AdministrativeMedicaidMedicare-Medicaid PlanJune 1, 2023

EVV Practice Period for Home Health Care Service Implementation

Beginning January 1, 2024, Amerigroup in Texas became Wellpoint. This article, published under the former brand, now applies to Wellpoint.

EVV home healthcare service implementation

The 21st Century Cures Act or Cures Act requires states to implement electronic visit verification (EVV) for home healthcare services (HHCS) by January 1, 2023. On July 1, 2022, the Texas Health and Human Services Commission (HHSC) submitted a good faith effort exemption from the Centers for Medicare & Medicaid Services (CMS) to extend this deadline by one year. CMS approved the request; therefore, HHSC and Amerigroup will implement EVV for Medicaid HHCS on January 1, 2024.

The information below provides a timeline for the EVV Practice Period for the home healthcare services that will be required to use EVV starting with date of service on and after January 1, 2024. It is vital for providers to fully understand the timeline and to begin to implement EVV in preparation for the start date.

The information in this notice pertains to all providers and financial management services agencies (FMSAs) that currently submit claims with a place of service, or type of bill is home for the procedure codes and modifier combinations listed on pages 4 to 9.

New EVV users

If your organization is currently not using an EVV system, the practice period for using an EVV system will include dates of service October 1, 2023, through December 31, 2023. During this practice period, claims for HHCS EVV services will not deny if they do not have a matching EVV visit transaction. Please email the new EVV Vendor for Texas, HHAeXchange at TXsupport@hhaexchange.com to get information about the onboarding process. Unless your organization has been approved by HHSC to use an EVV Proprietary System or have been approved for one of the Proprietary System Operator (PSO) onboarding path sessions.

Current EVV users

Effective October 1, 2023, HHSC is transitioning from two EVV vendor systems, DataLogic/Vesta and First Data/AuthentiCare, to a new single state-funded EVV vendor system provided by HHAeXchange.

By October 1, 2023, program providers, financial management services agencies (FMSAs), Consumer Directed Services (CDS) employers, and service providers using the current EVV vendor systems (DataLogic/Vesta or First Data/AuthentiCare) must transition to HHAeXchange if they are not approved to use a proprietary system. This means completing EVV training requirements and EVV system onboarding by October 1, 2023.

For more information about the transition, please visit the Amerigroup EVV website and review the EVV Vendor Transition Overview document posted under the EVV Alerts section.

Claim submission for EVV HHCS services

For dates of service June 1, 2023, through November 30, 2023, all providers and financial management services agencies (FMSAs) may submit their HHCS EVV claims to the HHSC Claims Administrator: Texas Medicaid & Healthcare Partnership (TMHP). The HHSC Claims Administrator will forward the claim to Amerigroup with the EVV match result code EVV07 confirming a bypass to the EVV claim matching process. Amerigroup will adjudicate the HHCS EVV claims and will not deny the claims due to an EVV mismatch. However, claims may deny for other reasons not related to EVV.

Cutover date for EVV HHCS claim submission

Providers and FMSAs must submit all HHCS EVV claims electronically to the HHSC Claims Administrator starting with dates of service on or after December 1, 2023. Amerigroup will reject any HHCS EVV claim back to the provider directing them to submit the claim to the HHSC Claims Administrator.

For information on how to submit electronic claims directly to the HHSC Claims Administrator, please visit the TMHP EDI Home page: https://www.tmhp.com/topics/edi. This website has user guides, forms, and technical information intended for billing agents that submit electronic claims for providers and FMSAs.

For more information on the EVV Claims Submission Policy, please visit the HHSC EVV Policy Handbook and refer to the entire section — 12000, EVV Claims: https://hhs.texas.gov/handbooks/electronic-visit-verification-policy-handbook.

EVV claims matching for EVV HHCS services

For dates of service between June 1, 2023, and December 31, 2023, providers and FMSAs that submit their HHCS EVV claims through the HHSC Claims Administrator will receive both an informational EVV claims match result (EVV07) and an actual claims match result (EVV01 through EVV06) for HHCS EVV claims. The actual claims match results and the informational claims match results will be viewable in the TMHP EVV Portal. During this time, all HHCS EVV claims received by the HHSC Claims Administrator will be forwarded to Amerigroup with an EVV07 match code. Amerigroup will not deny the claims with EVV07 for EVV related reasons during this period.

For dates of service on or after January 1, 2024, the EVV aggregator will begin sending the actual match result for HHCS EVV claims to Amerigroup, and Amerigroup will process the claims accordingly (in other words, deny claims that receive EVV02 – EVV06 match codes due to an EVV mismatch).

For more information on the EVV Claims Matching Policy please visit the HHSC EVV Policy Handbook and refer to the entire section — 12000, EVV Claims: https://www.hhs.texas.gov/handbooks/electronic-visit-verification-policy-handbook.

EVV resources:

If you have questions about EVV or the information in this notice, please send an email to TXEVVSupport@amerigroup.com.

EVV HHCS
procedure codes and modifier combinations

The procedure code and modifier combinations listed in the tables below pertain to the services under the Medicaid programs Amerigroup manages. To see all electronic visit verification (EVV) for home healthcare services (HHCS) procedure codes and modifier combinations impacted by the Cures Act HHCS EVV implementation, please refer to the EVV HHCS Service Bill Table:

TXAGP-CDMMP-025868-23