MEDICAID: EVV News; MEDsys Visit Maintenance, Recoupment Policy Guidance

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By Heather Kennedy posted 13 days ago

  
Dear Members, 

This week, HHSC announced that providers may request visit maintenance be opened on historical MEDsys data in order to make corrections beginning February 11, 2019. Providers will not be able to create new MEDsys visits as a result of the transition to DataLogic for EVV.

HHSC has set the following rules and deadlines for these changes:

  • Providers have 60 business days from Feb. 11 to request visit maintenance be unlocked from the appropriate payer.
  • DataLogic has 60 business days from the received approval date from the payer to open visit maintenance to make the approved changes and export the changes to the payer.
  • Managed Care Organizations and fee-for-services payers may not recoup until the re-exported file is received.
Some data elements may be changed and some may not.  Please refer to the full guidance document from HHSC (attached below) for a list of these elements and further instructions on requesting visit maintenance for these transactions, as needed.

This announcement follows a previous statement posted by HHSC that providers must be given prior notification and the opportunity to appeal before being recouped by any payer for claims issues related to EVV. Providers experiencing problems with EVV recoupments where these conditions have not been met should email HPM_Complaints@hhsc.state.tx.us (for managed care claims) or Electronic_Visit_Verification@hhsc.state.tx.us (for fee-for-service claims) and provide supporting documentation.


A list of MCO contacts for EVV is posted on the HHSC EVV website here; click the drop down for "Who Do I Contact if I have Questions?" below the heading, EVV At A Glance. This list is also provided as an attachment you may download below.

EVV_Visit_Maintenance_of_MEDsys_Historical_Data_02_08_19_Final.docx

MCO_Contact_Information_02_04_19.docx

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