Electronic Visit Verification - General Stakeholder Meeting June 15, 2021
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Electronic Visit Verification
General Stakeholder Meeting
June 15, 2021
1Our Mission
Improving health care equity, access
and outcomes for the people we serve
while saving Coloradans money on
health care and driving value for
Colorado.
2WELCOME Stakeholders
• HCPF Introductions
• Housekeeping
3The purpose of this meeting is to engage
providers, members, other stakeholders, and
the Department as we all work to implement
EVV for EVV-required services.
Meeting And specifically to:
Purpose • Clarify EVV in Colorado
• Discuss EVV Program Updates
• Provide a platform to gather stakeholder
feedback
4We ask that you:
• Mind E-manners
• Identify yourself when speaking
Meeting
Guidelines • Share the air
• Listen for understanding
• Stay solution and scope focused
5Overview of EVV
EVV Communications
Non-Utilizer Claims Suspense Notice
Agenda Updated 3rd Party Addendum
Best Practices Release
Call Center Report
Open Forum
6EVV Brief Overview
7• Electronic Visit Verification (EVV) is a
technology solution that verifies service
provision through mobile application,
telephony, or web-based portal.
• EVV is used to ensure that home or
What is community-based services are delivered to
EVV? people needing those services by
documenting the precise time service
begins and ends, and ensure caregivers are
paid for time and efforts
8TYPE OF SERVICE INDIVIDUAL DATE OF THE
PERFORMED RECEIVING THE SERVICE
What must SERVICE
EVV Capture?
LOCATION OF INDIVIDUAL TIME THE SERVICE
SERVICE DELIVERY PROVIDING THE BEGINS AND ENDS
SERVICE
9• EVV services happen in the home and in
the community.
Service • Capture location where the service occurs,
including telehealth.
Location
• EVV does not disrupt this flexibility of
service location.
10Colorado provides an EVV Solution (State EVV
Solution) free of charge.
State EVV Providers also have the option to use an
alternate EVV system (Provider Choice EVV
Model: System) if it correctly interfaces with program
rules and requirements.
Open/Hybrid
Providers are responsible for the correct use
and transmission of EVV data.
11• Verified Visit: A verified visit does not
contain any exceptions, meaning either no
exceptions exist, or they have been fixed,
making the visit eligible for claim
matching.
Key Terms
• Incomplete Visit: A visit is considered
Incomplete if it requires manual
intervention before it can be considered
closed, completed, or verified.
12• Sandata Provider Portal - the web-based
administrative tool used to manage EVV
activity, add Manual Visit Entry data
elements, and to monitor all activity
Key Terms recorded in the State EVV Solution.
• Data Aggregator is the read-only portal for
Provider Choice System users.
13• Remittance Advice (RA): RA contains a
weekly summary of all claims submitted
and is available the Monday following the
end of the claim submission cycle.
Key Terms • Explanation of Benefits (EOB) 3054:
Informational message on provider-specific
RA designating that a claim billed with an
EVV-required code does not have a
corresponding and verified visit recorded
through an EVV system.
14EVV Communications
15Email Addresses Out of Date
• Provider’s responsibility to ensure email address on file is up to date in Gainwell
Provider Portal
• Has caused delays due to credentials or communications being sent to out-of-date
email addresses
• Service Location Email Address – eTrac Credential Info sent and EVV communications
• Full instructions on how to update email address can be found in How to Update
Provider Email Address at Gainwell Technologies
• Contact Gainwell for email updates and confirmation that an email has been
correctly updated. Remember to note the Application Tracking Number (ATN) that
you receive
16Compliance Communications
• Continuing use of EVV Report Cards
• Suspense Notice
Require submission of Verified EVV by non-utilizing providers by June 24, 2021
Accidentally billing EVV-required services can put you on list
• Department continuing to monitor EVV utilization rate. Date for claim edit to go-live
not yet determined.
