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02/13/2019

ODM Delays EVV Claims Implementation

On Friday, Feb 8th, LeadingAge Ohio along with other provider associations were invited to meet at the Ohio Department of Medicaid (ODM) with Director Maureen Corcoran and the EVV (Electronic Visit Verification) team to hear an update on the Phase 1 EVV implementation and express concerns providers are experiencing with the implementation. ODM staff shared the claims edits, previously scheduled to be turned on February 13th , will be delayed until further notice, due to lack of provider readiness. ODM shared an analysis they conducted on October and November claims and had the edits been in place at that time, more than half of all claims would have been denied.  ODM asked the associations what more they could be doing to prepare providers for this new process as EVV continues to be a federal mandate and will move forward once more providers are prepared. ODM felt it was imperative to give providers a little more time to get adjusted to the EVV requirements before the claim’s edits were turned on.

In a follow up ODM EVV Stakeholder meeting on Monday, Feb 11th, the EVV team shared similar information as well as a presentation that will be highlighted below detailing the research ODM had done on approximately 1 million claims from October and November 2018.

ODM reminded the group the data in the EVV system must be an exact match with claims submitted as follows:

  • The provider of service
  • The individual receiving the service
  • The date of the visit
  • The service provided
  • Units recorded for the visit in Sandata EVV system must be greater than or equal to the units submitted on the claim

ODM then explained multiple edits related to EVV that might post and suspend the claim until the issue is resolved.  With the matching logic from the EVV system to the MITS portal ODM reiterated, had the claims edit been turned on for the October and November claims, 48.23% of those claims would have paid and 51.77% of claims would have denied.  Approximately 71% of the claims that would have denied had no matching visit in the EVV system, but the provider used EVV during the analysis period, in 9% of those claims the exceptions were not cleared and 20% of the claims had no data in the EVV system. 510 providers, approximately half being agency based and half independent, submitted claims during the analysis period but had no visits in the EVV system. ODM then went into detail about the amount of outreach they have communicated to providers and acknowledged the associations have also done extensive outreach to their members. Providers who have no data in the EVV system are being contacted directly by ODM.

Agency providers shared their concerns that they are attempting to be compliant with EVV, but their alternative EVV vendors may not be ready for one reason or another.  ODM wants providers to understand it is their responsibility to make sure their vendors are meeting their needs. If they have any questions or want to ensure their vendors are meeting all the necessary specifications, they can contact the EVV mailbox at EVV@medicaid.ohio.gov.  Agencies whose data is not showing up in the EVV system were sent letters to let them know an issue exists, and they need to rectify the problems.

ODM stated that all Phase 1 providers are mandated to be using the EVV system even though the claims edits have not been turned on. The department is still using EVV for program integrity purposes and will be conducting post payment reviews, looking at dates of service on or after February 13th. These reviews will look at 1-3 weeks of claims beginning with providers that have not used the EVV system at all or are the poorest performing providers. Providers will be responsible for an ODM payback if their claims do not match what is in the EVV system.

The training for Phase 2 implementation is still scheduled from May 5th to August 5th and as of now EVV will be mandatory for Phase 2 providers August 5, 2019. Phase 2 providers will include:

  •        Managed Care Organizations
  •        Department of Developmental Disabilities
  •        Ohio Department of Aging
  •        Group visits from Phase 1

If you have any questions regarding Phase 1 or Phase 2 EVV implementation, please contact Anne Shelley at ashelley@leadingageohio.org.

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