Beginning October 1, 2016: Attendant service providers subject to Electronic Visit Verification (EVV) requirement will see informational explanation of benefits (EOBs) on Long Term Care (LTC) claims submitted that do not match an EVV visit transaction received by Texas Medicaid & Healthcare Partnership (TMHP) from the HHSC-approved EVV vendors, MEDsys or DataLogic. Each day your EVV Vendor sends TMHP a visit transaction file for the attendant services being captured in your EVV system. These transactions files are subsequently matched by the payor to the claims visit data. If a claim cannot be matched with a EVV System visit transaction file your claim will be paid but you will see an informational message on the EOB.
The EOBs are informational only, and claims will continue to be processed as normal.
- For partial matches, EOB code F0344 will appear stating, “Claim for EVV applicable service does not have associated EVV visit transaction records for all dates of service on the claim.”
- If no match is found, EOB code F0345 will appear stating, “Claim for EVV applicable service does not have any associated EVV visit transaction records for this date of service.”
If one of the above EOBs appears, providers should work with their EVV vendor to ensure the visit is complete. Claims will not deny for EOBs F0344 and F0345.
New HHS EVV Website: Texas Health and Human Services (HHS) has set-up a new HHS EVV website. For more information please visit HHS new website for EVV.
EVV Education: Please join us on October 13, 2016 for our Hot Issues for Home Care & Hospice Conference including Community Care - EVV. Key Management staff from Health and Human Services, including the EVV Director Alesia Brown, along with representatives from all the Managed Care Organizations and TMHP will be presenting on where we are now, compliance plan numbers and much more. This is a great opportunity to get face-to-face training on appropriate use of the EVV Reason Codes. So please don’t miss this opportunity get EVV updates and ask questions. For more information and to register please go here.