Announcement for go-live date coming soon
17EVV Report Cards
• Monthly educational emails sent by the Department to offer insights into EVV
performance.
• Data based on all claims that were paid for that respective month.
• Contains past 4 months' pay rate percentage, dollar amount to pay, plus infographic
with tips on improving performance.
• "Pay rate" - Claims expected to pay once claim edit is active because they have
matched to verified visits.
• Emails sent from EVV inbox to Service Email Address on file.
18EVV Report Cards
19EVV Claim Suspension for Non-Utilizers
• Operational Memo 21-044 Released June 14, 2021
• Outlines claim suspension process for non-utilizing providers
• Timeline, criteria, exclusions, and actions required
• Department has directly outreached non-utilizing providers with additional
information and support options.
• Result of multiple outreach efforts to providers with no change in status as a non-
utilizer
20Suspense Criteria
• Non-utilizing provider: A provider agency that is required to collect EVV but has
not submitted any verified EVV records prior to claim submission between
January 1, 2021 and June 24, 2021.
• Verified EVV record: EVV data that includes all six points of mandatory data and
successfully transmits to the Data Aggregator.
• Verified visits can be viewed in the Data Aggregator
21Action Needed
• Providers are expected to utilize EVV for all EVV-required claims immediately
• To avoid suspension of claims, non-utilizing providers must begin submitting EVV
records by June 24, 2021
• Claim suspension will begin July 2, 2021
• Suspended claims will show as EOB 3090 “Billing provider under review - suspend all
claims” in Remittance Advice
• Providers with claims suspended for non-utilization will have the suspension removed
once EVV records are submitted
22Suspense Exclusions
• Providers utilizing EVV and who have submitted verified visits – no action required
and will NOT experience any disruption in payment
• New providers who have enrolled and began billing for EVV required services within
the last month
• Non-utilizing Providers who are experiencing system issues that require Department
escalation and resolution
23Provider Choice Reminder
• Emails sent to those using Provider Choice Systems.
• If experiencing significant delays or uncertainty when able to successfully perform
EVV – recommend switching to State EVV Solution.
• It is a provider’s responsibility to ensure all visits recorded in vendor’s technology
are successfully sent to Sandata and verified in the Data Aggregator.
• If visits not appearing in the Data Aggregator, providers should work with their EVV
vendor to ensure visits are being sent.
24Provider Choice Notice
• Agencies using the State EVV Solution often have easier transition and
experience fewer obstacles in implementing EVV.
• Approximately 30% higher compliance rates than agencies using Provider Choice
Systems.
• Consider temporarily or permanently switching to the State EVV Solution.
• See Switching EVV Technologies Guidance that outlines how to switch to and from
State EVV Solution.
25Questions
26General EVV Updates
27Updated Addendum
• Colorado HCPF Third Party EVV - Companion Guide (Addendum) to Alternate EVV
System Specification - Found on the Resources page under Provider Choice Materials
section
• This addendum does not impact claim processing and does not require any action
from the provider
28Updated Addendum
• Section 2:
Added Visit Status definitions (in process, incomplete, verified, and omit)
Required Segment Definitions, Required Field Definitions
Required Call Elements for manually entered visits
Clarification on adjusted time entries and Visit Changes Segment
Clarification on required location
Clarification on multiple Medicaid IDs and the "EntityGuid" header
29Updated Addendum
• Appendix 3:
Added information to the description for reason codes 15 and 16
• Appendix 4:
Added information to Appendix 4: exceptions for acknowledgment of an exception
Additional information added for exception code 41 “location required”
