Reporting Electronic Visit Verification (EVV) Data for Three Payer Types
The State solution for EVV and aggregation is Sandata. Use of the Sandata EVV solution is free to providers who capture visits for NC Medicaid beneficiaries receiving services through NC Medicaid Direct, previously known as fee-for-service.
The aggregator is free for all providers who have selected an alternate EVV vendor (Alt EVV vendors) to submit visit data for NC Medicaid Direct beneficiaries, Local Management Entity/Managed Care Organizations (LME/MCOs) and Prepaid Health Plan (PHP) members.
On July 1, 2021, use of EVV began for all payer types (NC Medicaid Direct, LME/MCOs and PHPs). For personal care services (PCS) subject to EVV with a soft launch initiative for the LME/MCOs and PHPs, refer to the Medicaid Bulletin dated June 28, 2021, for more details. All providers subject to the EVV mandate must work with an EVV vendor to begin reporting the five mandatory EVV components (clock in, clock out, type of service, the person receiving the service and the person rendering the service) during in-home visits for each payer type.
Separate EVV solutions will be used for each payer type to capture in-home visit data for PCS subject to the EVV mandate. All the EVV data collected from each EVV vendor payer type will flow through the Sandata aggregator for a full compilation of visit capture history to measure North Carolina’s compliance with the 21st Century Cures Act.
The three payer types are listed below with an overview of the availability of solution options. Each NC Medicaid provider must comply with the individualized payer type addendum to capture and report their EVV visit data. Providers are required to check the eligibility status of each of their assigned Medicaid beneficiaries before claim submission. Medicaid eligibility can be checked in the NCTracks provider portal using the NCTracks Recipient Eligibility Verification Tool.
Providers can check the managed care enrollment and the assigned pre-paid health plan (PHP) for their assigned beneficiaries in the NCTracks Provider Portal in the Benefit Plan Field.
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Payer Types |
EVV Solutions |
Integrating All EVV Data |
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NC Medicaid Direct |
The solutions listed below are only available for use with NC Medicaid Direct provider claims subject to EVV.
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Sandata free solution will only manage NC Medicaid Direct personal care visits. To integrate all payer types in one solution, provider must use:
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LME/MCOs |
The solutions below are only available for use with providers submitting LME/MCO claims for PCS subject to EVV.
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HHAexChange free solution manages LME/MCO personal care visits. To integrate all payer types in one solution, providers must use:
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PHPs |
The solutions below are only available for use with providers submitting PHP encounters for PCS subject to EVV.
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HHAexChange free solution manages PHP personal care visits. To integrate all payer types in one solution, providers must use:
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PHPs Soft Launch Instructions
Providers authorized to render PCS subject to EVV through the PHP payer type are required to complete their credentialing, testing or account setup before Aug. 22, 2021, to begin capturing and reporting the minimal EVV visit data. This will help identify system integration issues and other claim denial issues ahead of the non-negotiable statewide EVV implementation date of Sept. 1, 2021.
NC Medicaid permitted a soft launch period from July 1 through Aug. 31, 2021, to allow acclimation to this transition without financial penalty. During the soft launch period, the PHP will provide training opportunities and technical support assistance to ensure all providers have an account to capture EVV visit data prior to Sept. 1, 2021. The soft launch period involves:
- EVV claims submitted by providers with dates of service July 1 through Aug. 31, 2021 may be processed without EVV data being applied.
- The plan must submit the claims to the Encounter Processing System (EPS) by Sept. 30, 2021, and assuming everything else is correct, the claim will be accepted with informational EVV business rules being triggered.
- Personal care claims subject to EVV with dates of service Sept. 1, 2021 forward MUST contain EVV data.
- Starting Oct. 1, 2021, ALL encounters for personal care claims must contain EVV data, regardless of the date of service.
LME-MCO Instructions
Implementation of EVV for the Innovations Waiver, Traumatic Brain Injury (TBI) Waiver and (b)(3) services administered by the LME-MCOs is Aug. 31, 2021. NC Medicaid permitted this Aug. 31, 2021, soft launch to allow acclimation to this transition without financial penalty.
During the period prior to Aug. 31, 2021, LME-MCOs will continue to provide training opportunities and technical support assistance to ensure all providers have an account to capture EVV visit data by Sept. 1, 2021. The soft launch period involves:
- EVV claims submitted by providers with dates of service July 1 through Aug. 30, 2021, may be processed without EVV data being applied.
- Services subject to EVV with dates of service Sept. 1, 2021, forward MUST contain EVV data.
