On April 30, 2021, NC Medicaid posted an Electronic Visit Verification (EVV) update stating that the EVV pay and report period would end on May 31, 2021 and that claims submitted for dates of service June 1, 2021 and after will be required to validate EVV data prior to claims adjudication. NC Medicaid hosted an EVV stakeholder meeting on Friday, May 21, 2021, to support provider readiness for claim adjudication based on EVV data. The stakeholder meeting presentation highlighted EVV requirements, tips for success and identified resources to support EVV claim adjudication.
Personal Care Services (PCS) and Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) subject to EVV now require all claims for dates of service June 1, 2021, and after to validate EVV data prior to claims adjudication. There are two edits for EVV that will be applied if the claim submitted does not have the required EVV data. Once applied, these edits will pend for an identified number of days to allow for the issue to be cured prior to denial of the claim.
|
Edit |
Description |
Criteria |
|
02077 |
ELECTRONIC VISIT VERIFICATION (EVV) NOT ON FILE FOR DOS |
For claim lines with a Date of Service on or after 6/1/2021, the edit will pend for 14 days then deny. |
|
02079 |
SUBMITTED UNITS EXCEED VERIFIED VISIT UNITS FOR THIS DOS |
For claim lines with a Date of Service on or after 6/1/2021, the edit will pend for 7 days then cut back units to the sum of the verified units. |
Providers utilizing Sandata, the State’s EVV solution, should ensure that all visits are verified in the EVV portal prior to submitting claims. Providers utilizing an alternate EVV solution may confirm verified visits with their vendor and may also view visits in the Sandata aggregator. A visit with a status of ‘verified’ means there are no exceptions. A visit with one or more exceptions has an ‘incomplete’ status, which will impact billing. Providers should ensure they are clearing or resolving all exceptions on incomplete visits to update the visit status to ‘verified’ prior to submitting claims for adjudication.
Use of Manual Visits Entry for EVV
NC Medicaid is aware that entering manual visits is at times necessary as aides are adjusting to the EVV requirement. Manual visits may also be entered if a provider has a PCS authorization for a client and that client is not yet viewable in the Sandata EVV portal. Once the provider can access the client in the EVV portal, manual visits for services completed can be entered for visits where the aide provided services but was not able to enter through SMC, TVV or FVV.
To learn more about how to enter a manual visit in the State’s EVV solution, providers may visit the EVV Provider Agency Training Video Library and view the Visit Maintenance webinar.
Alternate Electronic Visit Verification Solutions
Provider agencies who have selected an Alternate EVV Solution (a solution other than Sandata, the State’s EVV solution), must contact their solution to confirm they have passed their testing validation and their agency EVV data is being sent to Sandata’s aggregator. If the Alternate EVV has not passed testing or is not currently sending EVV data to Sandata’s aggregator, provider agencies are required to enroll with Sandata to meet the EVV requirement.
To enroll with Sandata, providers should initiate training on the NC Medicaid EVV webpage, Provider Meetings and Training section, under Training information for NCDHHS Electronic Visit Verification (EVV) Program.
Questions regarding training and registration may be sent to the Sandata Customer Support team at 855- 940-4915 or NCCustomerCare@Sandata.com.
EVV System Updates
- Clients not found due to NC Medicaid ID updates – NC Medicaid identified an issue with some clients loading into the Sandata portal when the beneficiary had an updated Medicaid ID/Merged ID number. This error is now fixed and beneficiaries impacted should now be viewable in the Sandata EVV portal. Providers may enter manual visits for visits conducted on dates of service prior to their client showing in the Sandata EVV portal.
- Paid Live-In Caregiver EVV Exemption for CAP/C and CAP/DA Waiver Beneficiaries - A subset of caregivers authorized to render personal care services in the CAP/C and CAP/DA waivers are exempted from the EVV visit capture mandate. These caregivers are referred to as paid live-in caregivers. Provider agencies should not enter these paid live-in caregivers in the Sandata System or an Alternate EVV system. When submitting a claim for a paid live-in caregiver, the provider must use place of services (POS) code 99. The NCTracks system will recognize the POS code designated for a paid live-in caregiver to bypass the EVV edits.
EVV Implementation for Innovations and TBI Waivers Administered by LME-MCOs
NC Medicaid implementation of EVV for the Innovations Waiver, TBI Waiver and (b)(3) services administered by the LME-MCOs has been moved to June 30, 2021. This new date is to allow for additional testing and provider training.
Providers should continue to work with the applicable LME-MCOs to prepare for the June 30, 2021, EVV implementation date for Innovations Waiver, TBI Waiver and (b)(3) services administered by the LME-MCOs.
EVV Implementation for Managed Care Pre-Paid Health Plans
NC Medicaid Implementation of EVV for Managed Care Pre-Paid Health Plans begins on July 1, 2021. The State will allow the PHPs the flexibility to have a 'soft launch' for EVV from July 1, 2021 – Aug. 31, 2021.
Providers who submit PCS encounters that are not validated through EVV can still be paid for dates of
service between July 1, 2021 – Aug. 31, 2021. The PHPs would then work with those providers to validate all PCS claims with a date of service between July 1, 2021 – Aug. 31, 2021, through the EVV no later than Sept. 30, 2021.
Please note, NC Medicaid will relax EVV edits within the Encounter Platform System (EPS) to be informational only from July 1, 2021 through Sept. 30, 2021 to allow the PHPs to submit encounters during this period without EVV data. PHPs will be required to submit all EVV data for encounters through Aug. 31, 2021 by Sept. 30, 2021. Starting Sept. 1, 2021, all PCS encounters should be validated via the PHPs’ EVV.
Quick Help Tips and Resources
Q. Will an incorrect address or telephone number in Sandata’s EVV portal prevent a submitted claim from paying?
A. An incorrect address or telephone number will not prevent visits entered in the Sandata system from moving to a verified status in the Sandata portal. All verified visits will be transmitted to NCTracks for EVV validation to assist with claims adjudication. Address/GPS and telephone numbers are not data fields that are received or validated at the time.
Q. Can an update be made to the beneficiary address or telephone number in Sandata’s EVV portal?
A. The beneficiary address or telephone number cannot be modified, nor can another address or telephone number be added to the beneficiary profile in the Sandata system. To initiate an update of the address or telephone number in Sandata’s EVV portal, the beneficiary must contact their local Department of Social Services. The local DSS must update the address and telephone number in the NCFAST system which will transmit the newly updated address and telephone number to the beneficiary profile in Sandata’s EVV.
Q. What are NC Medicaid EVV Visit Exceptions?
A. Visit exceptions occur when the EVV system identifies that a program-defined issue exists for a visit. When this occurs, an agency user with the appropriate visit maintenance security privileges is able to document missing or incorrect data for the visit or acknowledge that the exception occurred and resolve it. For more information and a listing of EVV visit exceptions see the NC DHHS EVV Supplemental Training Guide.
Q. How will providers document deviations from the service plan? Will a paper timesheet and POC still be needed for licensure requirements?
A. Providers will continue to document deviations from the service plan/plan of care (POC) utilizing their current aide documentation practices. POC licensure requirements remain the same. Providers are to adhere to clinical coverage policy for the Medicaid service plan/POC requirements.
Please visit the EVV Webpage for all EVV updates including EVV Medicaid Bulletins, Provider Training and Stakeholder Meetings and Frequently Asked Questions.
Sandata Customer Support Team:
For assistance with Training, Welcome Kits, etc.
NCCustomerCare@Sandata.com or 855-940-4915
Alternate EVV Support:
NCAltEVV@Sandata.com or 844-289-4246