electronic visit verification (evv) · evv is the electronic verification and documentation of...
TRANSCRIPT
Provider Training
ELECTRONIC VISIT VERIFICATION (EVV)
H8423_MCDTX_18_69242_PR Approved
EVV is the electronic verification and documentation of visit data, such as the date and
time the provider begins and ends the delivery of services, the attendant, the recipient,
and the location of services provided.
• Services that require EVV:
– Personal assistance services
– Personal care services
– PAS Protective Supervision
– In-home respite services
– Community First Choice - Personal assistance services and habilitation
Note: Consumer Directed (CDS) Service and Service Related Option (SRO) Providers
are optional.
Electronic Visit Verification (EVV)
2 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
– EVV works with the member’s home landline or an approved small alternative
device
– EVV is a telephone and computer-based system that verifies visits when services
has been rendered
– A small alternative device can be ordered from the vendor if a member does not
have landline or the member does not want the landline to be used
– HHSC approved vendors will provide training and technical support to the providers.
– EVV services are at no cost to the provider
How does EVV work?
3 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
– DataLogic (Vesta)
– All HHSC approved EVV vendors are directly contracted with Cigna-HealthSpring
(CHS) STAR+PLUS.
• EVV vendors and CHS should be notified of any system issues that last longer
than 48 hours.
• EVV vendors and CHS should be contacted immediately (within 48 hours) of
any EVV system issues that affect the ability of your attendant's or office staff to
use the system as expected.
DataLogic(Vesta) Software, Inc.
Phone: 1-844-880-2400
Fax: 1-956-412-1464
www.vestaevv.com
Which Vendor will provide EVV services?
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• Vendors are responsible for training providers on the use of their system.
• Vendors are responsible for providing technical support for their system. Contact
your vendor directly for training or support.
• Vendors must submit a monthly training list of Cigna-HealthSpring’s (CHS)
contracted providers to CHS.
• Vendors will not bill providers for the use of the equipment that is needed, their
service includes:
– Vendor provision of provider training
– Visit verification
– Customer assistance and support
– Interfacing
– Reporting
– Hardware (i.e. small alternative device)
– Software
– Any other additional costs the vendor will incur to perform all of the required
services and deliverables
Vendor Responsibilities
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• EVV reporting is done primarily through your selected vendor.
• Vendor has an integrated reporting tool for providers to use.
• Any requests for EVV reports should be directed to your vendor.
• Vendor is required to provide you reports of transaction activity.
• Vendor is required to provide you access to the standard EVV reports created by the
Texas Health and Human Services Commission (HHSC).
• Each provider is responsible for ensuring that their vendor is submitting accurate
data to Cigna-HealthSpring on their behalf prior to submitting claims.
Vendor Reports
6 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• Vendors will provide EVV data reports to providers upon request. Reports such as:
– EVV Visit Log
– Units of Service Summary Report
– Attendant Providing Services by Individual
– Provider Agency/Financial Management Services Agency (FMSA) List
– Contract List
– Alternate Device Order Status
– EVV Compliance Plan Summary
– EVV Compliance Plan Daily
– Reason Code Free Text
– Reason Code Use
– CDS Employee List
– Provider Compliance Alert Report
– Failed to Export Report
– Monthly Summary Reports
– Individual/Member Device Type Report
– Landline Phone Sampling Report
Vendor Reports, continued…
7 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• Providers will verify times of service using the vendor’s specified process.
• Providers must ensure all visit maintenance is completed prior to submitting claims.
• Providers are responsible for ensuring all required data elements match prior to
submission and are uploaded or entered into the EVV system completely, accurately
and in a timely manner.
• Providers that do not correct missing, incomplete or inaccurate data will experience a
lockout of the system after 60 days from date of service. A system lockout will prevent
agencies from completing timely visit maintenance until all required data is entered into
the system. Providers will retain limited system access until all necessary data is
addressed to completion.