EVV Stakeholder Meeting and Technical Support Webinar – Aug. 25, 2021
To ensure all enrolled NC Medicaid providers subject to the EVV requirements are 100% compliant with this mandate, a technical support webinar will be held on Aug. 25, 2021, at 1 p.m. This technical support webinar is for all agencies, but most importantly for agencies that have not integrated with an EVV vendor, logged visits, or logged very few visits to capture the six required EVV data points specified in the 21st Century Cures Act.
Increase in Personal Care Rates
The Centers for Medicare and Medicaid Services (CMS) approved North Carolina State Plan Amendment to increase PCS Medicaid rates by 10% above the rate in effect. This increase is mandated by Section 12006 1903(1) of the 21st Century CURES Act. Effective Jan. 1, 2021, in adherence to EVV, payment for PCS reimbursement shall be increased by 10% above the rate in effect per 15-minute increment.
The State Plan PCS rates were updated in the NCTracks system on June 24, 2021, and the Community Alternatives Programs for Children (CAP/C) and Disabled Adults (CAP/DA) on June 26, 2021, with a retroactive date to Jan. 1. 2021. Providers can complete an adjustment to previously submitted claims to receive the newly increased 10% rate.
Follow the instructions provided in the NCTracks provider portal to initiate an adjustment claim to recoup the 10% rate increase dating back to Jan. 1, 2021. To ensure all impacted providers receive the 10% rate increase, NC Medicaid will perform a reprocessing effort. This effort will update all provider claims dating back to Jan. 1, 2021 through June 24 (PCS) or June 26 (CAP/DA) to apply the 10% rate increase and add missed EVV history data to each claim. This processing effort is complex due to the number of claims that must be adjusted. The anticipated timeline of completion is near the end of 2021.
EVV Visit History Tool in the NCTracks Provider Portal
The NCTracks provider portal offers NC Medicaid Direct providers the opportunity to check their EVV visits before submitting their claims to mitigate pended claims due to error code 784 (EVV edits 02077 or 02079),click here to learn more about error code 784.
- In the provider portal, click on prior approval and search for EVV visit history.
- Visits can be searched by entering your NPI and the date range.
- When using those search criteria, all verified visits recorded in the Sandata aggregator will show for the period selected.
- Visits can be searched by entering the MID and NPI and date range.
When using those search criteria, all verified visits recorded in the Sandata aggregator with that MID will show for the period selected. Using this tool will assist with identifying how to correct visit information to ensure the visits appear in the aggregator as verified before submitting a claim.
Providers who experience denied claims specific to error code 784 for EVV edits 02077 or 00279 may request a hardship advance by sending an email to Medicaid.hardships@dhhs.nc.gov. In the body of the email, include contact information, NPI, date of service that is impacted, and bullet points to explain the financial hardship.
Sandata July 9, 2021 Releases - Alt EVV
On July 9, 2021, Sandata updated its system to update exception codes, new program/service codes for PHPs and LME/MCOs, employee segment requirements, the client qualified and client ID qualified fields. On or after July 9, 2021, visits that are submitted in the aggregator that do not comply with the latest releases will be rejected. The Alt EVV vendor will need to update their system to align with the Sandata release functionality. Information about the system changes can be found in the addendum on the NC Medicaid EVV webpage under Provider Resources and Service Codes.
Technical Assistance Contacts
Sandata Customer Support Team:
855-940-4915 or NCCustomerCare@Sandata.com
EVV Policy Questions:
919-855-4360 or Medicaid.EVV@dhhs.nc.gov
Sandata Alternate EVV Support:
844-289-4246 or NCAltEVV@Sandata.com
HHAexChange customer support:
https://hhaexchange.com/contact-us/ or 855.400.4429
Carebridge Customer support questions:
844-772-7338 or support@carebridgehealth.com
AmeriHealth Caritas of North Carolina:
https://www.amerihealthcaritasnc.com/provider/forms/index.aspx
Blue Cross and Blue Shield of North Carolina | Healthy Blue:
https://provider.healthybluenc.com/north-carolina-provider/resources
Carolina Complete Health:
https://network.carolinacompletehealth.com/content/dam/centene/carolinacompletehealth/pdfs/Carolina%20Complete%20Health-%202020%20Provider%20Billing%20Manual.pdf
United Healthcare:
https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/NC-UHCCP-Care-Provider-Manual.pdf
WellCare of North Carolina:
https://www.wellcare.com/en/North-Carolina/Providers/Medicaid/Claims
NC Medicaid:
https://medicaid.ncdhhs.gov/providers/claims-and-billing
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