• Appendix 9 (New Appendix):
Additional technical information for the Sandata OpenEVV Alt-EVV APIs
Section contains sample data
30Website Updates
• Merged Overview and
Implementation Pages
• Merged State Solution and
Provider Choice Pages
• Added New Provider Page
• EVV Program Manual now on
homepage
31New Provider Page
32Questions
33EVV Best Practices
34Best Practices Overview
• Information intended to provide technical guidance and help program providers and
FMS vendors avoid EVV claim mismatches
• Information intended to help boost EVV knowledge and EVV performance
• 3 Main Sections
Prior to Claim Submission
After Claim Submission
Additional Tips
35Best Practices Overview
• Prior to Claims Submission – Collecting EVV, addressing exceptions, and verifying
visits
• After Claim Submission – Review claims for error, updating visits related to errors,
and rebilling/reprocessing
• Additional Tips – Group visits, poor internet/cell service, billing errors, and
additional resources
• Found on Resources page and New Provider Overview Page
36Questions
37EVV Program Updates:
Past Week Sandata Call Center
Report
38Call Center: Calls Answered
46 Total Calls 100% Answered
46 Presented / 46 Answered 0% Abandoned
39Call Times: What To Expect
Wait Time for a Call Representative Time With a Call Representative
21.80 Seconds 12.70 Minutes
40Open Forum
41General Stakeholder Open Forum
Questions on • Unmute self press *6
the phone • Share the air
Questions in • Type questions directly into
the Q&A the chat box
• Encrypt PHI and PII
Email • evv@state.co.us
42EVV Recurring Meetings
General • Third Tuesday of the month
• Next Meeting: July 20, 2021
Stakeholder • 10:30 am - 12:00 pm
EVV CDASS
• Next Meeting: June 22, 2021
Compliance • 10:00 - 11:00 am
Protocol
• First Thursday of the month –AND- the Thursdays following
Listening the EVV General Stakeholder Meeting
Sessions • Next Meeting: June 17 and July 1, 2021
• 10:00 - 11:00 am
Email evv@state.co.us for a calendar invite
43EVV Listening Sessions
• Informal setting for questions and discussions about EVV, like EVV Office Hours
• Open for all to participate
• First Thursday and Thursday following General Stakeholder Meeting of each month
• Google Meet link: meet.google.com/zcx-ytsv-bwa
• Toll Free Phone Number: +1 208-715-5308 / PIN: 438 295 119#
• Available on the Department’s EVV website under Stakeholder Information
44CDASS Compliance Protocol
Subcommittee
• Work group to gather stakeholder feedback to help guide CDASS EVV Compliance
Protocol
• Audience: Self-directing programs
• Next meeting: June 22, 2021, 10:00 - 11:00 AM
• Google Meet link: meet.google.com/ovb-bjxq-sda
• Toll Free Phone Number: +1 302-404-6610; PIN: 841 380 464#
• Available on the Department’s EVV website under Stakeholder Information
45EVV Resources
46EVV Support Pathways
Pathway Method Purpose Prepare Before Contacting Expected Initial Response
Time
EVV Help Desk 1-855-871-8780 Using State EVV Solution, Nothing needed Phone: As soon as
interfacing Provider connected
COCustomerCare@sandata.com Choice Systems, Sandata
trainings, EVV accounts Email: within two business
days
Gainwell (Billing) 1-844-235-2387 Provider billing or claims Review EVV Program As soon as connected
Help Desk processing questions Manual: Provider Medicaid
ID, ICN, and Visit ID
Information
EVV@state.co.us Dept. approval of Live-in Live-in Caregiver Within a week
HCPF EVV Inbox Caregiver exemption, Documentation for review,
Policy and Program Help Desk documentation
answers, Escalations from (Call number, who you
other support methods talked to, etc.)
Stakeholder Feedback Complete the EVV Feedback Form Allow members, Nothing Needed Within a week
or contact Jordan Larson, EVV caregivers, and
Policy, Mon-Fri 8 AM-4 PM at stakeholders to provide
303-866-3580 the Department with
feedback related to EVV
47Contact Information
EVV@state.co.us
Department's Distribution Lists Sign-Up page
Click the "Electronic Visit Verification Stakeholder Group"
hcpf.colorado.gov/evv
48Thank you!
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