Electronic Visit Verification

Electronic visit verification (EVV) is a computer based system that electronically documents and verifies service delivery information for certain Medicaid service visits. EVV helps prevent fraud, waste and abuse, while making sure Medicaid recipients receive care that is authorized for them.

Dell Children’s Health Plan complies with all of HHSC’s EVV policies and procedures.

Notice of New EVV Procedures

In accordance with HHSC direction, Dell Children’s Health Plan will allow all EVV providers to submit EVV claims directly to HHSC beginning June 1, 2023. Dell Children’s Health Plan will adjudicate the HHSC EVV claims with the EVV07 bypass. For more information, please see HHSC EVV webpage.

Why is EVV required?

The 21st Century Cures Act (Section 12006), or Cures Act, is a federal law passed in 2016 requiring states to implement EVV for Medicaid personal care services (PCS) and home health care services (HHCS) that require an in-home visit. States that do not implement EVV will receive reduced federal Medicaid funding.

Programs and Services required to use EVV:

Programs and services required to use EVV are defined in HHSC Texas Administrative Code Section 354.4005, Applicability.

A summary of the personal care services required to use EVV is available on the HHSC EVV webpage.

3100 EVV Service Bill Codes

The EVV Service Bill Codes Table provides current billing codes for EVV relevant services in long-term care, acute care and managed care programs.

Program providers must use the appropriate Healthcare Common Procedure Coding System (HCPCS) and modifier combinations in the EVV Services Bill Codes table to prevent EVV visit transaction rejections and EVV claim match denials.

Personal Care Services

EVV Policies & Procedures

This section provides EVV policies and procedures specific to Dell Children’s Health Plan and HHSC. We comply with all of HHSC’s EVV policies and procedures.

HHSC EVV Provider Policy Handbook
EVV Compliance
EVV Quarterly Provider Compliance Review
EVV Claim Adjustments and Recoupment Policy & Procedure Guide
EVV Complaints and Appeals

EVV Training & Education

The HHSC EVV Training Policy requires program providers, FMSAs, service providers, CDS employers and any staff who performs EVV system operations, to complete required EVV training before using an EVV vendor system or an EVV proprietary system and yearly thereafter.

EVV Visit Maintenance Unlock Request

An EVV Visit Maintenance Unlock Request allows a program provider, FMSA and CDS employer the opportunity to correct data element(s) on an EVV visit transaction(s) after the visit maintenance time frame has expired.

Program providers, FMSAs and CDS employers must follow the instructions on the EVV Visit Maintenance Unlock Request spreadsheets. Request emails must include a contact name, email address and phone number. Requests that are not sent securely could result in a Health Insurance Portability and Accountability Act (HIPAA) violation and the payer will deny the request.

Dell Children’s Health Plan follows the HHSC EVV Maintenance Unlock Request process:

EVV Alerts

This section provides EVV alerts on changes or updated information specific to Dell Children’s Health Plan and HHSC.

2024

2023

EVV Complaints and Appeals

Service providers wishing to file a complaint should reference this document: EVV Complaints and Appeals

Service providers may send their complaints to shpproviderservices@seton.org

EVV Support & Additional Resources

Dell Children’s Health Plan Provider Customer Services: shpproviderservices@seton.org