Provider Agencies Using Third-Party EVV Vendors FAQ

Provider Agencies Using Third-Party EVV Vendors FREQUENTLY ASKED QUESTIONS

 

----------------------------------- GENERAL QUESTIONS ---------------------------------

 

WHAT IS ELECTRONIC VISIT VERIFICATION?

Electronic Visit Verification (EVV) is the use of technology to record the timing, service provision details, and location of Caregivers during appointment Check-In and Check-Out. This verification method provides an accurate record of caregivers’ actions in accordance with the member’s person-centered service plan while minimizing or eliminating inappropriate claims.

 

WHO IS INVOLVED WITH EVV?

EVV involves Attendants, Homemakers, and Caregivers who deliver care to Members. Agencies must ensure their Attendants/Caregivers utilize EVV to validate service provision for specific Medicaid services. This change is required by a federal law called the 21st Century Cures Act.

 

WHEN DO PROVIDERS NEED TO START USING EVV?

The 21st Century Cures Act mandates all providers who deliver personal care, respite care (in some states), and companion care Medicaid services start using EVV by the date mandated by your state. We encourage you to begin using EVV before the deadline to allow time to prepare for this change, so you don’t experience a disruption in claims reimbursement and to ensure you are fully operational by the deadline.

 

WHAT INFORMATION MUST BE COLLECTED AND VERIFIED THROUGH EVV?

The 21st Century Cures Act requires EVV systems to collect and verify the following seven items:

  1. The type of service performed
  2. The Member receiving the service
  3. The Caregiver providing the service
  4. The date of service
  5. The location of service
  6. The time the service begins
  7. The time the service ends

CAN YOU INTEGRATE WITH MY PAYROLL/AP/HOURS SYSTEM?

Currently, we are unable to accommodate outbound integration with your payroll, AP, or hours system.

 

IS THERE A COST FOR INTEGRATION?

CareBridge does not charge to integrate with your Third-Party EVV Vendor or send EVV data on your behalf to an MCO and/or State aggregator if required. Our EVV solution is also available to use at no cost to Provider Agencies. Your Agency has the option of switching to CareBridge’s free EVV solution if your vendor is charging you to integrate with CareBridge.

 

----------------------------------- PROCESS QUESTIONS ---------------------------------

 

IS CAREBRIDGE ABLE TO INTEGRATE WITH MY EVV VENDOR?

CareBridge can integrate with 21st Century Cures Act compliant EVV Vendors.

In addition to the 21st Century Cures Act EVV requirements there are data requirements per state and per MCO. All data field requirements are listed below. You will need to ensure your EVV vendor captures and can send these data elements.

AGENCY INFO   CHECK-IN/CHECK-OUT INFO
Provider TIN   Service Code/Modifiers
Provider Medicaid ID   Check-In/Check-Out address
Provider NPI   EVV Check-In/Check-Out latitude/longitude
CAREGIVER/MEMBER INFO   Check-In/Check-Out time
Caregiver DOB (NJ only)   Manual/late/missed visit reasons
Caregiver govt.-issued ID (if applicable)   Manual/late/missed visit actions
Member Medicaid ID    
BILLING INFO    
Authorization Reference Number    
Diagnosis Code    
Rate    

 

HOW DO I KNOW IF CAREBRIDGE IS CURRENTLY INTEGRATING WITH MY EVV VENDOR?

To determine whether CareBridge is currently integrating with a particular EVV vendor, you can reach out to us at evvintegrationsupport@carebridgehealth.com or 1 (844) 920-0989. Let them know that you are a provider agency who has a 21st Century Cures Act compliant EVV vendor and would like to know if they are in the process of integrating with CareBridge.

 

MY VENDOR IS CURRENTLY INTEGRATING WITH CAREBRIDGE. WHAT DO I NEED TO DO DURING THE INTEGRATION PROCESS?

While your EVV vendor works with CareBridge to complete the integration process, there are several actions you can take to help ensure your agency’s successful integration.

  • Use the CareBridge provider portal to review your agency’s member and authorization details and confirm that what is in your Third-Party EVV system matches what CareBridge has received from our health plan/state partners
    • Information on accessing the CareBridge provider portal can be found on the CareBridge Integration page under Resources for Integrated Agencies > Integrating Agency-CareBridge Portal Access Request
  • Familiarize yourself with the CareBridge pre-billing validation errors.
    • Prior to each visit being loaded into CareBridge, a series of validation checks are performed to ensure that the visit:
      • Is compliant with the 21st Century Cures Act
      • Meets any state/health plan defined requirements
      • Passes common billing rule
    • The pre-billing validation check is a critical function performed by CareBridge which supports you and your agency by monitoring all appointments and visits and flagging issues that could lead to a claim being rejected.
    • Validations are returned to Third-Party EVV Vendors in 2 ways:
      1. The Visit Error Response file, which is returned to your EVV vendor for every file that they send to CareBridge
      2. The Appointment Error Report, which is sent to your EVV vendor daily
    • Some pre-billing validations errors are quick to resolve and others will require more focused attention and communication between you and your EVV vendor or the health plan/state program.
    • All pre-billing validation errors must be resolved before a claim can be generated.

