Helpful Tips for EVV Requirements

Date: 11/28/17

Please note: This article has been updated from the previously posted article, EVV Service Claims and Maintenance: How to Ensure Claims Get Paid.

As a reminder, Superior monitors Electronic Visit Verification (EVV) compliance based on claims validation against submitted EVV transactional data for STAR Health, STAR Kids, STAR+PLUS and STAR+PLUS Medicare-Medicaid Plan (MMP) providers. Providers are responsible for ensuring all EVV transactional data elements are uploaded or entered into the EVV system completely, accurately and in a timely manner.

Below are guidelines that must be followed in order to ensure EVV transactions are approved, and claims are not denied or recouped.

EVV Service Claims

For EVV covered services, Superior evaluates billed claims against verified visits, which are logged into EVV systems and transferred to Superior daily. EVV service claims follow the standard Superior claim submission procedure, however Superior will also execute an additional verification, matching the provider ID, member ID, dates of service, procedure codes and billed units that were entered into the EVV system to the claim submitted. 

If the transactional units entered into the EVV system match the billed units on the claim, Superior will process the claim for payment. Claims may be subject to denial, recoupment or partial payment if:

• There is no corresponding EVV transactional data in the EVV system.
• The billed units on the EVV service claim exceed the validated EVV transactional units.
• The correct payor ID is not listed, or it does not align with the date of service billed.

Providers should work with their EVV vendor to ensure all required EVV data fields contain complete and accurate data prior to submitting a claim. EVV systems offer a variety of detailed reports that can assist providers identify data entry errors and/or missing required data. 

EVV Maintenance

Visits that do not coincide with a member’s schedule may need to be automatically verified by performing visit maintenance. Providers are allowed to make adjustments to their EVV transactions; this includes updates to any member, provider or visit data element. In order for these visits to be verified, providers must:

• Complete any and all required visit maintenance in the EVV system, within 60 days of the date of service.  
• Complete all required EVV visit maintenance prior to any claim submissions.  
• Utilize the "Failed to Export" EVV vendor report to resolve any issues prior to billing for affected dates of services. 
• Ensure the most appropriate reason code is associated with each EVV change made in visit maintenance and enter any required free text in the comment section.
• Clear visit exceptions through the visit maintenance process.
• Review the member’s weekly authorized units, to ensure they are not overusing/overbilling on a weekly basis.

After the 60-day visit maintenance window is closed, Superior will only approve visit maintenance unlock requests in limited circumstances, such as retro-authorization, eligibility and/or payor changes. Any claim not supported by EVV for dates of service on April 1, 2016 or later, may be denied or subject to recoupment.

HHS EVV Business Requirements

Texas Health and Human Services (HHS) prohibits providers from using mobile/wireless phones for EVV transactions. HHS requirements state that EVV transactions must be logged using the HHS-approved Small Alternative Device (SAD), or a member’s home landline telephone.

Please note: Attendants are allowed to enter the SAD token code via cellular phone.

Providers must inform members about the use of their telephonic landline in order to use EVV. If a member refuses the use of the landline, then the provider must educate on the use of an SAD and how that device must remain affixed to a designated location within the member’s home. To order an SAD, visit: https://www.dads.state.tx.us/evv/docs/SmallDeviceAgreementOrderForm.pdf

Please note: Providers are responsible for educating members and their attendants regarding EVV processes and requirements.

EVV Resources

• Reference the EVV Provider Training for more information on all provider responsibilities and billing requirements.
• Visit Superior’s EVV section of the Provider Resources webpage, for additional resources on EVV.
• Download the following HHS resources to find EVV FAQs and to learn more about Electronic Visit Verification At-A-Glance.

For questions, please reach out to your local Account Manager.