EVV Claims Matching Bypass from January 1 to March 31

Date: 02/09/24

The Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024, for Electronic Visit Verification (EVV) claims with dates of service from January 1 through March 31, 2024 to be paid without a matching EVV visit.

Program providers, Financial Management
Services Agencies (FMSAs), and Consumer Directed Services (CDS) employers must note:

To enter missing EVV visits not entered during the EVV claims matching bypass period within the 95-day visit maintenance period.
Providers who receive a “No EVV Visit Match” denial for claims with dates of service beginning January 1, 2024 can submit adjustment claims
after February 1, 2024.
EVV claims matching will begin with dates of service on April 1, 2024.
Managed Care Organizations (MCOs) will not allow the entry of missing EVV visits after the 95-day visit maintenance timeframe has passed.
- Failure to use the EVV system to record visits may result in recoupments.

Additional Information:

If billing through the HHAeXchange system:
- You must ensure you have a valid, accepted visit on file, or you will not be able to invoice and bill your claim.
- Program providers and FMSAs using HHAeXchange, who need to bill
  but don’t have a valid visit on file in the HHAeXchange system, may submit their claims through TexMedConnect.
- Claims paid without a valid matching visit are subject to recoupment.
EVV claims for EVV required services must be submitted to the
Texas Medicaid & Healthcare Partnership (TMHP).
MCOs will reject any managed care claims with EVV services and dates of service on or after December 1, 2023, back to the program provider and FMSA, directing them to submit the claim to TMHP for EVV claims matching.

For information on submitting EVV claims to TMHP, refer to the HHSC Prepare for EVV Cures Act Home Health Care Services Implementation webpage.

For assistance regarding EVV claims with mismatched results, please email TMHP at EVV@TMHP.com.