Electronic Visit Verification (EVV) Provider Stakeholder ......MCO websites 1/15/2018 11. Senate...

Electronic Visit Verification(EVV)

Provider Stakeholder Meeting

Presented by HHSC EVV Operations

Fall 2017

Objectives

• This meeting is for providers who are required to use an HHSC approved EVV system and are contracted with:

• HHSC/Department of Aging and Disability Services (DADS); or

• Management Care Organizations (MCOs)

• This material reflects a collaboration between HHSC, Texas Medicaid Healthcare & Partnership (TMHP), and MCOs

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Objective

• It is intended to provide an update of:

• EVV – Cures Act

• EVV - Senate Bill 894

• Individual/Member Communication

• MCO Authorizations

• EVV Pilots

• EVV Compliance Scores

• Most Commonly EVV Recoupments

• Most Commonly EVV Denials

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Objective

• It is intended to introduce new EVV polices and changes relating to:

• EVV Provider Manual

• Unlocking Visit Maintenance Process

• New Small Alternative Device Order Process

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Objective

• It is intended to provide a review of:

• EVV Reason Codes

• Reason Code Free Text

• EVV Reports

• It is intended to allow provider agencies an opportunity to ask questions.

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Schedule

Section I

Welcome/Introductions/Provider Feedback

Section II

EVV Updates

• EVV – Cures Act

• EVV - Senate Bill 894

• Individual/Member Communication

• MCO Authorizations

• EVV Pilots

• EVV Compliance Scores

• Most Commonly EVV Recoupments

• Most Commonly EVV Denials1/15/2018 6

ScheduleSection III

New and Revised EVV Polices • EVV Provider Manual • Unlocking Visit Maintenance• New SAD ordering process

Section IV

EVV Review• EVV Reason Codes• Reason Code Free Text• EVV Reports

Section V

Questions and Answers1/15/2018 7

Section I

WelcomeIntroductionProvider Feedback

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Section II

EVV Updates

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21st Century Cures Act

• Section 12006. Electronic Visit Verification System Required for Personal Care Services and Home Health Care Services under Medicaid

• HHSC is currently discussing requirements

• HHSC is waiting on additional clarification from CMS

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Senate Bill (SB) 894

• HHSC is working on meeting all of the requirements in Section 531.024172 Electronic Visit Verification System of SB 894

• As the requirements are reviewed and finalized, the requirements will be posted on the HHSC EVV and MCO websites

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Senate Bill (SB) 894

The following requirements are currently being reviewed:

(c) Inform Medicaid recipients who receive services required to use EVV;

(d)(2)(A) the information required to be reported by health care providers is standardized across managed care organizations that contract with the commission to provide health care services to Medicaid recipients and across commissions programs;

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Senate Bill (SB) 894The following requirements are currently being reviewed:

(e)(1) Consider the administrative burden placed on health care providers to comply with standards; and

(h) create a stakeholder work group comprised of representatives of affected health care providers, MCOs, and Medicaid recipients and periodically solicit from that work group input regarding the ongoing operation of the electronic visit verification system under this section. 13

Individual/Member Communication

EVV Enrollment Flyer

• HHSC and the MCOs have developed an EVV Information Flyer that will be included in all enrollment packets

• The EVV Flyer is intended to provide education to the individual/member on EVV requirements

• The EVV Flyer informs the individual/ member EVV is required by the State

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EVV Rights and Responsibility Form

• MCO services coordinators (SC) and HHSC (DADS) case managers (CM) will provide each individual/member receiving EVV required services an EVV Rights and Responsibility Form at initial face to face meeting

• The SC and the CM will verbally review the form and have the individual/member sign the form

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EVV Rights and Responsibility Form

• The SC or CM will keep a copy of the signed form and leave a copy for the individual/member

• A new form will be sign annually

The estimated effective date EVV Enrollment Flyer and the EVV Rights and Responsibilities Form is March 2018.

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MCO EVV Authorization

All MCOs will send an electronic authorization file of active members to each EVV vendor daily.

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• Providers will still be required to enter the required data elements in the EVV system

• Providers will be able to see what the MCO sent to the EVV vendor and what the provider entered into the EVV system

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• The number of data elements providers entered will be reduced beginning in March 2018.

