HHSC has postponed when Electronic Visit Verification claims for Home and Community-based Services and Texas Home Living will start to be denied for not matching an accepted EVV visit transaction. This will start for dates of service March 1, 2023, and after.
The purpose is to give program providers and financial management services agencies more time to improve their EVV claims matching. HHSC and the Texas Medicaid and Healthcare Partnership will continue outreach and training support. Effective immediately, program providers and FMSAs should take necessary steps to improve EVV claims matching to avoid future payment denials or recoupments. Refer to the resources below.
Resources to improve EVV claims matching
HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (PDF) provides technical guidance to prevent EVV claim mismatches when submitting EVV claims to CARE or TMHP.
Many EVV claim mismatches are the result of program providers and FMSAs using incorrect bill code combinations for day habilitation. Refer to the HHSC notice posted on Sept. 15, to know which day habilitation bill codes to use.
- Note: As of March 1, 2023, day habilitation will no longer be a service in the HCS and TxHmL programs. Starting March 1, 2023, individualized skills and socialization bill codes will replace day habilitation bill codes. HHSC will post more information related to the transition to individualized skills and socialization in future notices.
The EVV Claims Matching Refresher Webinar recording and question and answer (Q&A) document are available in the TMHP Learning Management System. Refer to TMHP’s notice for more information and instructions.
Email TMHP to request help with correcting EVV claim mismatch results (EVV02-EVV06), and to learn how to receive EVV01 matches.
Program providers, FMSAs and Consumer Directed Services employers must continue to use EVV for all personal care services required to use EVV (PDF). EVV claims for HCS and TxHmL with dates of service from May 1, 2022, through Feb. 28, 2023, are still subject to reviews and recoupments conducted by HHSC Provider Fiscal Compliance.