The Health Care Authority is providing the following guidance for MCOs regarding electronic visit verification (EVV) for home health care services (HHCS).
The HCA will not begin denying claims and rejecting encounters without the EVV HHCS data on 1/1/2024. There will be a period of technical assistance for providers to come into compliance with EVV HHCS requirements, including enrolling individual HHCS providers with HCA.
MCOs should not deny EVV HHCS claims that do not have all the required EVV data elements with service dates starting 1/1/2024, as stipulated under 9.15.15 of the upcoming amendment to the MCO contract. Initially, there will be a period of technical assistance for providers to become compliant with EVV requirements. HCA will give notice to MCOs for when to begin denying claims without the required data.
MCOs must have their systems ready by 1/1/2024 to begin collecting EVV data elements on claims submitted by providers and send EVV HHCS data to HCA on encounters as detailed in the EDRG and companion guides. This is necessary for HCA’s EVV HHCS reporting requirements to CMS, for HCA to monitor the number of claims without EVV HHCS data, and to identify which providers are not submitting EVV HHCS data.
HCA will perform outreach to those providers not sending the EVV data elements and requests the MCOs also perform outreach and provide support to providers not meeting EVV HHCS requirements starting 1/1/2024.
This information will be incorporated into the EVV HHCS FAQs on the HCA’s EVV HHCS website in the upcoming days. You’ll be notified as to when this has been updated.
Please see HCA’s EVV HHCS website at: https://www.hca.wa.gov/billers-providers-partners/program-information-providers/home-health-care-services-electronic-visit-verification.
The Frequently Asked Questions (FAQ) for EVV HHCS have been updated to reflect the guidance HCA provided via email (#37128) to the MCOs on 11/9/2023. The updated FAQ can be found on HCA’s EVV HHCS website at: https://www.hca.wa.gov/billers-providers-partners/program-information-providers/home-health-care-services-electronic-visit-verification.
Please send any questions to HCA about EVV HHCS to [email protected]. – Christina McDougall, HCA FADS & EVV HHCS Project Manager
