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.

• Learn more about EVV (PDF)

Programs Services Required to Use EVV

• Personal Care Services required to use EVV (PDF)

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

HHSC and managed care organizations, the payers, conduct EVV compliance reviews to ensure program providers, Financial Management Services Agencies and Consumer Directed Services employers are in compliance with EVV requirements and policies.

Review Section 10000 EVV Compliance Reviews from the EVV Policy Handbook for more information.

EVV Consumer Directed Services Option

Visit the EVV Consumer Directed Services Option webpage for related resources and information.

Policies

Policy Handbook

• EVV Policy Handbook

Policy Handbook Revisions Log

• Nov. 1, 2021 revisions (PDF)
• Jan. 7, 2022 revisions (PDF)

Policy Guidance and Temporary Policies

• Guidance Related to DataLogic/Vesta EVV System Outage in December 2020 (PDF)
• 180 Day & 90 Day Visit Maintenance Temporary Policy (PDF)
• Temporary EVV Policies for COVID-19 (PDF)
• Temporary EVV Policies for Severe Winter Weather (PDF)

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

• EVV Reason Codes Effective Jan. 1, 2021 (PDF)

Historical HHSC EVV Reason Codes

• EVV Reason Codes Effective Sept. 1, 2019 – Dec. 31, 2020 (PDF)
• EVV Reason Codes Effective July 1, 2017 – Aug. 31, 2019 (PDF)

Resources

Contact Guides

• The following guides contains useful contact information for EVV:
  • CDS Employer EVV Contact Information Guide (PDF)
  • Program Provider and FMSA EVV Contact Information Guide (PDF)

Getting Started with EVV

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

• For Program Providers and Service Providers (PDF)
• For Financial Management Services Agencies, Consumer Directed Services employers, Designated Representatives and CDS employees (PDF)

Best Practices

• The following documents provide technical guidance to improve EVV claims matching results:
  • Best Practices to Avoid EVV Claim Mismatches (PDF)
  • HCS and TxHmL Best Practices to Avoid EVV Claim Mismatches (PDF)
• Best Practices for Temporary EVV Policies for COVID-19 (PDF)
  • This is a reference guide to help program providers avoid recoupments related to Temporary EVV Policies for COVID-19 (and only applies to visits with dates of service March 21 – Dec. 31, 2020.)

Form 1718, Responsibilities and Additional Information (MCO)

• Form 1718, EVV Responsibilities and Additional Information (MCO): A form MCO service coordinators must use to inform Medicaid recipients of their requirements to comply with EVV (reference TAC §Section 354.4011).

Glossary of Terms

• EVV Glossary of Terms (PDF) is a document that lists common EVV terminology, definitions and acronyms.

Benefits of Using the EVV Mobile Method

• Benefits of Using the EVV Mobile Method (PDF) is a document that lists facts about the EVV mobile method.

Historical EVV Alerts

• Historical EVV Alerts (PDF) is a document of EVV alerts (notifications) that have published since 2018.

Statutes and Rules

• State
  • Texas Administrative Code, Title 1, Chapter 354, Subchapter O
  • Texas Government Code, Section 531.024172
  • Texas Human Resources Code, Section 161.086
• Federal
  • The 21st Century Cures Act, Section 12006

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

• EVV PCS Service Bill Codes Table – version 9.6 (Excel)
• EVV PCS Service Bill Codes Table – version 9.6 (PDF)

Training Resources

• EVV Training Requirements Checklists (PDF): A resource to track EVV training requirements and completion of requirements
• HHSC EVV Policy Training
• TMHP EVV Portal Training

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

Visit Maintenance Unlock Request

An EVV 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 EVV Visit Maintenance Unlock Request spreadsheets. Request emails must include a contact name, email address and phone number. 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.

• EVV Visit Maintenance Unlock Request for Program Providers and FMSAs (Excel)
• EVV Visit Maintenance Unlock Request for CDS Employers (Excel)