EVV Process in Provider Management

Service Code Setup

Make sure all EVV reportable services codes are setup in the service code master as EVV REPORTABLE.

Service Code Master

Consumer Recipient Number

In the consumer master, the consumer recipient number needs added in the recipient number field.

Employee Setup

For those employees who will be providing EVV reportable services, an unique employee ID and email address need added in the Employee Master.

Enable Location Tracking Services

Make sure staff devices have location tracking services enabled.  This will be required to gather the GPS location as punches are made, either on the web version or with the mobile app.

Employee Submissions

  1. Any employee with the Sandata ID completed in the Employee Master will be submitted to the aggregator when you run the employee submission process.
  2. If the employee was submitted/accepted to the aggregator, the Employee Master will show SANDATA REGISTERED as checked. 
  3. As new employees are hired, the employee submission file will need processed.
  4. If an employee has a name or email change, uncheck the SANDATA REGISTERED box in the Employee Master and run the employee submission process again to upload the new information.
  5. To remove an employee from the employee submission listing, uncheck the SANDATA REGISTERED box in the Employee Master and delete the Sandata ID.

Consumer Submissions

  1. Any consumers who has an EVV reportable service authorized and listed in their service plan will be submitted when you run the consumer submission process. 
  2. If the consumer was submitted/accepted to the aggregator, the consumer master will show SANDATA REGISTERED as checked. 
  3. If a consumer has a change in mailing address, services, etc., uncheck the SANDATA REGISTERED box in the consumer master and run the consumer submission process again to upload the new information.

Recording EVV Information Using Consumer Time Tracking

The Consumer Time Tracking process captures all the required information for EVV reporting.  Staff can use the web version or mobile app to make EVV entries. Refer to the training manual for directions.

Review of Consumer Time Tracking

  1. As staff are making entries into the system using the TRANSACTIONS menu > Consumer Time Tracking, it is critical that the entries are reviewed.
  2. The Consumer Time Tracking Listing report will show you all punches made into the system (REPORT menu > Consumer Time Tracking Listing).
  3. If a punch wasn’t completed (no end time), the end time field will be blank.
  4. Review the service codes that were selected during entry.
  5. If the note was completed, the documentation column will display COMPLETED.  If the note was not completed, the column will be blank.
  6. The system will allow a time tracking administrator to make manual entries.

Correcting EVV Visit Information

  1. Staff who will be making edits need to be set-up as a Time Tracking Administrator in the Employee Master. 
  2. If corrections are needed, a Time Tracking Administrator will need to correct the visit information (TRANSACTIONS menu > Consumer Time Tracking) before it is submitted to the aggregator. 
  3. The system will track the changes being made to visit information and allow staff to make a note as to why a change was necessary.
  4. DHS continues to develop a policy bulletin that will outline additional requirements, including compliance benchmarks for manually edited visits. Once the bulletin is released, Horizon will finalize the reporting of manual entries, change tracking, monitoring ESC’s, and visit verifications.

EVV Visit Submissions/Billing

  1. Visit information will be submitted by January 31, 2020.  Once visit information has been submitted and you can view that information, you will need to verify with Sandata that you can see the visits in the aggregator.
  2. Visit information will need submitted to the Sandata Aggregator BEFORE billing is submitted or your billing will be denied after July 1, 2020.  When you submit your visit information to the Sandata Aggregator, you’ll get a response from Sandata if the submission was accepted.  After you get the acceptance response, you can submit your billing as usual. 
  3. The Unauthorized Services Report will be updated so that if visit information has not been reported, the service will become unauthorized and not bill.

EVV Error Service Codes (ESC)

  1. The claims adjudication process will basically flow as it currently does today EXCEPT, when an EVV service is found on the claim, PROMISe will make a “call” to the EVV aggregator to validate a record(s) is present and ensure the EVV record(s) found in the aggregator matches the claim. If the claim detail line passes EVV validation, the claim will continue processing and next validate against the plan in HCSIS. No EVV validation call will be made when a claim is voided. 
  2. During claims processing in PROMISe, validation against the aggregator will continue to be performed and EVV Error Service Codes (ESCs) will set without impacting claim payment until July 1, 2020.  The codes are as follows:
    1. ESC 925:  This code means that the visit was verified and the claim was submitted for processing.
    2. ESC 927 and ESC 928:  These two codes mean the claim was denied and further research needs to occur to resubmit the claim;  ESC 927 means the units billed exceed the units verified in EVV and ESC 928 means the EVV visit was not found.
    3. ESC 926, ESC 929, and ESC 930: the PROMISe technical vendor (DXC) will resolve the error and reprocess the claim when these ESC are set; no action is needed by the provider other than checking to make sure the claim was resubmitted after 24 hours.

3/2022

NEED MORE HELP?  Submit a ticket to the Help Desk or call (814) 535-7810 or (800) 889-3388