• This date is subject to change.

• The data elements providers would be required to enter will be published on the HHSC EVV and MCO websites.

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GPS Mobile App Pilot

• The GPS Mobile Application (App)

captures the geolocation coordinates

(longitude and latitude) of where the

attendant clocks-ins and clocks-outs

• Currently under pilot testing with

DataLogic only

• The attendant must have a smart phone

with GPS capabilities and volunteer to

use it for EVV

• No reimbursement for using phone


• The attendant downloads the Vesta Mobile app on their smart phone and uses the app to clock-in and out by pressing the clock in/out button

• The GPS App estimated data usage is less than two megabytes (MB) per month and does not use minutes from cell phone plan

• There is no PHI stored on the mobile app1/15/2018 21


Some restrictions:

• Smart Phone cannot be “jail broken” or “Rooted”;

• Must have Apple iOS, or Google Android platform on smart phone; and

• Attendant cannot live in the same residential complex as the individual/member receiving services.

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GPS Pilot Participation

• If you would like to be part of the EVV GPS Pilot and your EVV Vendor is DataLogic, please contact DataLogic.

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Visit Maintenance Reduction Pilot

• Pilot Objectives:

• To reduce visit maintenance

• Increase auto-verified visits

• Provide more flexibility

• Pilot includes HHSC and MCOs payors

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DataLogic:

• As of Aug. 2017, 31 provider agencies participating

• Average percent of increased auto-verified visits is 17%

MEDsys:

• As of Aug. 2017, 71 provider agencies participating

• Average percent of increased auto-verified visits is 8%

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There are four (4) solutions used in the visit maintenance reduction pilot.

• Call Matching Window for Auto-Verification;

• Expanded Time Option for Auto-Verification;

• Optional Alert Feature – Authorized Hours Close to Being Reached; and

• Automatic Downward Adjustment Option.

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Option 1 - Call Matching Window for Auto-Verification

Current Rule: If the EVV clock-in is within 2 hours of the start of a scheduled visit or 2 hours after a scheduled visit, and no other exceptions exist, the calls will auto-verify. Otherwise visit maintenance is required.

Proposed Solution: If the EVV clock-in and clock-out is between 12:00am through 11:59pm, on the same date of a scheduled visit, and no other exceptions exist, the calls will auto-verify.

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Option 2 – Expanded Time Option for Auto-Verification

Current Rule: If the rounded EVV pay hours equals the scheduled hours, and no other exceptions exist, the calls will auto-verify. Otherwise visit maintenance is required.

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Option 2 – Expanded Time Option for Auto-Verification

Proposed Solution: • Providers have the option to select the

Expanded Time Option which will extend the auto-verified timeframe by 0.25 rounded hours.

• For providers that choose this option, if the rounded EVV pay hours are equal to the scheduled hours plus or minus 0.25 rounded hours (plus or minus 22 minutes), and no other exceptions exist, the calls will auto-verify and log the actual rounded EVV pay hours. Otherwise, visit maintenance is required.1/15/2018 29


Option 3 – Optional Alert Feature –

Authorized Hours Close to Being Reached

Current Feature: No Alert is present in

EVV systems to inform provider that

Authorized Hours are close to being

reached.

Proposed Feature: Each EVV vendor

will provide an optional "alert".

The alert will notify the provider when the

individual/members authorized hours are

close to being reached for the week.1/15/2018 30


Option 4 – Automatic Downward Adjustment Option:

• The provider has an additional option to choose the Automatic Downward Adjustment Option.

• If checked, the rounded EVV pay hours will automatically be downward adjusted to the original scheduled hours, in order to prevent issues with EVV pay hours exceeding the authorized levels for the individual/member.

• If left unchecked, the auto-verified visit will include the additional .25 hours in the actual rounded EVV pay hours.

