HHSC: EVV Claims Matching Bypass from Jan. 1 to March 31

By Jessica Boston posted Jan 30,2024 12:37 PM

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Members:

As you may recall, TAHC&H met with HHSC Commissioner Young, Representative Richard Raymond, and their dedicated teams to address pressing issues surrounding Electronic Visit Verification (EVV) for providers and vendors. In that meeting, TAHC&H recommended that HHSC work with CMS to continue to allow providers to pass claims through the system, giving them visit error data on the back end. Please see below for an update from HHSC that authorizes EVV claims matching bypass from Jan. 1 to March 31, 2024.

Please don't hesitate to let us know if you have any questions.

EVV Claims Matching Bypass from Jan. 1 to March 31

The Texas Health and Human Services Commission (HHSC) will implement a claim matching bypass on Feb. 1, 2024 - for EVV claims with dates of service from Jan. 1 through March 31 - to be paid without a matching EVV visit.

Program providers, financial management services agencies (FMSAs), and Consumer Directed Services (CDS) employers must enter missing EVV visits not entered during the EVV claims matching bypass period within the 95-day visit maintenance period.

Payers (HHSC and managed care organizations (MCOs)) will not allow the entry of missing EVV visits after the 95-day visit maintenance timeframe has passed. Failure to use the EVV system to record visits may result in recoupments.

Program providers and FMSAs who received a "No EVV Visit Match" denial for claims with dates of service beginning Jan. 1 can submit adjustment claims after Feb. 1. EVV claims matching will begin with dates of service on April 1.

Billing Claims

If billing through the HHAeXchange system, you must ensure you have a valid, accepted visit on file or you will not be able to invoice and bill your claim. Program providers and FMSAs using HHAeXchange, who need to bill but don't have a valid visit on file in the HHAeXchange system, may submit their claims through TexMedConnect. Claims paid without a valid matching visit are subject to recoupment.

Reminders

EVV claims for EVV required services must be submitted to the Texas Medicaid & Healthcare Partnership (TMHP). MCOs will reject any managed care claims with EVV services and dates of service on or after Dec. 1, 2023, back to the program provider and FMSA, directing them to submit the claim to TMHP for EVV claims matching.

Providers listed in Home Health Care Services Required to Use EVV (PDF), including providers of physical therapy, occupational therapy, or nursing services in the home who bill service codes listed in EVV Home Health Care Services Bill Codes Table (PDF), should have begun submitting claims to TMHP as of Dec. 1, 2023.

Resources

For information on submitting EVV claims to TMHP, refer to Prepare for EVV Cures Act Home Health Care Services Implementation, found on the EVV webpage.

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