6000, EVV Visit Transaction

Revision 22-4; Effective Sept. 1, 2022

An EVV visit transaction is a record generated by an EVV system that contains data elements for an EVV visit. 

The EVV visit transaction includes:

  • Service authorization data
  • Member data
  • Service provider data
  • Program provider or FMSA data
  • EVV service delivery data

Once steps 1-3 as described in 4000 EVV System and Setup are complete, program providers, FMSAs or CDS employers are ready to begin using the EVV system. 

The following steps explain how to use the EVV system and how the EVV system processes EVV visit transactions. 

Step 4: Service providers and CDS employees must:

  • Clock in at the beginning of service delivery using an approved clock in and clock out method.
  • Clock out at the end of service delivery using an approved clock in and clock out method.

Step 5: The EVV system: 

  • Captures and verifies visit data. (Refer to 4400 Data Collection)
  • Validates the identification and visit data against Texas Medicaid data.
  • Notifies program providers, FMSAs or CDS employers of exceptions in the EVV visit transaction.
  • Submits the EVV visit transaction to the EVV Aggregator.

Step 6: The EVV Aggregator:

  • Conducts data validation.
  • Determines if the EVV visit transaction is an accepted or rejected EVV visit transaction.
    • Stores accepted EVV visit transactions for the claims matching process.
    • Stores rejected EVV visit transactions and returns results to the EVV system.

Step 7: Program Providers, FMSAs and CDS employers complete visit maintenance, if necessary, to:

  • Correct exceptions and rejected visit transactions sent back by the EVV aggregator.
  • Adjust bill hours.
  • Add reason codes and free text as required.

EVV Steps 4 through 7 

Step 8: Program Providers and FMSAs use the EVV Portal to:

  • Search and review visit data.
  • Verify accepted EVV visits for billing.
  • Access the claims matching results.

Step 9: Program Providers and FMSAs:

  • Submit EVV claims to the appropriate claims management system. 

Step 10: EVV Aggregator: 

  • Matches EVV claim line items to accepted EVV visit transactions.
  • Returns EVV claims match result codes to the claims management system.

EVV Steps 8 through 10

6100 EVV System

Revision 22-4; Effective Sept. 1, 2022

The EVV system identifies exceptions and notifies program providers, FMSAs or CDS employers of any exceptions they must correct. 

Each night the EVV system will send verified EVV visit transactions to the EVV Aggregator. Once the EVV Aggregator receives an EVV visit transaction, it will validate the data.

If the EVV visit transaction is rejected, the EVV system will receive a rejection code. The rejection code will be available in the EVV system and accessible by program providers, FMSAs or CDS employers, if applicable. Contact your EVV vendor or PSO for details on how to view rejection codes.

Program providers and FMSAs can use EVV Portal reports and search tools to identify EVV visit transactions they need to correct. Once corrected, the EVV system will re-send the EVV visit transaction to the EVV Aggregator for data validation. 

Payers will not pay an EVV claim for reimbursement unless there is an accepted EVV visit transaction in the EVV Aggregator that matches the claim line item. Refer to 12200 Claims Matching.

6200 EVV Aggregator

Revision 21-1; Effective Nov. 1, 2021

The EVV Aggregator is a centralized database that collects, validates and stores statewide EVV visit transaction data transmitted by an EVV system.

Once the EVV Aggregator receives an EVV visit transaction from an EVV system, the EVV Aggregator:

  • Conducts validation on data from the EVV visit transaction received from the EVV system.
  • Stores all accepted and rejected EVV visit transactions.
  • Accepts or rejects EVV visit transaction and returns results to the EVV system.
  • Matches EVV claim line items to accepted EVV visit transactions in the EVV Aggregator and
  • Sends claims match results to the claims management system for final processing by the appropriate payer.

6300 EVV Portal

Revision 21-1; Effective Nov. 1, 2021

The EVV Portal is an online system that allows users to perform searches and view reports associated with the EVV visit transaction data in the EVV Aggregator.

Program providers, FMSAs, MCOs and HHSC can search, view, print and export:

  • EVV Portal Reports
  • Accepted Visits
  • Visit History
  • EVV Claim Search

Note: CDS employers will not use the EVV Portal but will have access to EVV visit logs and related reports in the EVV system.

Program providers and FMSAs can:

  • View accepted EVV visit transactions ready for billing.
  • Access standard EVV reports and run queries on EVV visit data.
  • Check the status and identify reasons for rejection of submitted EVV visit transactions.