Electronic Visit Verification Hard Claims Edit

Date: 08/02/22

Providers, please read this entire communication for the most up-to-date information on Electronic Visit Verification (EVV) requirements and guidance.

 

1.       Timeline for the Hard Claim Edits (starting November 1, 2022)

The hard claim edits will be in effect for dates of service starting November 1, 2022. AHCCCS undertook a number of activities in partnership with CMS, Sandata, and Managed Care Organizations (MCOs) to inform the plans and timeline to make the transition from the soft claim edits to the hard claim edits period. 

·         The timeline decision was largely informed by Arizona’s EVV system certification by CMS and DDD’s implementation of the Wellsky claims system. 

·         To maintain compliance with CMS, AHCCCS was required to implement the EVV claims enforcement plan AHCCCS presented to CMS during the EVV system certification review process

·         The date of the enforcement also considered the timeline for the completed rollout of DDD’s new claims system to mitigate service payment disruptions for providers who are contracted with DDD and also subject to EVV.

·         AHCCCS has been tracking various provider readiness milestones representing a continuum of compliance. MCOs are using that data to inform provider engagement and outreach plans to ensure that providers have the support they need to fully implement EVV. If providers are contacted by their contracted MCO(s), they are strongly encouraged to respond and connect to ensure their readiness for the hard claim edits. 

2.       It is incumbent upon providers to maintain documentation standards that validate the provision of services as they transition to EVV, as well as the standard requirements outlined in their Provider Participation Agreement. 

·         If you are unsure as to whether or not the EVV mandate is required for your organization, please visit the AHCCCS EVV webpage (www.azahcccs.gov/EVV) and read information provided within the “Providers and Services Subject to EVV” section, including general information about services requiring EVV and resources to support providers to initiate the compliance process.

3.       Agency EVV Contact

Each agency must have an EVV contact on file to set up a Sandata account or, in the case of providers that use alternate EVV vendors, access the Sandata Aggregator. 

·         The Aggregator contains detailed information about the visit data Sandata, AHCCCS, and the MCOs are receiving

·         Please use the directions found on the AHCCCS EVV webpage (www.azahcccs.gov/EVV) in the document EVV Contact and Update within both the “Sandata EVV System Resources and Technical Assistance” and “Alternate EVV System Requirements and Technical Specifications” sections. Providers may also use this process if they need to update their EVV Contact.  

 

 

 

4.       Payment for EVV Services

During the soft claim edit period through 10/31/22, providers can still receive reimbursement for services even if there is no EVV visit to match to a claim or the EVV visit data is incomplete. 

·         Providers should use this period to incorporate EVV into day-to-day business practices, including developing operational procedures, training administrative personnel, onboarding members and caregivers, and logging visits

·         More importantly this is an opportunity for providers to self-monitor agency compliance to avoid billing challenges when the hard claim edit period begins on November 1, 2022. Once the hard claim edits begin, providers will not get paid unless all the required EVV visit data is present

5.       AHCCCS has provided new/updated resources here that will help agencies self-monitor compliance and detect any issues that may be contributing to notifications of claim failures during the current soft edits period. These notices are directly indicative of the hard edits that agencies will receive for dates of service beginning November 1, 2022 if these issues are not addressed.

·         EVV Policy Compliance

The AHCCCS Medical Policy Manual, EVV Policy 540 has been in effect since January 01, 2021. The policy and the following associated forms are linked on the EVV web page. 

-          Designee Attestation,

-          Contingency Plan, and

-          Paper Timesheet Attestation

·         The MCOs will be initiating audits to ensure provider compliance with the AHCCCS policy including reviewing documentation as evidence that providers have had conversations with members and completed the forms (noted above) as allowable/required under the policy. 

·         After an initial compliance audit, the EVV compliance standards will be incorporated into ongoing credentialing/quality monitoring audits performed by the MCOs to ensure ongoing compliance. 

6.       Information for Sandata EVV System Users

Please contact the Sandata Customer Care at 855-928-1140 for any technical support for

the system including, but not limited to:

·         Accessing training,

·         Finding your welcome kit,

·         Changing your EVV Contact,

·         Importing your employees, and

·         All other technical issues experienced by users on devices or the EVV portal

 

7.       A commonly reported problem is that members or authorizations are missing from the agency accounts. 

·         There can be a few different reasons why this might occur

·         Please note, members will show up in the agency account when they are tied to a prior authorization from the health plan or when the agency has entered information into the AHCCCS EVV Service Confirmation Portal that links the agency to a member (in lieu of an authorization) when prior authorization is not required for a service. 

