Electronic Visit Verification Long-Term Services and Supports Care Provider Agency Training 2018

Transcription

1 Electronic Visit Verification Long-Term Services and Supports Care Provider Agency Training 2018

2 EVV Overview Electronic visit verification (EVV) documents that members are receiving authorized long-term services and supports (LTSS), such as when a personal care attendant provides services in a member s home. Texas Health and Human Services (HHS) requires EVV for certain home and community-based services to members in the following programs: STAR+PLUS UnitedHealthcare Connected (Medicare-Medicaid Plan) STAR Kids EVV replaces paper timesheets by electronically documenting information about the: Member receiving services Attendant or assigned staff providing services Care provider agency Precise time the attendant begins and ends the service

3 Services Requiring EVV Care providers need to use EVV for: Personal assistance services (PAS) Personal care services (PCS) In-home respite care Community First Choice: Habilitation and PAS/PCS Flexible Family Support Services (STAR Kids only)

4 How EVV Works Step 1: Securing When a member needs long-term services and supports to meet basic needs at home or in another community setting, our service coordinator requests the medically necessary authorization and helps the member choose a service provider. Step 2: Delivering Attendants or assigned staff can document when visits begin and end by using a telephone, an alternate device or conducting visit maintenance into the EVV system. The information is electronically registered by the EVV vendor, so it s documented when the agency submits claims to UnitedHealthcare Community Plan. Step 3: Monitoring We check to make sure the services provided were: Authorized to help the member Electronically documented using EVV Submitted for claims reimbursement

5 EVV Vendors

6 Service Provider and Vendor Requirements Your agency needs to: Use the HHS-approved EVV vendor. Train workers how to use EVV. Ensure workers enter EVV data for every visit. Perform any necessary visit maintenance to the EVV entries. Submit claims after the EVV data elements are entered into the system. The vendor works with you to set up reporting, including: Provider demographics Attendant or assigned staff and member profiles Authorizations Visit schedules

7 Approved Vendor - Datalogic To initiate services with DataLogic providers must complete the Vesta EVV Agency Information form located at vestaevv.com > Vesta EVV Agency Information Form.

8 EVV Requirements

9 Using a Telephone for EVV The primary device used for EVV is a landline telephone in the member s home when it s registered as a single residence. Landline telephone service may be provided through traditional copper cables, DSL, coaxial cable, fiber optic lines or other transmission methods physically connected to the member s home. The following types of phone services can t be used for EVV: Phone service provided over a cellular, satellite or other mobile network Portable alternative phone services that use VoIP, including magicjack, Vonage, Skype or Google

10 Unallowable Phone Identification and Recoupment Policy Beginning March 1, 2018, all attendants must follow the EVV Unallowable Phone Identification and Recoupment Policy, which requires attendants in a member s home to call from an approved phone. Violations may be discovered through EVV vendor phone sampling reports. You ll receive warning letter if an unallowable phone type is used. Continued violations could result in recoupment of payments, compliance actions and/or termination of your network contract. For more information, go to UHCprovider.com/TXCommunityPlan > Bulletins and Newsletters > Electronic Visit Verification > HHSC Notice: EVV Cell Phone Policy Alert.

11 Small Alternative Devices (SAD) If a member doesn t have a landline, or won t allow use of their landline, a small alternative device can be installed in their home. To request a small alternative device, please contact DataLogic electronically using the esad ordering process within seven days of learning no landline is available. A representative of your agency should place it in the member's home within 14 calendar days of receipt of the request. The SAD must remain in the member's home for the use of EVV services. Please contact DataLogic Vesta at info@vestaevv.com for questions about the esad ordering process.

12 Visit Maintenance Designated staff can edit EVV records by reviewing, modifying and correcting visit information. This maintenance must be completed within 60 days after the date of service. The system entry will be locked after that. A few situations could include: o The attendant forgot to call in or out using the approved method. o An attendant other than the regularly scheduled attendant delivered the service. o The service was delivered outside the scheduled visit time or not at all. o A phone wasn t accessible. Please use a reason code for each transaction. Some edits will require a comment to be entered along with the reason code. To avoid claim denials, please run the Failed to Export reports in the DataLogic system to look for any failed transactions that need to be corrected. If you experience technical difficulties with the EVV system, contact your provider advocate or call LTSS Customer Service at

13 Reason Codes Select the code that seems most appropriate for the situation. Reason codes are categorized as follows: o Preferred Reason Codes document visit maintenance necessitated by a situation in which the provider staff are delivering and documenting services in accordance with HHSC expectations. o Non-Preferred Reason Codes document visit maintenance that is necessitated by a situation in which the provider staff is not delivering and documenting services in accordance with HHSC expectations. For the list of reason codes with instructions and examples, visit UHCprovider.com/TXCommunityPlan > Bulletins and Newsletters > Electronic Visit Verification > Training > Complete List of Reason Codes.