• Providers must submit a request to CHS with an explanation, including supporting
documentation in order to unlock visit maintenance past 60 days. CHS will review and
make a determination if the visit will be reimbursed.
Provider Responsibilities
8 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• The following data elements must be entered accurately and completely in the EVV
system to identify:
– The provider agency: TIN (Taxpayer Identification Number)
– NPI (National Provider Identifier)
– API or TPI (if applicable)
– Provider legal name
– Provider address
– Provider city
– Provider ZIP
Provider Responsibilities, continued…
9 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
The following data elements must be entered accurately and completely in the EVV
system to identify, continued:
– The individual/member receiving services: Medicaid identification number
– First name
– Last name
– Date of birth
– Home telephone landline number(if applicable)
– Payor
– MCO HCPCS
– MCO modifier(s)
– MCO System Unique Member ID
– MCO Service Delivery Area of member's residence
Provider Responsibilities, continued…
10 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
The following data elements must be entered accurately and completely in the EVV
system to identify, continued:
– Employee providing services: Employee ID (Employer Assigned ID for HR/Payroll
purposes)
– Employee last four Social Security numbers or passport number
– Employee discipline (must be one of the following: attendant, nurse, CNA, PT, OT,
SLP, other)
– Employee first name
– Employee last name
– Employee start date (start date of employment with provider)
– Employee end date (end date of employment with provider) (if applicable)
– Additional data that is required, but will not result in system lock out. ◦Employee EVV
user ID (user ID used to conduct visit maintenance)
– Employee EVV user first name (EVV user name — first name of person associated
with EVV user ID)
– Employee EVV user last name (EVV user name — last name of person associated
with EVV user ID)
Provider Responsibilities, continued…
11 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• Ensure that authorization for services is in place prior to providing services to the
member. Only authorized and verified units of service will be paid. Any unauthorized
and/or unverified units will be denied and/or recouped.
• To avoid denials and/or delay in payment, claims for multiple dates of service (DOS)
should be billed on a separate line for each day with the number of units per day.
• CHS “highly recommended” billing on separate lines for each day, with the number of
units per day. (this will allow the provider to know exactly which date/unit was recouped
versus bulk billing and researching the information).
• Split shifts hours should be added together as a single claim DOS.
• Unit amounts can be billed in full or partial amounts.
• Units amounts will change – effective 12/1/2018, from 1 unit = 1 hour to 15 minute
increments = 1 unit (Example: 4 units = 1 hour).
Claims Process for EVV
12 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• If a claim fully denies:
– Review submitted data with your EVV vendor
– Review Failed to Export report from Vendor system
– Any changes to your data will need to be made by the provider agency into your
vendor system.
Note: Exception to the rule is, Visit Maintenance Unlock Request for scenarios outside
provider’s control - approval is at Cigna-HealthSpring’s discretion.
Claims Process for EVV, continued…
13 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
In order to unlock visit maintenance past 60 days, you must submit a request to CHS with
an explanation (include supporting documentation with your request). CHS will review
and make a determination.
Please send the completed form electronically from our website at:
http://starplus.cignahealthspring.com/evv
Click on the link ‘Electronic Visit Verification (EVV) Initiative Information’ on the
homepage to send a SECURE email to Cigna-HealthSpring Mailbox at
[email protected] with the following information:
• Provider Name Member Name
• Contact Number Medicaid ID
• NPI/TIN/Contract Number Dates you need to access
• EVV Vendor Name Explanation of why you need to unlock
Request to Unlock Visit Maintenance for Cigna-HealthSpring
(CHS)
14 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• Providers must use an HHSC approved reason code on visit maintenance EVV
transactions.
– As of December 1, 2016 there are 28 reason codes in the HHSC approved EVV
systems.
– 23 Preferred Reason Codes
– Five Non-preferred Reason Codes
– Providers must associate the most appropriate reason code with each change made
in visit maintenance and enter any required free text in the comment field.