·         If the agency is experiencing missing members or authorizations, please use the Missing Authorization and Member Checklist  available on the EVV web page to research and determine what steps should be taken before contacting Sandata (refer to the section entitled “Sandata EVV System Resources and Technical Assistance.”)

8.       AHCCCS wants to make providers aware that Sandata can interface with EMR/EHR systems to, specifically, import employees and schedules into the Sandata EVV system

·         This may mitigate duplication of effort

·         If providers are interested in this opportunity, they should contact Sandata Technical Support for a copy of the technical specifications to initiate the process.

·         Lastly, AHCCCS continues to pursue opportunities to streamline EVV for providers. For example, AHCCCS is finalizing a change request with Sandata to help streamline the check in/out process for group visit service delivery scenarios. AHCCCS and Sandata sought input directly from providers to ensure the change request will be the intended outcome.

 

9.       Information for Alternate EVV System Users 

It is incumbent upon each provider, using an alternate EVV system, to ensure the vendor’s compliance with AHCCCS business requirements and technical specifications

·         One practical way for providers to understand and monitor what information Sandata is receiving from the alternate vendor, is to access the Sandata Aggregator

·         The Aggregator contains detailed information about the visit data Sandata, AHCCCS, and the Health Plans are receiving

·         You can find more information on how to access the Aggregator using the Sandata Aggregator Information document located on the EVV webpage (www.azahcccs.gov/EVV) (refer to the section entitled “Alternate EVV System Requirements and Technical Specifications.”)

·         The current AHCCCS/Sandata priority is preparing updated technical specifications/business requirements that both remove and add requirements. These changes are in response to stakeholder feedback, (including clarification to existing specifications) and in response to Sandata system changes to ensure alignment across all EVV systems. The updated technical specifications will:

-          Clearly outline the changes;

-          Denote the specific elements that will be tested in the next phase. This includes elements in the current version of the technical specifications that were not tested in the initial round of testing (i.e., data elements that were noted as optional).  

·         AHCCCS and the Sandata technical team will follow the release of the updates with a webinar to answer questions about technical specifications and the associated business requirements

·         The notice will include a timeline for the development and testing process, reflective of the hard claim edits timeline 

-           For example, AHCCCS/Sandata are currently outlining specifications that have a direct impact on the hard claim edit timeline

-           One consideration is to allow the vendors to complete testing for those specifications ahead of the hard claim edit to mitigate provider billing issues while affording vendors more development/testing time for the remaining specifications not directly impacting provider claims payment after November 1, 2022.   

·         AHCCCS is also preparing to host an Operational Readiness Review (ORR) with each vendor to ensure compliance with business requirements on how the data is being collected that is being sent to Sandata and documentation required for audit purposes. More details on the scope and how to prepare for the ORRs is forthcoming.  

·         For technical issues related to the current alternate system technical specifications, please contact the Sandata Customer Support at AZAltEVV@sandata.com or 844-289-4246.

 

10.   Provider Resources

AHCCCS is working on resources to support provider compliance with EVV. The resources coinciding with this communication focus on helping providers understand the EVV process from start to finish and providing practical ways to understand and assess gaps in EVV compliance. The following resources can be found on the EVV web page (refer to the section entitled “General Resources and Frequently Asked Questions.”) 

·     Sandata EVV Workflow, 

·     Alternate Vendor EVV Workflow,

·     EVV Billing Checklist, and

·     Billing FAQ (updated).

 

11.   Upcoming Updates or Releases of New FAQs

AHCCCS is also concurrently updating existing FAQs and writing new FAQs (see below), prioritizing the Documentation FAQ as a desk aide for individuals responsible for visit maintenance to reconcile missing/incomplete visit information for billing and ensure maintenance of documentation for audit purposes.

·         New Documentation FAQ,

·     New Contingency Plan, 

·     New Designee FAQ,

·     New Case Management FAQ, and

·     Service Confirmation Portal FAQ (Updates).

 

12.   Stay Informed

Please sign up for email notices about EVV.