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.

Programs Services Required to Use EVV

Personal Care Services required to use EVV (PDF)

21st Century Cures Act Updates

HHSC is implementing the federal 21st Century Cures Act (Section 12006).

  • Effective Jan. 1, 2021, EVV is required for Medicaid personal care services.
  • Effective Jan. 1, 2024, EVV is required for Medicaid home health care services.

States that do not implement EVV will receive reduced federal Medicaid funding.

Visit the 21st Cures Act webpage for more 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.

EVV Compliance Job Aids

Refer to the EVV Policy Handbook section, 10000 EVV Compliance Reviews, for more information.

EVV Consumer Directed Services Option

Visit the EVV CDS Option webpage for related resources and information.

Policies

Policy Handbook

Policy Handbook Revision Log

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.

Visit the EVV Proprietary Systems webpage for more information.

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

Historical HHSC EVV Reason Codes

Resources

Contact Guides

The following guides have contact information for EVV inquiries:

Getting Started with EVV

The following guides are for getting started with EVV:

Best Practices

Form 1718, Responsibilities and Additional Information (MCO)

Form 1718 is used by MCO service coordinators to inform Medicaid recipients of their requirements to comply with EVV (reference TAC §Section 354.4011).

Schedules

Program and Service Requirements for Schedules (PDF)

Statutes and Rules

Service Bill Codes Table

The EVV Service Bill Codes 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

Training Resources

Visit the HHSC EVV Training webpage for more information.

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.

VMUR Instructions and Templates

VMUR Job Aids

Communications