Medicaid Electronic Visit Verification (EVV) Reminder
Date: 11/23/21
Pursuant to Section 1903 of the Social Security Act (42 U.S.C. 1396b), the 21st Century Cures Act, in order to prevent a reduction in the Federal Medical Assistance Percentage (FMAP), AHCCCS was mandated to implement Electronic Visit Verification (EVV) for non-skilled in-home services (attendant care, personal care, homemaker, habilitation, respite) and for in-home skilled nursing services (home health). As a result, AHCCCS required EVV for personal care and home health services beginning January 1, 2021. If your agency is registered with AHCCCS as one of the provider types listed in the tables below and you deliver any of the services listed in any of the locations listed in the tables, you are subject to EVV and required to participate in order to continue to be paid when the soft edit timeframe ends. In mid-January, 2021, we confirmed that Sandata, the AHCCCS EVV Vendor, was rejecting service confirmations we submitted on your behalf due to its inability to accommodate modifiers. As a result, AHCCCS began working on a change to address the issue and in the interim, we suspended further submissions of service confirmations.
Starting 11/15/21, we resumed submitting EVV service confirmations to Sandata.
If you submitted a service confirmation to us for a date of service after 11/15/21 prior to 11/15/21, we ask that you please resubmit it.
Provider Type and Services
Provider Description | Provider Type |
---|---|
Attendant Care Agency | PT 40 |
Behavioral Outpatient Clinic | PT 77 |
Community Service Agency | PT A3 |
Fiscal Intermediary | PT f1 |
Habilitation Provider | PT 39 |
HomeHealth Agency | PT 23 |
Integrated Clinic | PT IC |
Non-Medicare Certified HomeHealth Agency | PT 95 |
Private Nurse | PT 46 |
Services and Service Codes
Service | HCPCS Service Codes |
---|---|
Attendant Care | S5125 |
Companion Care | S5135 |
Habilitation | T2017 |
HomeHealth Services (aide, therapy, and part-time/intermittent nursing services) | |
Nursing | G0299 and G0300 |
Home Health Aide | T1021 |
Physical Therapy | G0151 and S9131 |
Occupational Therapy | G0152 amd S9129 |
Respiratory Therapy | S5181 |
Speech Therapy | G0153 and S9128 |
Private Duty Nursing (continuous nursing services) | S9123 and S9124 |
Homemaker | S5130 |
Personal Care | T1019 |
Respite | S5150 and S5151 |
Skills Training and Development | H2014 |
Places of Service and POS Codes
Place of Service Description | POS Code |
---|---|
Home | 12 |
Assisted Living Facility | 13 |
Other | 99 |
As a reminder…
- If you are subject to EVV, you need to complete training with Sandata, the AHCCCS EVV Vendor, or an *alternate vendor. The training must be completed by the identified EVV Administrator or Key Contact. This must occur immediately so please register, complete the required training and receive your welcome kit to begin the EVV process.
- Visit Alternate EVV System Requirements and Technical SpecificationsExternal Link for more information about alternate vendors.
- If your EVV Administrator or EVV key contact has changed, it’s IMPORTANT to report the change to Sandata by calling 855-928-1140. Please make sure your current EVV Administrator key contact on file is correct.
- For more information regarding the required Sandata training, visit this the Sandata websiteExternal Link.
- The authorization process won’t change. For those services subject to EVV for which we require prior authorization, we will continue to review and respond to your requests as we do today. Authorizations will be automatically uploaded to Sandata for you to view. PLEASE NOTE: Prior to billing for services that require prior authorization, you must enter the visit information into Sandata or another *alternative vendor system.
- For services which we do NOT require prior authorization, you will need to enter the visit information into the AHCCCS Service Confirmation PortalExternal Link.
EVV Claims Denials
- We are currently allowed to apply soft claim edits, meaning we use specific codes on the Explanation of Payment to notify you the service is subject to EVV. We are not yet certain when AHCCCS will require the health plans to begin to actually deny claims, but feel it is coming soon. We will provide you as much notice as we can. We also encourage you to sign up for the AHCCCS Constant Contact email notification list to receive updates on recent developments for the EVV initiative.
- If you are subject to EVV and do not participate after the soft claim edit period has expired, you can’t be paid for the services you deliver, so your participation is CRITICAL.
- We’ve established two EVV denial codes that we are using during the soft claim edit period.
- EX8i - DENIAL WOULD BE APPLIED IF NOT VERIFIED THROUGH EVV VISIT VERIFICATION
- EX8h - NO EVV VISIT MATCH FOR MEDICAID ID
AHCCCS has developed a number of FAQs to assist you with the EVV process. Please visit the page for more information on the EVV process and requirements: https://www.azahcccs.gov/AHCCCS/Initiatives/EVV/.External Link
Additional Information
If you have questions regarding the information contained in this update, please feel free to contact our Provider Customer Service Center at 866-796-0542 or contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.