Healthfirst Medicaid Star Member Complaints And Appeals

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.

Parkland Community Health Plan complies with all of HHSC’s EVV policies and procedures. 

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 and FMSAs 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.

EVV Policies & Procedures

EVV Training & Education

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.

PCHP follows the HHSC EVV Maintenance Unlock Request process:

EVV Alerts

EVV Support & Additional Resources