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Example #1: Schedule 8am - 12pm; 4 hours

• The Provider has Expanded Time Optionchecked

• The Provider has the Automatic Downward Adjustment Option checked

• Attendant called in anytime between 12:00 am - 11:59 pm

• The actual hours worked is 4 hours and 22 minutes

• The call will AUTO-VERIFY at 4 EVV rounded pay hours (automatically downward adjusted to Scheduled Hours instead of 4.25 hours)

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Example #2: Scheduled 1pm - 3pm; 2 hours

• The Provider has the Expanded Time Option checked

• The Provider has Automatic Downward Adjustment Option unchecked

• Attendant called in anytime between 12:00 am - 11:59 pm

• The actual hours worked is 2 hours and 11 minutes

• The call will AUTO-VERIFY at 2.25 EVV rounded pay hours

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Example #3: Scheduled 1pm - 3pm; 2 hours

• The Provider has the Expanded Time Option checked

• The Provider has Automatic Downward Adjustment Option unchecked

• Attendant called in between 12:00 am -11:59 pm

• The actual hours worked is 1 hour and 40 minutes

• The call will AUTO-VERFIY at 1.75 EVV rounded pay hours

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Want to Participate?

• If you consent to participate, your entire agency (all branches) will be set-up to test the pilot solutions

• After your consent form is received by HHSC and the EVV vendor, your EVV Vendor will reach out to you to provide training on the pilot solutions

• You can choose what pilot options you would like to test

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How to sign up for VM Pilot?

• Please contact your EVV vendor if you are interested in participating in the Visit Maintenance Reduction Pilot.

• You must sign the HHSC Visit Maintenance Reduction Pilot consent form before starting

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EVV Compliance Scores

HHSC (DADS) EVV Compliance Scores Quarter 1*

DataLogic: 65 out of 1208 contracts were below 90%.

MEDsys: 83 out of 864 contracts were below 90%.

* Quarter 1=April, May, June, 2017

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EVV Compliance Scores

• Aetna

• Amerigroup

• Blue Cross/Blue Shield

• Children’s Medical Center

• CIGNA

• Community First Health

• Cook Children’s

• Driscoll

• Molina

• Texas Children’s

• Superior

• United

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MCOs EVV Compliance Scores Quarter 1

Most Common Reasons for EVV Recoupments Fee-for-Service

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HHSC/DADS

RegionReason for EVV Recoupment

1/10

• No free text documentation for RC 900, 905, 910 & 305

• Billing over weekly authorized units

• Use RC 305 for everything with no free text when required

2/9• Failure to document the appropriate information in the free text

field on required reason codes

3

• Visit Maintenance completed after billing

• Unable to pull the EVV Visit Log

• Using other reports such as Client Visit Log and Payroll reports to

verify services rendered

• Failure to document the appropriate information in the free text


3/4

• Unable to pull the EVV Visit Log

• Failure to document the appropriate information in the free text


• Overbilling-suspect the contractor is using the schedule instead

of actual EVV Visit time

5/7 • No free text on required reason codes

6• Failure to document the appropriate information in the free text


8 • Failure to use correct free text or not using free text at all

11• Failure to document the appropriate information in the free text


Most Common Reasons for EVV Recoupments - MCOs

• Aetna

• Amerigroup



• CIGNA



• Driscoll

• Molina


• Superior

• United

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Each MCO will provide an update on Recoupments. If the MCO is not present, the information will be available on their website.

Most Common Reasons for EVV Denials - MCOs

• Aetna

• Amerigroup



• CIGNA



• Driscoll

• Molina


• Superior

• United

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Each MCO will provide an update on Recoupments. If the MCO is not present, the information will be available on their website.

Section III

New and Revised EVV Policies

and Requirements

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EVV Provider Manual

• The EVV Provider Manual:

• Includes all EVV policies and

requirements;

• Available electronically on the HHS

EVV website; and

• Each MCO will have the same

information in the EVV Provider on

each MCO website.

Tentative Published date is: Jan. 1, 2018

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EVV Provider Manual

• Appeal Process

• Cell Phones

• HHS or MCO Complaints

• EVV Compliance

• Consumer Directed Services

• Contract Monitoring and EVV

• Data Elements

• EVV Forms

• Fraud/Waste and Abuse

• GPS

• How does EVV work

• Introduction to EVV

• Landlines

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EVV Provider Manual

• New Contracts/ Grace Period

• Program Definitions

• Program and services required to use EVV

• Reason Codes

• EVV Reports

• EVV Billing Codes

• Small Alternative Device

• Unlocking Visit Maintenance Process

• Visit Maintenance

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Unlocking Visit Maintenance

What does this mean?

