Provider Alert! EVV Claims Matching Bypass from January 1 to March 31, 2024
Date: February 9, 2024
Attention: STAR Kids Providers/Consumer Directed Services employers and FMSA Providers
Effective: March 31, 2024
Call to action: 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.
Program providers, financial management services agencies (FMSAs), and Consumer Directed Services (CDS) employers must enter missing EVV visits not entered during the EVV claims matching bypass period within the 95-day visit maintenance period.
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.
TCHP 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.
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.
EVV claims for EVV required services must be submitted to the Texas Medicaid & Healthcare Partnership (TMHP). TCHP 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.
Resources:
For information on submitting EVV claims to TMHP, refer to Prepare for EVV Cures Act Home Health Care Services Implementation.
Email TMHP for assistance with EVV claims with mismatched results.
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.
