Home health care services: electronic visit verification

Overview

Electronic visit verification (EVV) is a federal requirement of the 21st Century Cures Act, passed by Congress in 2016 requiring that Medicaid funded in-home personal care services, respite care services, and home health care services are verified as having been provided.

Home health care services (HHCS) covers any home health services included in the home health billing instructions and encounter data reporting guide.

HHCS providers will be required to have an EVV solution in place by January 1, 2024 or risk having their claims denied or encounters rejected under a mandate included in the 21st Century Cures Act.

Current and new required data elements

Beginning January 1, 2024, there will be three new required data elements. All data element requirements include:

• Type of service performed (existing)
• Individual receiving the service (existing)
• Date of service (existing)
• Location of service delivery (new)
• Individual providing the service (new)
• Time the service begins and ends (new)

HCA will require the data elements to be submitted with the claim either via direct data entry (DDE) or the 837i. The data elements indicated as “existing” are currently required and Home Health agencies are submitting those today. The data elements indicated as “new” will be new requirements for the Home Health agencies to include in claims submittals.

See the provider requirements section below for additional guidance on these newly required data elements.

Provider requirements

Providers will need to:

• Procure an EVV solution. Providers shall procure their EVV solution of choice and must self-fund their EVV implementation. This allows the flexibility to select an option that best meets their business needs and the needs of their client.
• Enroll employees providing home health services as servicing providers with HCA.
  • Employees will be required to obtain a national provider identifier (NPI) from the national plan and provider enumeration system (NPPES) to enroll with HCA.
  • Home Health agencies can use the ProviderOne roster upload template to facilitate enrolling multiple servicing providers altogether or add them individually using the online screens. See the enroll individuals as a servicing provider section below.
• Submit the required EVV HHCS existing and new data elements on all HHCS claims and encounters. See guidance for newly required data elements below.

Location of the service delivery

• For DDE claims: Submit this data at header level on the “Other Claim Info” tab: “Miscellaneous Claim,” “Service Facility.” Do not enter Facility NPI, use only address fields.
• For 837i claims: The 2310E loop outlined in the 837i companion guide only outlines Medicaid’s use of the that portion of the loop in whole. Please reference both the note section in the 837i companion guide and the ANSI TR3 HIPAA implementation guide for requirements.

Individual providing the service

• The employee’s NPI will be required to be submitted as the “rendering provider” on the 837i claims.

Time the service begins and ends

• For DDE claims, submit this data in the “Additional Service Line Information” field.
• For 837i claims, the 2400 Loop SV202-7 segment outlined in the 837i companion guide only outlines Medicaid’s use of that portion of the loop in whole. Reference the ANSI TR3 HIPAA implementation guide for requirements.

Enroll individuals as a servicing provider

To enroll individuals as a servicing provider, visit the enroll as a health care professional practicing under a group or facility page.

Timeline

• Home Health billing instructions updated and published July 1, 2023.
• 837 companion guide was updated and published July 1, 2023.
• ProviderOne began accepting the new EVV HHCS data elements as of July 1, 2023.
• Encounter data reporting guide (EDRG) will be updated and published the week of December 25, 2023.
• New EVV HHCS data elements will be mandatory for HHCS claims with service dates on or after January 1, 2024.

Frequently asked questions

• View frequently asked questions.