Provider Alert! Enter Missing EVV Visits and New EVV TAC Rules

Date: January 3, 2024

Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers

Effective: June 1, 2023

Call to action: Update 2/6/2024: Texas Children’s Health Plan (TCHP) would like to let providers know that the Texas Health and Human Services Commission (HHSC) implemented a claim matching bypass on February 1, 2024 — for EVV claims with dates of service from January 1 through March 31 — to be paid without a matching EVV visit.

Billing Claims

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.

Enter Missing EVV Visits

Program providers, financial management services agencies (FMSAs), and Consumer Directed Services (CDS) employers must enter missing EVV visits not submitted during the EVV claims matching bypass period within the 95-day visit maintenance timeframe.

TCHP will not allow the entry of missing EVV visits after the 95-day visit maintenance timeframe has passed.

Program providers and FMSAs who received a “No EVV Visit Match” denial for claims with dates of service beginning January 1 can submit adjustment claims after February 1. EVV claims matching will begin with dates of service on April 1.

New EVV Texas Administrative Code (TAC) Rules

HHSC has adopted new Electronic Visit Verification rules in Texas Administrative Code, Title 1, Chapter 354, Subchapter O. The new EVV TAC is effective January 1, 2024.

Update 1/11/2024: The new EVV TAC rules:

• Add the home health care services required by the 21st Century Cures Act (1903(l) of the Social Security Act (42 U.S.C. §1396b(l))).
• Add the current policies regarding training, visit maintenance, and requests by program providers and FMSAs to become Proprietary System Operators (PSOs).
• Add definitions related to the addition of the new TAC rules.
• Reorganize the structure of the existing EVV required Personal Care services list for clarity.

Next steps for providers: Providers are encouraged to share this communication with their staff.

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

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