Provider Alert! Retrospective Review of Paid Claims with Electronic Visit Verification (EVV) Claims Matching

Provider Alert!

Provider Alert! Retrospective Review of Paid Claims with Electronic Visit Verification (EVV) Claims Matching

Date: September 10, 2021

Attention: STAR Kids Providers/Personal Care Services & FMSA Providers

Effective Date: September 10, 2021

Call to action:  In alignment with HHSC requirements, Texas Children’s Health Plan will begin a review of paid claims that require a matching EVV transaction for dates of service March 21, 2021 – December 31, 2021. Claims that were bypassed under the “EVV007 – Match Not Required” exception were granted 180 days to complete the necessary visit maintenance. This time period has now lapsed. Upon the claims review, if paid claims do not have a complete match to an accepted EVV visit transaction, EVV Overpayment Procedures will commence. Providers with identified EVV overpayment claims will receive a notification letter in the mail with detailed information regarding the procedures and timeline requirements.

Next Steps for providers:
Providers should review the EVV Claim Match Reconciliation Report within the Texas Medicaid & Healthcare Partnership (TMHP) EVV Portal to review paid claims for the impacted date range to ensure claims have the appropriate accepted matching EVV transaction information. You may also review the HHSC policies and requirements for EVV at:

https://www.hhs.texas.gov/laws-regulations/handbooks/evvpph/section-1000-evv-program

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers

Share this post

Leave a Reply

Your email address will not be published. Required fields are marked *