It's important that you discuss with your vendor how your agency will receive pre-billing validation error details and how you should resubmit the visit once the error has been resolved.

      • It is recommended that visits being sent to CareBridge are initially sent with the ClaimAction field left blank/null.
      • Once all pre-billing validation errors have been resolved then the visit should be sent to CareBridge with the claim indicator of ‘N’ in the ClaimAction field.
    • Common validations can be found HERE.
    • If you have any questions about the CareBridge pre-billing validation errors, please contact evvintegrationsupport@carebridgehealth.com.
    • Continue to follow up and check in with your EVV vendor to ensure that they are moving through the integration process with CareBridge to meet necessary deadlines. If there will be any new enhancements impacting your users, may want to communicate these changes to your staff in preparation. You can also ask your vendor for regular status updates to confirm they are meeting the timeline to progress through the integration process activities listed below:

       

        ACTIVITIES

      1.


      Complete Third-Party EVV Vendor Intake Form
      Third-party EVV vendor must inform CareBridge of intent to aggregate by answering necessary questions relating to their EVV system capabilities and agencies needing aggregations.

      2.



      Third-Party EVV Vendor Completes Integration Testing in Accordance with the 'Third-Party EVV Vendor Integration Testing Process Guide'
      This process is designed to assist Third Party EVV Vendors in becoming acclimated with and successfully submitting data to CareBridge for purposes of claim generation.

      3.


      Initial Production Data Go-Live 
      Once a vendor has successfully completed the required test cases and is approved to send data to production, they can begin sending production appointment/visit data to the production environment.

      4.


      Claim(s) Submitted via CareBridge 
      Third-Party EVV vendor submits data for at least 1 claim per agency via CareBridge. CareBridge subsequently generates the claim and sends to the MCOs (where applicable).

      5.


      All Claims Submitted via CareBridge
      Agency and Third-party EVV vendor determine date to begin sending all EVV visit data to CareBridge for all claims applicable claims generation (where applicable).

       

      As your EVV vendor nears the completion of the integration process with CareBridge, you should review the Provider Agencies Using Third-Party EVV Vendors Preparedness Checklist. This can be found on the CareBridge Integration page under Resources for Integrated Agencies > Provider Agencies Using Third-Party EVV Vendors Preparedness Checklist.

Although most of the integration activity will be completed by your vendor. You can follow up with them and ask if there will be any new enhancements impacting your users. If yes, you will need to plan to communicate the change to your staff in preparation. You can also ask your vendor for regular status updates to confirm they are meeting the timeline to progress through the integration process activities as outlined above. 

 

MY VENDOR HAS COMPLETED THE INTEGRATION PROCESS. WHAT DO I NEED TO DO NOW?

That’s great! Please see the Agency Preparedness Checklist.

 

WHAT HAPPENS IF MY VENDOR IS UNABLE TO INTEGRATE BY THE STATE-MANDATED EVV COMPLIANCE DATE?

You have the following options:

  1. You may utilize CareBridge EVV free of charge until your vendor is able to capture the required data fields.
  2. Switch to another Third-Party EVV Vendor that does capture all the required data fields.

 

WHAT DO I DO IF MY VENDOR DOESN’T CAPTURE ALL OF THE NECESSARY FIELDS?

You have the following options:

  1. You may utilize CareBridge EVV free of charge until your vendor is able to capture the required data fields.
  2. Switch to another Third-Party EVV Vendor that does capture all the required data fields.

 

CAN I USE CAREBRIDGE EVV AS WELL AS ANOTHER EVV VENDOR FOR INTEGRATION?

There is not a need for Agencies to use both CareBridge and a Third-Party EVV Vendor for capturing service details on the same visits. However, if there are subsets of Caregivers that would need to use one system vs. another, please reach out to CareBridge.

 

----------------- DATA VALIDATION/ERROR QUESTIONS ------------------

 

WHAT IS A PRE-BILLING VALIDATION ERROR?

