Important update for HCBS providers: guidelines for using alternative EVV vendors

Summary:

• HCBS providers must verify electronic visit verification (EVV) data before submitting claims in order to be reimbursed.
• Ensure all EVV records are cleared and in Verified status in Sandata Aggregator prior to billing.
• Claims that don’t have required information for adjudication will not be reimbursed and will need to be resubmitted.

We wish to address an important update for home and community-based services (HCBS) waiver providers who use alternative EVV vendors.

In our ongoing efforts to ensure compliance with regulatory requirements, we have identified key changes and updates that may impact your operations. We are committed to providing you with the necessary information and support to navigate these changes effectively. Please review the following details carefully to ensure your services are in full compliance:

• Log in to the Sandata Aggregator, the state sponsored EVV solution, at evv.sandata.com/VM/Login to review that the expected EVV visit data is appearing within their system. This verification must be done before submitting your claim to maximize the potential of your claim being reimbursed.
• Confirm that you are only billing for services that have EVV records documented in the Sandata Aggregator.
• Ensure EVV record exceptions are cleared and records are in a Verified status within the Sandata Portal before billing for services.
• If using an alternate EVV vendor, ensure that all EVV record exceptions are cleared before moving the EVV data into the Sandata Aggregator.
• Make sure you have completed the above steps before submitting your claim to help prevent receiving one of these non-reimbursement messages:
• ZII: Sandata could not match your claim details to your EVV visit details. This might happen because you are using an alternate EVV vendor that is not transmitting to Sandata daily. Make sure the visits are fully visible in Sandata before submitting claims to us. If a claim covers multiple dates of service, it is imperative that visit data for all dates of service appear.
• ZIH: Sandata was unable to match the units of time billed on your claim to the units covered by the visit. While a visit was found that matches the claim, the units being different means that we cannot continue adjudication. Review the rules for rounding to the nearest quarter hour to ensure units are properly calculated. A ZIH denial could also result in cases where your claim is for multiple dates of service but not all visits are accounted for in Sandata. Submit a new claim with the correct number of units and view the visit information in Sandata to ensure that all dates of service and units are correct.
• ZVU: We did not receive a response from Sandata regarding your claim. This could be due to missing or incorrect provider ID information, such as missing digits, using the legacy provider identifier (LPI) as the NPI or vice versa, or using the TIN in place of the NPI or LPI. Resubmit the claim using the correct information.

A clean claim means we have all the information necessary to review the claim. If you use an alternate EVV vendor, following these guidelines will help you have a successful claims experience.

If you have questions regarding visit data not being reflected in the Sandata Aggregator, contact your EVV vendor for assistance.

We look forward to working together to achieve improved outcomes.