– All reason codes allow a provider agency to enter free text in the comment field;
however, eight reason codes require specific information be entered in the comment
field.
– If the provider agency does not enter the required free text with the specified
information, the visit is subject to recoupment or denial.
Please refer to HHSC for up-to-date list and definitions at:
https://hhs.texas.gov/sites/default/files//documents/doing-business-with-
hhs/providers/long-term-care/evv/hhsc-reason-code.pdf
EVV Reason Codes
15 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• If Cigna-HealthSpring determines a provider agency has misused preferred reason
codes per policy, the provider agency compliance plan score may be negatively
impacted, and the provider agency may be subject to:
– Assessment of liquidated damages
– Imposition of contract actions
– Implementation of the corrective action plan process
– Referral for a fraud, waste, and abuse investigation
• For example, providers use a preferred reason code 100 when there is no call in or call
out. Providers can use the ‘Request to Unlock Visit Maintenance’ form available on our
CHS website at https://www.cigna.com/starplus/health-care-professionals/evv/
EVV Reason Codes, continued…
16 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
17
Payment Disputes
Payment Dispute Form
A payment dispute is a written communication (i.e. a letter) from the Provider about a disagreement with the
manner in which a claim was processed, but does not require a claim to be corrected and does not require
medical records.
The Payment Dispute Form is located on our website at:
https://www.cigna.com/static/docs/starplus/providers/payment-dispute-form.pdf
Examples of when to use the payment dispute form: (this is not a
complete list)
• Denial for “timely filing”, but provider has proof of timely
• Denial for “no authorization on file”, but provider has
authorization listed
• Denial for “misuse of EVV reason code(s)”
• Denial for “no coverage”, but member was active during the Date
of Service (DOS)
• Provider not being paid at correct reimbursement rate, paid
incorrectly
• Denial for incorrect modifier, CPT code, NPI/TIN/TPI, Place of
Service (POS), Date of Service (DOS), Diagnosis (DX) code,
etc. and denied incorrectly
• Denial for “no active provider contract” and provider does have
an active contract listed
• Denial for insufficient units, per authorization on file there’s units
available, or there’s no units available due to error on our end
• Denial for incorrect payment
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
• CHS will review all Electronic Visit Verification (EVV) claims and transactions submitted
with a dates of service April 1, 2016 and after. Any paid claims that do not have an
EVV associated transactions will be subject to recoupment.
• In addition, we want to reiterate, starting April 1, 2017 all providers must achieve a
quarterly compliance score of 90%. CHS will be closely monitoring the score and
assessing liquidated damages and corrective action plan for those providers that do
not meet the target.
• A separate letter will be mailed to providers detailing the claim overpayment and allow
you time to reply with additional documentation to support the claim submitted.
• Cigna-HealthSpring will compare EVV data retrospectively and recoup if there is not an
associated transaction for the date of service(s) and/or units, modifiers and HCPCS
codes billed that does not match.
Recoupment Process
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• Providers who do not agree with Cigna-HealthSpring’s findings on the recoupment letter,
have 45 days to submit a check or request a review before we offset future claim
payments.
• You can find our forms on our website at: http://starplus.cignahealthspring.com/evv
EVV Recoupment Reconsideration
• EVV Review Request Form (Use only when you have verified visits to submit for
reconsideration.)
• EVV Visit Maintenance Unlock Request Form (Use only for dates of services listed on
your Request for Refund of Unverified Services letter - NOTE: approval is at MCO's
Discretion.)
For additional questions, contact our Provider Services Department at 1-877-653-0331,
Monday to Friday, 8 a.m. to 5 p.m. CT or email: [email protected]
Recoupment Process, continued…
19 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Q: I do not have a home landline. Do I need to get one to continue my services?
A: No, EVV does not require individuals/members to get a home landline phone. If you do
not have a home landline or you do not want your personal attendant to use your home
landline, a small alternative device will be ordered and installed in your home for your
personal attendant to use to clock in and out.
