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On Wednesday, January 25, 2017, Texas Health and Human Services (HHS) held a quarterly electronic visit verification (EVV) provider stakeholder meeting from 9:00 a.m. until 4:00 p.m. TAHC&H has requested electronic copies of the PowerPoint presentations from HHS and will update this post as soon as they are received.

 HHS presented information in the morning on:

• EVV Reminders and Updates
• EVV Compliance Scores
• HHS Unlocking Visit Maintenance Policy
• The TMHP Provider Portal

The Texas Workforce Commission had a presentation on Texas Pay Day Law followed by a question and answer (Q&A) session.

In the afternoon, HHSC Contract Monitoring had a presentation on the most common EVV errors, followed by a Managed Care Organization (MCO) Panel.

The MCO Panel consisted of representatives from every MCO in the state. The MCO Panel gave an initial report about the percentages of EVV compliance with their contracted home health agencies (HHAs), followed by a Q&A on service coordination, the authorization process, and contact information for when one may have an EVV question.

 There were many questions asked of the MCO panel to which not all MCO representatives were able to give complete answers.

 Some of the topics presented to the MCO Panel of service coordinators were:

• Small Alternative Device (SAD) verification by Service Coordinators and the proper zip-ties to use.
• The process of provider notification when a client has an inpatient hospital stay.
• Dealing with retro-enrollment and back-dated authorizations,
• Working with MCO members who frequently change providers and plans.
• Diagnosis Codes
• Proper Documentation
• Initial Authorization

As time ran out, HHS staff stated that will get with the MCOs to answer the questions and then publish them to the HHS website once they are completed. TAHCH will monitor the Texas HHS website for that information and will let you know once it has been published.

 Terry Frazier from the HHS Health Plan Management (HPM) Complaints department shared information regarding an update to the HPM complaints process due to the high amount of Prior Authorization issues that providers have been experiencing with the implementation of STAR Kids. The HPM complaints department stated that if prior authorizations for services from the STAR Kids MCOs are taking longer than the required three days, providers should email HPM complaints (HPM_Complaints@hhsc.state.tx.us) with the subject line, Prior Authorization Urgent immediately and Cc: Terry.Frazier@hhsc.state.tx.us.  Providers must remember to encrypt/secure any emails that contain Protected Health Information) PHI.

HPM is updating how they handle complaints from individuals and providers and will be posting information concerning this process soon. TAHCH will monitor the Texas HHS website for that information and will let you know once it has been published.

After the MCO Panel and short HPM Complaints presentation, HHSC took feedback from providers on the small alternative device (SAD) ordering process, and reviewed EVV reason codes before adjourning the meeting.

From the Agenda

EVV Reminders:

If you are experiencing system issues, please report those to the EVV vendor first.

• Be sure to always request ticket numbers from your EVV vendor when reporting issues.
• Notify HHSC or the appropriate MCO within 48 hours of any ongoing issues with EVV system.
• System issues involving purchases software will need to be addressed directly with your EVV vendor.
• MDCP providers that transitioned to STAR Kids need to change their payor from DADS to STAR Kids MCOs and select the appropriate HCPCS/modifiers in the EVV system.
• Provider agencies must ensure data elements entered in to the EVV system are accurate and complete.
• Ensure your agency can pull the EVV Visit Log for each individual/member in your system.
• Only visits that have been exported by the EVV vendor will show on the EVV Visit Log, if the provider cannot pull the EVV Visit Log, which means that there is incorrect information which needs to be corrected.
  • Reasons why the EVV Visit Log may not populate data:
    • Missing HCPCS or Invalid HCPCS billing code combos
    • Missing or Invalid Contract Number (The contract number is nine digits and must include any leading zero’s)
    • Missing or Invalid Tax Identification Number (TIN) (invalid=incorrect number of characters)
    • Missing or Invalid National Provider Identification Number (NPR) (invalid=incorrect number of characters)
    • Missing or Invalid Texas Provider Identification (TPI) (invalid=incorrect number of characters)
    • Missing or Invalid Medicaid ID (invalid=incorrect number of characters)
    • Incorrect Payor assigned to the individual/member
  • Missing or incorrect data elements in the EVV system may result in:
    • Denied Claims
    • Recoupment during contract monitoring
    • Contract Actions
    • Inaccurate or blank EVV reports
  • EVV Vendors will lock visit maintenance until the provider agency enters missing data elements into the system
  • If the provider has not addressed the missing or inaccurate data elements, the EVV vendor will notify each payor for further action.
  • Providers who use Vesta/DataLogic, Contract Managers conducting a monitoring visit will only accept and review the EVV Visit Log, not the Client Visit Log. HHS will no longer use the Client Visit Log because they no longer have access to it. (HHSC alert)
  • Cell phones are not allowed to be used to call-in and out of the EVV system
  • Cell phones can only be used to call in SAD values
  • Visits are subject to recoupment if found to be confirmed using a cell phone
  • Ensure the individual/member’s home landline phone number entered into the EVV system is truly their landline phone number
  • EVV Vendors conduct random samples of the phone numbers entered as landlines in the EVV system
  • Each payor receives a report from the EVV vendor showing cell phone numbers that were entered as landline numbers.

EVV Updates:

• The Vesta/DataLogic GPS pilot is tentatively scheduled to begin on February 6, 2017 in select regions for one to two months.

• The EVV visit maintenance reduction pilot is scheduled to start February 1, 2017, and will consist of an open 24 hour window to auto adjust .25 hours.

• A system is being developed to alert providers when authorized hours are getting close to being used, and will require authorization in the system to receive an alert.

• An EVV provider manual is being developed.

Unlocking Visit Maintenance after the 60-day Window

Providers must submit requests with all required information and supporting documentation to the appropriate payor in a secure email

• Required Information:
  • Provider Name
  • Payor’s Name
  • EVV Vendor Name
  • HHSC (DADS) Contract Number
  • Tax Identification Number (TIN)
  • National Provider Identification Number (NPI)
  • Individual/Member(s) Name
  • Individual/Member(s) Medicaid Identification Number
  • Dates Provider Needs Access To
  • Explanation of why provider needs to unlock visit maintenance past 60 days, with any supporting documentation. NOTE: Supporting documentation can include: EVV vendor ticket numbers, Correspondence with the vendor or payor

Overall the meeting was well attended and a lot of information was discussed.  TAHC&H will continue to participate, offer solutions and share additional meeting information with members as it becomes available.