Medicaid Electronic Visit Verification (EVV) Reminders
Date: 05/05/21
Pursuant to Section 1903 of the Social Security Act (42 U.S.C. 1396b), also known as the 21st Century Cures Act, in order to prevent a reduction in the Federal Medical Assistance Percentage (FMAP), AHCCCS was mandated to implement Electronic Visit Verification (EVV) for non-skilled in-home services (attendant care, personal care, homemaker, habilitation, respite) and for in-home skilled nursing services (home health). As a result, AHCCCS required EVV for personal care and home health services beginning January 1, 2021.
Please review the tables below. If your agency is registered with AHCCCS as one of the provider types listed and you deliver any of the services listed in any of the locations listed you are subject to EVV and required to participate.
| Provider Description | Provider Type |
|---|---|
| Attendant Care Agency | PT 40 |
| Behavioral Outpatient Clinic | PT 77 |
| Community Service Agency | PT A3 |
| Fiscal Intermediary | PT f1 |
| Habilitation Provider | PT 39 |
| HomeHealth Agency | PT 23 |
| Integrated Clinic | PT IC |
| Non-Medicare Certified HomeHealth Agency | PT 95 |
| Private Nurse | PT 46 |
| Service | HCPCS Service Codes |
|---|---|
| Attendant Care | S5125 |
| Companion Care | S5135 |
| Habilitation | T2017 |
| HomeHealth Services (aide, therapy, and part-time/intermittent nursing services) | |
| Nursing | G0299 and G0300 |
| Home Health Aide | T1021 |
| Physical Therapy | G0151 and S9131 |
| Occupational Therapy | G0152 amd S9129 |
| Respiratory Therapy | S5181 |
| Speech Therapy | G0153 and S9128 |
| Private Duty Nursing (continuous nursing services) | S9123 and S9124 |
| Homemaker | S5130 |
| Personal Care | T1019 |
| Respite | S5150 and S5151 |
| Skills Training and Development | H2014 |
| Place of Service Description | POS Code |
|---|---|
| Home | 12 |
| Assisted Living Facility | 13 |
| Other | 99 |
- Providers subject to EVV are required to complete training with Sandata, the AHCCCS EVV Vendor, or an *alternate vendor. The training must be completed by the identified EVV Administrator or Key Contact. This must occur immediately so please register, complete the required training and receive your welcome kit to begin the EVV process.
*Visit Alternate EVV System Requirements and Technical Specifications for more information about alternate vendors at: https://www.azahcccs.gov/AHCCCS/Initiatives/EVV/. - If your EVV Administrator or EVV key contact has changed it’s IMPORTANT to report the change to Sandata by calling 855-928-1140. Please make sure your current EVV Administrator key contact on file is correct.
- For more information regarding the required Sandata training, visit this link to sign-up: https://www.sandatalearn.com/?KeyName=AZEVVagency.
- The authorization process will not change. For those services subject to EVV for which Arizona Complete Health-Complete Care Plan (AzCH-Complete Care Plan) requires prior authorization, we will continue to review and respond to your requests as we do today. Authorizations will be automatically uploaded to Sandata for providers to view. PLEASE NOTE: Prior to billing for services that require prior authorization, you must enter the visit information into Sandata or another *alternative vendor system.
- For services for which we do NOT require prior authorization, you must enter the visit information into the AHCCCS Service Confirmation Portal. The AHCCCS Service Confirmation Portal training is found here: https://www.youtube.com/embed/TNm3HOgRfHc .
EVV Claims Denials
- We are currently allowed to apply soft claim edits, meaning we use specific codes on the Explanation of Payment to notify you the service is subject to EVV. AzCH-CCP will provide you as much notice as we can regarding when the soft claim period will end. We also encourage you to sign up for the AHCCCS Constant Contact email notification list receive updates on recent developments for the EVV initiative. To subscribe, click on the link below or copy and paste it into your browser:
https://visitor.r20.constantcontact.com/manage/optin?v=001gF-kjPbNwUkjAeak65PHSgLUZfF69ZO6RXBCAAbHv8heAcaheQ_-WfduMQGsN3O2op25HcUg5yFMkioRyBg0yyW6i9m3UkjG6trezpL0LRs%3D - Providers subject to EVV that do not participate after the soft-claim edit period has expired will not be reimbursed for the services they deliver.
- We’ve established two EVV denial codes that we are using during the soft-claim edit period.
- EX8i - DENIAL WOULD BE APPLIED IF NOT VERIFIED THROUGH EVV VISIT VERIFICATION
- EX8h - NO EVV VISIT MATCH FOR MEDICAID ID
- AzCH-Complete Care Plan Provider Engagement Specialists are currently outreaching providers to remind them of the EVV requirements and assist with compliance prior to the soft-claim edit period ending.
- AHCCCS has developed a number of FAQs to assist providers with the EVV process. Please visit the below for more information on the EVV process and requirements.
ADDITIONAL INFORMATION
If you have questions regarding the information contained in this update, please feel free to contact our Provider Customer Service Center (866-796-0542). If you need your assigned Provider Engagement Specialist contact
information, please email us at: AzCHProviderEngagement@azcompletehealth.com.