Prior to each visit being loaded into CareBridge, a series of validation checks are performed to ensure that the visit:

  • Is compliant with the 21st Century Cures Act
  • Meets any state/health plan defined requirements
  • Passes common billing rules

The pre-billing validation check is a critical function performed by CareBridge which supports you and your agency by monitoring all appointments and visits and flagging issues that could lead to a claim being rejected.

 

WHERE DO I FIND INFORMATION RELATED TO PRE-BILLING VALIDATION ERRORS?

CareBridge sends a daily file that will report on appointments and visits that are not currently passing data validations and have pre-billing validation errors associated with them. Any appointment or visit that has a pre-billing error associated with it will not be able to be billed or correctly transmitted to Payers and/or State Aggregators. While these pre-billing errors are also reflected in the response files associated with each 'visits file' that CareBridge receives, this report can be helpful in seeing the pre-billing errors across all 'visits files' sent to date.

Please discuss with your vendor their receipt of this report and your ability to access the information.   

 

CAN I GO INTO THE CAREBRIDGE SYSTEM TO MAKE CHANGES WHEN THERE ARE ERRORS IN THE DATA?

Changes to data will need to be made within your EVV solution and they will need to send updated
records to CareBridge via integration.

 

WHAT HAPPENS IF A VISIT IS COMPLETED MANUALLY? WILL CLAIMS BE DENIED FOR MANUAL VISITS?
In some cases when an EVV Check-In or Check-Out cannot be completed or there is a need to edit an EVV Check-In or Check-Out, you will need to indicate a manual visit in your EVV system. You will also need to indicate a manual visit reason as configured in your EVV system. At this time, claims will not be denied for manual visits.


WHAT IS AN EARLY VISIT? WHY DO I NEED TO INCLUDE EARLY VISIT REASONS/ACTIONS

  • Arkansas only - A visit is considered early when a Check-In occurred seven (7) minutes or more before the appointment 'start time'.
  • Arkansas DOH is requiring agencies to record early visit reasons and early visit actions when this occurs. This information will be documented in your EVV system.

 

WHAT IS A MISSED VISIT? WHY DO I NEED TO INCLUDE MISSED VISIT REASONS/ACTIONS?

  • Arkansas - A visit is considered missed when a Check-In did not occur thirty (30) minutes or more after the appointment 'start time'.
  • New York, New Jersey, Iowa - A visit is considered missed when a Check-In did not occur more than three (3) hours after the appointment 'start time'.
  • MCOs are requiring agencies to record missed visit reasons and missed visit actions when this occurs. This information will be documented in your EVV system.

 

WHAT IS A LATE VISIT? WHY DO I NEED TO INCLUDE LATE VISIT REASONS/ACTIONS

  • Arkansas - A visit is considered late when a Check-In did not occur seven (7) minutes or more after the appointment 'start time'.
  • New York, New Jersey, Iowa - A visit is considered missed when a Check-In did not occur more than one (1) hour after the appointment 'start time'.
  • MCOs are requiring agencies to record late visit reasons and late visit actions when this occurs. This information will be documented in your EVV system.

 

----------------------------------- BILLING QUESTIONS ---------------------------------


WHERE DO I FIND INFORMATION RELATING TO SUBMITTED CLAIMS?

CareBridge sends a daily file that will report on the status of all appointments received for a provider agency. This report will contain information regarding the status of claims for the appointment, the billed amount, and whether there are unresolved pre-billing errors for the appointment.

Please discuss with your vendor their receipt of this report and your ability to access the information.   

 

HOW DO I FIND CLAIM STATUSES?

CareBridge sends a daily file.

 

WHERE DO I FIND CLAIM RESPONSES?

You will find your claim remittance information via the Clearinghouse portal, just as you do today. Please see the Agency Preparedness Checklist for additional information.

 

HOW DO I CORRECT/VOID A CLAIM? 

Both correcting and voiding a claim are initiated in your EVV system. Once you have made the necessary updates to the visit/claim in your EVV system, such as changing the billed rate. Visits can be resent to CareBridge with the necessary changes. Your vendor will use the ApptID field to communicate to CareBridge which visit should be modified, and the ClaimAction field to indicate the type of modification; 'N' is used for new/corrected claims, and 'V' is used to void an adjudicated claim. 

 

------------------------------- COMPLIANCE QUESTIONS -----------------------------


IS ATTESTATION MANDATORY FOR BILLING?

The ‘Attestation’ field is required. It must be populated with one of the codes provided to your EVV  vendor by CareBridge. You can find these codes in the CareBridge Technical Specifications.


IS THERE A CERTAIN COMPLIANCE RATE WE MUST ACHIEVE?

Compliance rates are determined by states. There is no specific compliance rate required at this time.

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