14 Claims Submission A visit may not be billed until all EVV data has been entered and any necessary visit maintenance is complete. Claims should be submitted no later than 95 days from the date of service. For more information, please go to UHCprovider.com/TXCommunityPlan > Claims and Payments.

15 Compliance Scores

16 Compliance Score Monitoring We monitor EVV data quarterly to calculate your HHS EVV Initiative Provider Compliance Plan Score by: o o o Adding the number of visits entered and verified to have been completed as authorized Dividing that sum by the total number of visits for that quarter, including visits containing a non-preferred reason code Rounding that number to the nearest whole percent The score must show at least 90 percent compliance. You can monitor your own compliance by obtaining reports through your EVV vendor. The quarters monitored for compliance are: Jan. 1 March 31 April 1 June 30 July1 Sept. 30 Oct.1 Dec. 31

17 Noncompliance If your agency s compliance score is less than 90 percent, we ll send you a certified noncompliance letter explaining any required action on your part. Actions may include: Education for you and your staff about how to correctly document EVV A Corrective Action Plan (CAP) outlining actions Participation in an investigation of fraud, waste and/or abuse Assessment of liquidated damages; this is a rate that you would owe for all visits conducted by your agency for each day that your score is below the acceptable compliance Termination of your UnitedHealthcare Community Plan Provider Agreement To access our EVV Initiative Provider Compliance Plan, visit UHCprovider.com/txcommunityplan > Bulletins and Newsletters > Electronic Visit Verification > Your Plan Compliance > Provider Compliance Plan for UnitedHealthcare Community Plan EVV.

18 Informal Review If you believe your score was noncompliant due to a failure of the EVV system, you may request an informal review. We must receive your request 10 calendar days from the date you received our certified noncompliance letter. Your request should include: Your provider agency name, tax identification number (TIN) and national provider identification (NPI) number The dates and description of the EVV system failure The date the system issue was reported to UnitedHealthcare Community Plan and the name of the person it was reported to Your contact method: address, phone or fax number Any documentation that supports your experience of the system failure Send your request to: EVV Informal Review UnitedHealthcare Community Plan Southwest Fwy., Suite 800 Sugar Land, Texas We ll inform you in writing of our findings.

19 Contacts and Resources

20 Member Complaints Please address any complaints you may hear from our members or their representatives and document its resolution. Members can file a complaint with us by calling Member Services at: (for STAR Kids members) Members can also mail written complaints to: UnitedHealthcare Community Plan Attn: Complaint and Appeals Dept. P.O. Box Salt Lake City, UT

21 Care Provider Complaints You can submit a complaint to us by completing our complaint form at UHCprovider.com/txcommunityplan > Provider Forms > Complaint Form. If you need help with the form, call You can submit your form in two ways: Mail to: UnitedHealthcare Community Plan Attn: Complaint and Appeals Dept. P.O. Box Salt Lake City, UT Fax:

22 Submitting Complaints to HHS You can also submit a complaint to Texas Health and Human Services Provider Resolution Services in two ways: Mail to: Texas Health and Human Services Commission Provider Complaints Health Plan Operations, H320 P. O. Box Austin, TX hpm_complaints@hhsc.state.tx

23 Contacts and Resources Sign up for updates at hhs.texas.gov > Sign Up for Updates. Check updates at UHCprovider.com/txcommunityplan > Bulletins and Newsletters > Electronic Visit Verification. Review the Care Provider Manual at UHCprovider.com/txcommunityplan > Care Provider Manuals > Texas. Contact your Provider Advocate directly for issue resolution. For LTSS questions, please contact us at: o Phone: o uhc_cp_prov_relations@uhc.com o Fax:

24 Thank you. Doc#: PCA _ United HealthCare Services, Inc.