Claim Submission Changes for Electronic Visit Verification Services
Date: 06/12/19
Effective September 1, 2019, providers required to use Electronic Visit Verification (EVV) services must submit all claims for EVV to Texas Medicaid and Healthcare Partnership (TMHP), for the new claims-matching process to be performed. All claims with dates of service on or after September 1, 2019 must be submitted to TMHP, through TexMedConnect or Electronic Data Interchange (EDI).
EVV claims submitted to Superior HealthPlan with dates of service on or after September 1, 2019 will result in a denial or rejection of the claims, and will require submission directly to TMHP. This includes any claims submitted through Superior's Secure Provider Portal. All EVV claims must be submitted directly to TMHP for the claims-matching process to be completed.
Providers, or a provider’s 3rd party billing service, who do not currently submit claims to TMHP, must establish a Compass 21 (C21) Submitter ID, and in order for providers to submit claims through EDI, a Receiver ID is also required prior to Sept. 1, 2019.
Providers and Financial Management Services Agencies (FMSAs) can access TMHP’s EDI homepage for basic information needed to file claims electronically as well as user guides, forms, and technical information intended for billing agents that file claims for providers.
Providers and FMSAs that need assistance in setting up C21 or CMS Submitter IDs should contact the EDI Help Desk at: 1-888-863-3638, Option 4.
Once a claim for EVV services has been received at TMHP, it will be matched against the EVV visit data. If the following data elements do not match, the claim will be denied by Superior:
- National Provider Identifier or Atypical Provider Identifier
- Date of Service
- Medicaid Identifier of the individual
- Healthcare Common Procedure Coding System (HCPCS) code
- HCPSC Modifier(s), if applicable
- Billed Units once TMHP performs the matching process, claims will be forwarded to Superior Health Plan for final adjudication and processing. Please note: Superior’s Personal Assistance Services (PAS) policy remains in effect. Billing for multiple dates (date spans) in a single line on claims will not be accepted.
In addition to the EVV relevant claim being denied for not having a matching EVV visit transaction, the claim may also be denied for other reasons. The reason for the denial will be listed on the explanation of payment (EOP).
To prepare and guide providers in the use of EVV, the Texas Health and Human Services Commission (HHSC) is providing an EVV Tool Kit throughout the calendar year. The EVV Tool Kit is a collection of resources that will help prepare providers, FMSAs and Consumer Directed Services (CDS) employers, in the use of EVV. The EVV Tool Kit contains resources such as:
- Informational updates, posted online on the 1st and 15th of each month
- Live Q&A webinar sessions, available on the 22nd of each month
For more information or to access on the EVV Tool Kit visit: 21st Century Cures Act
For any questions about the EVV Claim Submission process, please contact your Superior Account Manager.