12 Feb Pennsylvania EVV Update
In this edition of the Alora Home Health blog, we return our attention to the state of Pennsylvania, with an update on compliance and general EVV information for the state as of February 2021.
Click here to view Alora’s EVV System for Pennsylvania
Update on Pennsylvania EVV Compliance
All claims and encounters for personal care services subjected to EVV requirements for dates of service on or after January 1, 2021 must have a corresponding electronic visit or claims payment will be impacted. Manual editing compliance rates went into effect on January 1, 2021. Please reference the recently released bulletins Electronic Visit Verification (EVV) for Personal Care Services (PCS) Bulletin, number 07-20-04, 54-20-04, 59-20-04, 00-20-03 and Electronic Visit Verification for Personal Care Services Provided in Fee-for-Service Delivery System, number 05-20-03 for additional details.
EVV Error Status Codes (ESCs) are actively setting for all claims with services subject to EVV that are submitted through PROMISe for fee-for-service programs. Providers should be actively reviewing these ESCs to determine if their claims and EVV data are matching appropriately. The EVV ESC Guide published on the Department of Human Services (DHS) EVV website outlines the conditions when claims deny for dates of service January 1, 2021 and after.
HOME HEALTH CARE SERVICES (HHCS)
Section 12006 of the 21st Century Cures Act requires that DHS implement a statewide EVV system for providers rendering HHCS by January 1, 2023. The HHCS service codes and modifiers are currently being finalized and will be shared in the near future. DHS will communicate with providers regarding the status of EVV for HHCS, including dates and times of provider training and public meetings.
EVV does not change billing processes and practices. DHS now requires visits for Medicaid and Commonwealth funded personal care services to be electronically verified before they can be paid by DHS. The DHS Aggregator receives EVV visit data for claims validation purposes.
For fee-for-service programs, billing is done through PROMISe. As a reminder, if a fee-for-service provider is using a third party billing entity, those entities need to be submitting claims to PROMISe. Third-party billing entities require certification; additional information can be found here:
For Community HealthChoices (CHC), billing is done through the Community HealthChoices Managed Care Organization (CHC-MCO) in which the participant is enrolled for services provided. Each CHC-MCO has its own claims processes and requirements. Any CHC-MCO related billing questions should be directed to the specific CHC-MCOs. Users of the DHS Sandata EVV system can expect the billing module to be available later this year.
HANDLING MANUAL EDITS
Caregivers should be using EVV to capture PCS visits at all times. In those few instances where the caregiver is unable to use EVV, a manual entry is allowed. Manual edits will not cause a claim to deny. Manual edits should be kept to a minimum since they will count towards the 50% threshold for manual edits per quarter for the provider agency. The first quarter for manual edit compliance is January 1, 2021 through March 31, 2021. As a reminder, any manual entry/edit should have hard copy documentation to show the reasoning for the manual entry/edit for compliance and auditing purposes.
Both the DHS Sandata EVV software and DHS Aggregator are programmed in accordance with program rounding rules. Therefore, the time worked should be submitted without editing and the system will apply any relevant rounding rules for the service code in order to match it to a corresponding claim submitted to PROMISe. For questions about rounding rules for a specific service, please contact the appropriate DHS program office. EVV visits should only be edited if the information is incorrect. For example, a manual edit would be necessary if a worker was actively providing services but was unable to clock in or out due to technical difficulties, an emergency, etc.
The manual edit threshold is based on the federal fiscal year quarterly basis for fee-for-service. For providers enrolled in the CHC managed care delivery system, the CHC-MCO will conduct the review of manual edit data on a federal fiscal year quarterly basis and contact the provider regarding any needed quality improvement plan.
For questions regarding manual entry/edit monitoring by the CHC-MCOs, please contact the appropriate CHC-MCO.
Additional information on how providers can check their manual edit percentages will be provided in the future.
Fee-for-service providers using an Alternate Pennsylvania EVV system should confirm the number of records going into the DHS Aggregator via the DHS Aggregator portal. If any issues are identified, Alternate EVV users should contact the PA Sandata Alternate EVV support team via email at firstname.lastname@example.org or by phone at 1-855-705-2407.
Providers experiencing issues should reach out to the appropriate contacts included below based on the issues they are experiencing.
For technical issues such as DHS Sandata EVV software (provider portal, SMC/ MVV, TVV, etc) assistance, Welcome Kit reissuance, please contact:
Provider Assistance Center (PAC) – email@example.com or 1-800-248-2152
For billing issues such as why EVV ESCs are setting, what the EVV ESCs mean, questions about what is in the Aggregator, please contact the following program office claims units:
ODP Claims Resolution Section
Hours of operation: Monday-Friday, 8:30 a.m.-noon and 1-3:30 p.m.
OLTL Provider Call Center
1-800-932-0939; choose option 2 for billing questions
Hours of operation: Monday-Thursday, 9 a.m.-noon and 1-4 p.m.
OMAP Provider Inquiry Line
1-800-537-8862, choose option 2, then option 6, then option 1
Hours of operation: Monday-Friday, 8:00 a.m.-noon and 12:30 p.m.-4:30 p.m.
For general EVV program issues or requests to be added to the EVV Listserv, please contact: EVV Resource Account at firstname.lastname@example.org
Do not forget you have available resources on the PA DHS EVV website link provided here: https://www.dhs.pa.gov/providers/Billing-Info/Pages/EVV.aspx
DHS APPROVED ALTERNATE EVV SYSTEM
Alora is a certified alternate EVV vendor for Pennsylvania. Alora is a strong alternative to the state offered free solution with minimum functionality. Why just get by when you can THRIVE with a powerful EVV solution that is part of a complete agency management system, Alora.
The Alora Homecare Software Blog
Read the Alora blog for industry news, including recent news, articles, and commentaries, as well as other issues that pertain to Homecare in the U.S and beyond. For more information on Pennsylvania EVV, or other topics in the homecare spectrum, please send us an email to HomeHealthSoftware@Alorahealth.com