Providers who recognize a correction is needed to a data element past 60 calendar days from the visit may request visit maintenance unlocked.

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How do I know a correction is needed?

• If you unable to pull an EVV visit log;

• Check the Mismatch Payor Report from the MEDsys EVV system; or

• Check the Failed to Export Report from the DataLogic EVV system.

*For questions with these reports please reach out to your vendor

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What is NOT allowed for corrections?

• Actual Visit Date

• Actual Time In

• Actual Time Out

• Visits prior to Apr. 1, 2016

If a request is made during the time of a contract monitoring review your request will NOT be accepted.

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How do I request visit maintenance be unlocked?

• Contact your payor associated with the request via email asking to have visit maintenance unlocked.

• Your payor will send you a spreadsheet that must be completely filled out and emailed back in a secure email.

• Unsecure email requests will not be processed and may result in a HIPAA violation.

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How is a decision made?

• Approvals are at the payor’sdiscretion.

• Payors will determine their decision on a case-by-case basis.

• Supporting documentation is required per request and will be reviewed by the payor.

• Payors may request additional information if needed.

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What happens once the decision has been made?

Approved Requests:

• Your payor will send you an email with approval; and

• Your vendor will reach out to you with further instruction.

Denied Requests:

• Your payor will send you an email explaining the reason your request was denied.

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Please Note:

• Data element(s) corrections will not impact prior or current recoupments, denials, appeals, and contract action as a result of the provider agency entering an incorrect data element(s).

• Prior and current recoupments, denials, appeals, and contract action will remain.

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Send unlocking visit maintenance requests to:

• HHSC/TMHP [email protected]

• Cook Children’s Health Plan [email protected]

• Children’s Medical Center Health Plan [email protected]

• Driscoll Health Plan [email protected]

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mailto:[email protected]






• Superior Health Plan [email protected]

• Texas Children’s Health Plan [email protected] (email updated 1-8-18)

• Community First Heal Plan [email protected]

• Aetna [email protected]

• Blue Cross Blue Shield [email protected]/15/2018 54








• Cigna Healthcare [email protected]

• Molina [email protected]

• United [email protected]

• Amerigroup [email protected]

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New Small Alternative Device Order Process

• Each EVV vendor is currently developing an electronic request process to order SADs directly from the EVV system

• This electronic request process will eliminate the SAD paper form

• Individuals’ and members’ signature are no longer required to order a SAD

• More information and effective date will be posted on the HHSC EVV and MCOs websites

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Section IV

ReviewEVV Reason Codes EVV Free Text RequirementsEVV Reports1/15/2018 57

Reason Codes

Update:

• Effective July 1, 2017, Reason Code 305 free text now only requires the provider agency to document the missing time in and/or out, the EVV system did not capture.

• Failure to document the missing time in and/or out in the free text comment field may result in claim denial, recoupment or contract action.

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Reason Codes

Update:

• Example: The attendant used the SAD to clock-in at 9am. The SAD malfunctioned at clock-out, 12:00pm, so attendant did not receive the values from device.

• The EVV visit screen shows the 9am clock-in but missing clock-out. The EVV required free text is actual clock-out time of 12:00pm.

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Reason Code Free Text

Seven (7) reason codes require free text entry in the comment field.

1.Reason Code 130 – Disaster or Emergency

• Must document the nature of the disaster or emergency and actual time in and/or time out

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Seven (7) reason codes require free

text entry in the comment field.

2.Reason Code 305 –

Malfunctioning Small Alternative

Device and/or Invalid Small

Alternative Device Value –

Verified Services Were Delivered

• Must document the missing actual

time

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3.Reason Code 310 – Mobile Application Problems

• Must document the nature of the problem and actual time in and time out

4. Reason Code 900 – Attendant Failed to Call In – Verified Services Were Delivered

• Must document actual time in

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5. Reason Code 905 – Attendant Failed to

Call Out – Verified Services Were

Delivered

• Must document actual time out

6. Reason Code 910 – Attendant Failed to

Call In and Out – Verified Services Were

Delivered

• Must document actual time in and time

out

7. Reason Code 999 – Other

• Must enter free text in the comments field

to explain the use of this reason code.1/15/2018

Reason Code Scenarios

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Scenario 1

An attendant worked from 9:00 a.m. to 1:00 p.m. but did not use the token device that was already installed in the home to clock in and out.