Q: I do not have a landline but I have a cell phone. Can my attendant use my personal
cell phone to call the EVV system?
A: No. The use of the individual's/member's personal cell phone is not allowed and your
attendant should never ask to use your cell phone to call in and out.
Note: The only exception to cell phone use is if you are a Consumer Directed Services
(CDS) employer.
Q: Can an individual/member receive services in the community with EVV?
A: Yes. The use of EVV does not change the way and location in which services are
delivered. Individuals /members will be allowed to receive services in accordance with
their service plan and existing program rules.
Frequently Asked Questions
20 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Q: When will the contract for MEDsys expire?
A: HHSC is working in collaboration with MCOs, MEDsys and DataLogic to transition all
providers before the MEDsys contract expires on Nov. 6, 2018. The contract will not be
extended or renewed.
Q: What steps should I take for unsent transactions or transactions that have been
rejected by Cigna-HealthSpring?
A:
• Prior to submitting a claim to Cigna-HealthSpring (CHS), providers must review
DataLogic’s (Vesta) Failed to Export Report to identify rejected transactions
• If the report shows unsent or rejected transactions the provider must make the
applicable corrections, to ensure all data elements are correct and the transaction(s) is
submitted to the correct payer.
• Transactions can be rejected for multiple reasons.
• Before billing CHS, please verify and confirm all transactions associated to the claim
have been successfully transmitted to CHS.
• Failure to review the failed to export report and make applicable corrections prior to
submitting a claim to CHS may result in your claim being denied or recouped. For
training on how to use the Failed to Export Report, please contact Vesta at 1-844-880-
2400 or email them at [email protected]
:
Frequently Asked Questions
21 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Q:What is timeline for transitioning from MEDsys to DataLogic (Vesta) EVV system?
Please follow the steps listed below to initiate the vendor transition as soon as possible to
remain in compliance with EVV requirements:
1. Initiate the transition process with DataLogic by completing the Vesta EVV Agency
Information form.
2. Submit the form to DataLogic today by email or fax to 956-412- 1464.
3. DataLogic will contact the provider agency representative to begin transition activities
and initiate data transfer from MEDsys.
Your agency must begin logging EVV visits using the DataLogic Vesta EVV system by
Sept. 30, 2018. The last day to retrieve visit reports or perform any visit maintenance
within the MEDsys EVV system will be Oct. 28, 2018.
Once your agency has submitted the Vesta EVV Agency Information form, your agency
can begin training on the DataLogic EVV system. For more information on DataLogic
Vesta training opportunities, visit the training schedule on the Vesta website.
You may contact DataLogic Vesta at [email protected].
Q: What happens if a Provider fails to transition to the DataLogic system?
A: Providers who do not transition to the Vesta EVV system on or before Sept. 30, 2018
may be unable to record EVV visits for transmission to payers. Providers who submit
claims without EVV visits may have claims denied or recouped by payers.
Frequently Asked Questions
22 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
Q: What telephone service types are approved for EVV use?
A: Wired phone connected to a phone jack in the wall.
• Non-wired phone with base connected to a phone jack in the wall (i.e., cordless phone)
• Home telephone service where the phone cannot be disconnected and used at a
different address/location. This includes phone service through the local:
• Cable Internet Provider (e.g., Time Warner, Comcast, AT&T, etc.), and
• Digital Voice via Verizon’s FiOS (Fiber Optic Service).
Q: How should claims be filed that have multiple dates of service?
A:
Frequently Asked Questions, continued…
23 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2018 Cigna
For example: if billing DOS 01/01/2017 to 01/15/2017, bill each date of service on (DOS) a
separate line. The DOS 01/01/2017 on the first line, DOS 01/02/2017 on the second line, DOS
01/03/2017 on the third line, etc..
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring
Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-
HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to
enrollees. © 2018 Cigna
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