tuesday, the program provider completes visit maintenance and resubmits the EVV visit transaction to the EVV Aggregator. The EVV Aggregator rejects the EVV visit transaction again.
- On Wednesday, the program provider completes visit maintenance and resubmits the EVV visit transaction to the EVV Aggregator. The EVV Aggregator accepts the EVV visit transaction.
- In this scenario the Rejected EVV Visit Transaction Score will reflect:
- Two rejected EVV visit transactions
- One non-rejected EVV visit transaction
- Three total exported EVV visit transactions
A rejected EVV visit transaction only counts against the Rejected EVV Visit Transaction Score if the rejection is identified as a program provider or FMSA error.
The following table shows data elements, as applicable, and EVV visit transaction rejection reasons identified as program provider or FMSA errors that count as a rejected EVV visit transaction.
| Edit Number | Data Elements (as applicable) | EVV Visit Rejection Reason |
|---|---|---|
| Ex0002C | NPI | Provider NPI cannot be validated as active for the visit date. |
| Ex0003C1 | API | Provider API cannot be validated as active for the visit date. |
| Ex00031C | Payer | The Member's Payer on the EVV visit does not match our records for this Member. |
| Ex00034C1 | Member Medicaid ID | The member Medicaid ID on the EVV visit is not found in our records. |
| Ex00034C2 | Member Medicaid ID (no active eligibility) | The member Medicaid ID on the EVV visit does not have active Medicaid eligibility for the visit date. |
| Ex00043C | MCO Member Service Delivery Area (SDA) | The MCO member SDA on the EVV visit does not match the Plan Code associated with the member's payer. |
| Ex00057C1 | Service Group and Service Code combination | The service group and service code combination on the EVV visit are not eligible for EVV. |
| Ex00057C2 | Service Group not valid for Provider Number | The service group and Service Code combination on the EVV visit are not valid for the Provider number on the visit. |
| Ex00057C3 | Member not authorized for Service Group/Service Code combination | The member on the EVV visit is not authorized for this service group/service code on this visit date in our records. |
| Ex00059C | HCPCS and Modifier combination not eligible for EVV | The HCPCS Code and EVV Modifier combination on the EVV visit is not eligible for EVV. |
Refer to the TMHP EVV website to access the EVV Visit Transaction Rejection Guide which explains all rejection reasons.
11040 How EVV Usage Reviews are Conducted
Revision 22-4; Effective Sept. 1, 2022
Payers conduct EVV Usage Reviews by the following contract and agreement types:
- Program providers and FMSAs with LTC FFS contracts are monitored at the provider number level.
- Example: If a program provider or FMSA has five different LTC FFS contracts, each unique provider number will receive an EVV Usage Score.
- Program providers and FMSAs enrolled with TMHP for Acute Care FFS are monitored at the NPI or API/TIN combination level.
- Example: If a program provider or FMSA has three different NPIs or APIs with the same TIN or three different TINs, each NPI or API/TIN combination will receive an EVV Usage Score whether the TIN is the same or different.
- Program providers and FMSAs with MCO contracts are monitored at the NPI or API/TIN combination level.
- Example: If a program provider or FMSA has three different NPIs or APIs with the same TIN or three different TINs, each NPI or API/TIN combination will receive an EVV Usage Score whether the TIN is the same or different.
- CDS employers are monitored at the member level.
- Example: Each member who has selected the CDS option will be reviewed.