A.RC 900- Attendant or assigned staff failed to call in

B.RC 905- Attendant or assigned staff failed to call out

C.RC 910- Attendant or assigned staff failed to call in and out

D.RC 205- Small Alternative Device Pending Installation 1/15/2018 65

Scenario 2

An attendant shows up to an individual/ member’s home and immediately sees they have fallen.

Instead of making the individual/member wait for help so the attendant can call into the EVV system what reason code is the most appropriate to use for the missing clock-in time?

A. RC 130- Disaster or Emergency

B. RC 405 Phone unavailable- Verified Services were delivered

C. RC 500- In-Home Respite Services

D. RC 999- Other66

Scenario 3

An attendant is scheduled for a visit today and at the last minute the individual has to reschedule. What is the most appropriate reason code?

A. RC 121- Attendant or Assigned Staff-no call and no show

B. RC 115- Individual/Member agreed or requested attendant/assigned staff not work schedule

C. RC 135- Confirm visits with no schedule

D. RC 110- Fill-in for regular attendant or assigned staff

Scenario 4

My attendant said the SAD token codes did not go through when calling into the EVV system. What reason code do I use to confirm the visit?

A.RC 300-Phone lines not working

B.RC 305-Malfunctioning small alternative device or invalid small alternative device value

C.RC 310-Malfunctioning Mobile Application

D.Both RC 300 and RC 305

Reason Code Questions Received

From the Electronic Visit Verification Mailbox

Reason Code 100

Schedule Variation

What reason code should be used if the attendant stays with the client longer than the scheduled hours?

• RC 100

• Must save a non-preferred code if attendant failed to clock-in or out.

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Reason Code 200

Small Alternative Device Has Been Ordered

Our agency has an individual/member who is pending token arrival. The SAD form was already sent out and has been approved. Which Reason Code should we use?

• Token/ Small Alternative Device has been ordered

• Provider waiting to receive the device

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Reason Code 700

Downward Adjustment to Billed Hours

Reason Code 700 Downward Adjustment is to only be used for the rounding of the pay hours done by the EVV system.

• Reason Code 700 is used to offset the rounding, usually 15 minutes

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Reason Code 905

Failed to Call Out

What happens if the attendant clocked out at 10pm because they forgot to clock out when services were finished?

What code would I use? Can I adjust the pay hours (what I am billing) from 12 hours to 5 hours?

• RC 905

• Adjust the pay hours to what was actually worked and what you are actually going to bill, which in this case is 5 hours.1/15/2018 73

EVV Reports

The following HHSC EVV standard reports can be reviewed by HHSC and MCOs and provider agencies:

• Attendant/Nurse Providing Services by Individual

• Alternate Device Order Status

• CDS Employee

• EVV Compliance Summary Snapshot Report-MCOs

• EVV Compliance Plan Summary Snapshot – HHSC

• EVV Compliance Plan Daily Snapshot Report1/15/2018 74

EVV Reports

The following HHSC EVV standard reports can be reviewed by DADS/ MCOs / TMHP and provider agencies:

• Contracts List

• EVV Visit Log

• Provider Agency/FMSA List

• Reason Code Free Text Report

• Reason Code Use Report

• Units of Summary Report

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EVV Complaints

Complaint Process:

• If you have a compliant regarding your EVV vendor please send an email to HHSC:

• [email protected]

• Please be sure to include any ticket numbers, if applicable

• If you have a complaint against an MCO, please send an email to:

• [email protected]

1/15/2018

EVV Contacts

For EVV inquires please send an email to:[email protected]

For information on EVV please visit the HHSC EVV or your MCO website.

The HHSC EVV website is located at:

https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/electronic-visit-verification

https://hhs.texas.gov/doing-business-hhs/provider-portals/resources/electronic-visit-verification

Questions and

Answer

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1

Electronic Visit Verification (EVV)

Frequently Asked Questions HHSC EVV Mailbox: [email protected]

Reason Codes

1. Why can't there be a reason code that says, "merged call only"?

HHSC reviews all request for reason code changes. If you have

a suggestion for a reason code, please submit it to the HHSC EVV mailbox.

