Anthem HealthKeepers Plus Electronic Visit Verification for Home Health

Beginning July 1, 2023, HealthKeepers, Inc. will require the use of electronic visit verification (EVV) for certain home health services rendered to Anthem HealthKeepers Plus members. This change is being made in coordination with the Virginia Department of Medical Assistance Services (DMAS) and the managed care organizations in Virginia to comply with the 21st Century Cures Act and the Virginia Appropriations Act. EVV will be required for service codes G0299, G0300, S9122, G0151, G0152, and G0153.

Why is this change needed?

We are committed to effectively coordinating quality care for our members. The use of EVV systems, as mandated by the 21st Century Cures Act, helps to reduce fraud, waste, and abuse. Together, we are embracing technology to verify, simplify, and improve service delivery.

EVV clearinghouse and claims submission

HealthKeepers, Inc. is working with Netsmart* for EVV data aggregation and claims submission in Virginia. Netsmart EVV compares prior authorizations, schedules, and rendered service data to ensure compliance and allows you to review claims prior to submission. We will no longer accept paper claims for dates of services on or after October 1, 2023.

EVV data collection

The Commonwealth of Virginia is implementing a Provider Choice Model for EVV. This model requires that providers and agencies select and implement the EVV application for collecting rendered service data that suits your business requirements. We have established the following minimum requirements for the EVV application:

• Health Insurance Portability and Accountability Act (HIPAA) compliant
• Operates in an offline mode when cellular or Wi-Fi connectivity is unavailable
• Allows manual edits only by administrators in the system of record
• Tracks all edits to data completed by administrators, recording user name and date/time stamp in an audit log
• Ensures all protected health information (PHI) is always encrypted
• Maintains historical data via backups for the minimums defined by DMAS
• Captures the required six data points of the 21st Century Cures Act
• Allows for EVV data to be submitted electronically via Netsmart EVV clearinghouse

EVV testing

Testing will begin in July 2023. All EVV systems must complete integrations with Netsmart EVV clearinghouse.

Resources

Additional information on EVV is located at dmas.virginia.gov. If you have questions about EVV in Virginia, contact Bria Loiseau, Provider Relationship Account Director, at bria.loiseau@anthem.com.