2. Does the provider agency need to use Reason Code 121 when

the attendant did not show up to work?

Yes, Reason Code 121, Attendant or Assigned Staff - No Call and

No Show (NEW) should be selected when the attendant or

assigned staff failed to report to work and did not inform the

provider agency until after the missed schedule visit.

Remember, provider agencies must follow any program

documentation rules and policies (if applicable) when the

schedule is not worked.

3. Can Reason Code 105 also be used if the caregiver is with the

client at a doctor appointment?

Yes, if the task is part of the individual/member service plan.

4. What reason code do we use if a Small Alternative Device (SAD) is being ordered?

Reason Code 200 should be used if a SAD has been ordered –

(Initial or Replacement Order).

Reason Code 205 should be used when the SAD is pending

installation.


2

5. Can Reason Code 305 be used if the attendant writes down

the wrong token number?

Yes, you may use Reason Code 305 for an invalid SAD value,

however free text is required. The provider must document the

actual time service delivery begins and ends in the comment

field. If the EVV system is missing the start or end time, the

provider must document the missing time in the free text.

If Reason Code 305 is used for the same individual/member over

a period greater than 14 calendar days, this may constitute

misuse. If the attendant cannot enter the correct SAD value,

more training should be provided.

6. What reason code do I use if an attendant says she is doing

laundry (in the home) and is unable to clock out or in?

Laundry is not an emergency situation, the attendant should be able to clock-in or out. You must use a non-preferred reason

code (900, 905 or 910) for this situation.

7. Can we use Reason Code 115 if the attendant calls in sick?

Yes, Reason Code 115, Individual or Member Agreed or

Requested Attendant or Assigned Staff Not Work Schedule is selected when the attendant does not work and the

individual/member was contacted and agreed, or the individual/member contacted the agency and requested the

attendant not work.

Remember, provider agencies must follow any program

documentation rules and policies (if applicable) when the

schedule is not worked.

8. If the attendant does not work can the visit be deleted with documentation or do we use Reason Code 115 with

documentation?

Only future visits can be canceled or deleted. If the attendant missed a visit you need to use the most appropriate reason code

to explain why a visit was not worked.

3

Reason Code 115 should be used if the attendant does not work

and the individual/member agreed. You may add Free Text to Reason Code 115, explaining why the visit was not worked but it

is not required.

9. If a client is hospitalized should we delete a visit using Reason Code 600 or zero out?

Use Reason Code 600 when the individual/member is

hospitalized. Confirm a visit using Reason Code 600 with zero

pay hours.

10. Do we have to enter the exact times made in and out, into the

free text field?

Yes, the actual time the attendant started and stopped providing

services must be entered into the free text field, if required.

11. If an attendant was instructed to call time in and out using a cell phone while the attendant is waiting on a SAD, do we have

to go back and change reason codes to Reason Code 900.

If the 60-day visit maintenance deadline has not passed, the

provider agency may add the most appropriate reason code. Reason Code 200 – Small Alternative Device Has Been Ordered –

(Initial or Replacement Order) is selected when a SAD has been ordered, but the provider has not yet received the device.

Please remember cell phone are not allowed to be used to clock-

in and out of the EVV system.

12. What reason code do we use if the attendant worked over the

scheduled hours but was not authorized to do so?

Reason Code 100 Scheduled Variation would be used. Reason

Code 100 is selected when the attendant or assigned staff provided more or fewer hours of service than scheduled.

Remember, Reason Code 100 cannot be used when an attendant

or assigned staff fails to clock-in and/or clock-out, unless the

appropriate non-preferred reason code (900, 905, or 910) is also

saved to the visit.

4

Pay hours must be adjusted to reflect what the provider agency

is going to bill the payor for that visit.

Provider agencies must follow any program documentation rules

and policies (if applicable) when there is a schedule variation.

13. What reason code should be used when the attendant cannot

clock in or out due to having problems with their cell phone not working.

Cell phones are not allowed to be used to clock-in and out of the

EVV system. If an attendant uses their cell phone or the individual’s cell phone to clock-in or clock-out the provider

agency would have to use non-preferred Reason Code 915, Wrong Phone Number to confirm the visit.

14. What would be a good code when attendant clocks in and

clocks out with an incorrect ID number but the time is shown when the attendant did clock out?

Reason Code 120, Invalid Attendant or Assigned Staff or

Individual or Member ID Entered – Verified Services Were

Delivered is selected when an attendant did not accurately or

completely enter their employee EVV ID or the

individual/member EVV ID into the EVV system.

15. An attendant is headed to their shift, and the motor on their

car blows. Is this a Reason Code 130?

No, Reason Code 130, Disaster or Emergency only applies to the individual or member. The most appropriate reason code to use

would depend on if the attendant ended up working or not or if

another attendant filled in.

16. If the attendant pressed 1 to clock-in for both the in and out call, we switch the later call to out call. Can we then use

Reason Code 215 to confirm that visit?

Yes, Reason Code 215- Reversal of Call-In / Call-Out Times

(NEW) is selected when an attendant or assigned staff reversed

a call-in for a call-out or a call-out for a call-in.

5

17. What reason code would you use if the individual/member

relocates from one place to another and their landline is

pending reconnection?

Reason Code 400, Individual/Member Does Not Have Home

Phone – Verified Services Were Delivered would be the most

appropriate reason code. If the phone is not reconnected within

14 days, please document the situation and how long it will take

to reconnect the phone line.

18. What reason code do we use if the attendant called-in, but did not call-out and you are not going to pay attendant?

If the attendant or assigned staff forgets to call-out, you would

have to use Reason Code 905, Attendant or Assigned Staff Failed to Call Out –Verified Services Were Delivered. Free text is

required and you must document the actual time service ended in the comment field. Please contact Texas Workforce

Commission for any questions regarding paying your attendants.

19. If we employ an attendant with disabilities (deaf and/or blind), what reason code are we to use?

There is not a specific reason code to use if an attendant has a visual or hearing impairment. Contact your EVV vendor and

payor to see how the attendant can be accommodated.

20. If an attendant clocked out more than 30 minutes after their shift ends, would the visit be eligible to use Reason Code 700

for downward adjust or Reason Code 905 failed to clock-out?

This would depend on if the attendant forgot to clock-out and remembered 30 minutes later or if the attendant worked 30

minutes extra.

If they forgot to clock out, you would use Reason Code 905 and can adjust the pay hours down. If they worked more hours than

scheduled, then you can use Reason Code 100.

21. If we have to create visits after the fact because they did not call in and out, do we use Reason Code 700 if they worked

over the scheduled hours more than an hour?

6

No, if an attendant did not call in and out you must use Reason Code 915, Attendant or Assigned Staff Failed to Call In and Out

– Verified Services Were Delivered.

You must verify services were delivered and enter required free text. You must document actual time services started and

ended.

Reason Code 100, Schedule Variation is used when the attendant worked more or less hours than scheduled. If there is

no call in/out, the appropriate non-preferred reason code must also be saved to the visit.

22. Will there be a reason code for supervision hours?

At this time, there is no reason code specific to supervisor hours.

23. If Reason Code 200 is used more than 14 days because the provider agency is still waiting on a token, what will happen?

Provider agencies should contact the vendor to check status of

the request. If the vendor has not sent a SAD within 10 business days from the date the vendor received a complete order form,

the provider should notify the appropriate payor.

Using Reason Code 200 for an extended period of time may constitute misuse of this preferred reason code.

24. What if the provider forgot to clock-out and then clocked out

more than an hour later?

That is a failure to clock-out, use non-preferred Reason Code

905 and add the required free text. Adjust the pay hours down to what was actually worked and what you are billing for.

25. What if the case worker asked us to stop services; do we

suspend in EVV services?

Yes, if a schedule is already in the system you can use Reason Code 600-Service Suspension to clear those visits. Remember

only future visits can be canceled.

October 2017 HHSC EVV Reason Code Scenarios

For Training Purposes Only

Attendant Sandy is scheduled to work from 8am to 12pm. Mrs. Harris is sleeping and doesn’t

answer the door. Sandy calls the provider agency to tell them about the situation. Sandy later

arrives at 9am and Mrs. Harris answers the door. Sandy clocks in at 9am and provides

services till 12pm and clocks out. What would be the most appropriate reason code(s) to use?

1.

a. RC #100 – Schedule Variation

b. RC #900 – Attendant Failed to Call In – Verified Services Were Delivered

c. RC #110 – Fill-in for Regular Attendant

d. RC #999 - Other

2. Mr. Jones has temporarily gone to a nursing facility for rehabilitation. There are scheduled

visits in the EVV system for Mr. Jones which will not be provided, and this may cause an

exception that requires visit maintenance. Which is the most appropriate reason code(s) to

use?

a. RC #410 – Individual/Member Refused Attendant or Assigned Staff Use of Phone –

Verified Services Were Delivered

b. RC #600 – Service Suspension

c. RC #121 – Attendant or Assigned Staff – No Call and No Show

d. RC #115 – Individual/Member Agreed or Requested Attendant or Assigned Staff Not

Work Schedule

3. Attendant Harper forgot to call in and call out of the EVV system as required when she

provided services to Mr. Smith. Which is the most appropriate reason code(s) to use?



c. RC #905 – Attendant Failed to Call Out – Verified Services Were Delivered

d. RC #910 – Attendant Failed to Call In and Out – Verified Services Were Delivered

4. Mrs. Jackson’s hair appointment ended later than expected so she calls the provider agency

and asks that Cindy, her attendant, come in 30 minutes later. Cindy is scheduled from 12pm

to 5pm. Cindy shows up 32 minutes later and works from 12:32pm to 5pm. Which is the

most appropriate reason code(s) to use?


b. RC #910 – Attendant Failed to Call In and Out – Verified Services Were Delivered

c. RC #999 – Other

d. None of the above

Page 1 of 5

October 2017 - HHSC Reason Code Scenarios - For Training Purposes Only

5. Mr. Houston informed the provider agency that his home landline phone was disconnected,

and he does not plan to replace it. The provider agency immediately ordered a small

alternative device for Mr. Houston, but the device has not yet arrived. Which is the most

appropriate reason code(s) to use?

a. RC #200 – Small Alternative Device Has Been Ordered – (Initial or Replacement

Order)

RC #205 – Small Alternative Device Pending Installation

RC #400 – Individual/Member Does Not Have Home Phone – Verified Services

Were Delivered

RC #405 – Phone Unavailable – Verified Services Were Delivered

b.

c.

d.

6. Ms. Washington’s home landline phone was recently disconnected, but she says that the

phone will be back on in a day or two and that she would rather use her home landline phone

than get a small alternative device. Which is the most appropriate reason code(s) to use?

a. RC #200 – Small Alternative Device Has Been Ordered – (Initial or Replacement

Order)

b. RC #300 – Phone Lines Not Working – Attendant Not Able to Call – Verified

Services Were Delivered

c. RC #400 – Individual/Member Does Not Have Home Phone – Verified Services

Were Delivered

d. RC #410 – Individual/Member Refused Attendant Use of Phone – Verified Services

Were Delivered

7. Attendant Edwards was scheduled to provide services to Mrs. Simpson but got a flat tire on

her way to work. The provider agency sent Attendant Miller to provide the scheduled

services to Mrs. Simpson for that visit. Which is the most appropriate reason code(s) to use?

a. RC #110 – Fill-in for Regular Attendant


c. RC #910 – Attendant Failed to Call In and Out – Verified Services Were Delivered

d. RC #115 – Individual/Member Agreed or Requested Attendant Not Work Schedule

8. Attendant Wilson arrives at Connie’s home to provide services. Wilson tries to get the values

from the small alternative device but the numbers are not visible when he clocks in. After

services are provided, Wilson clocks out by writing down the small alternative device values

with no problem. Which is the most appropriate reason code(s) to use?

a. RC #310 – Malfunctioning Mobile Application

b. RC #305 – Malfunctioning Small Alternative Device and/or Invalid Small

Alternative Device Value – Verified Services Were Delivered

c. RC #300 – Phone Lines Not Working – Attendant Not Able to Call – Verified


d. RC #100 – Schedule Variation

Page 2 of 5


9. Attendant Williams began providing services immediately upon arriving at the home and

forgot to call in to the EVV system. She did remember to use the EVV system to call out but

worked longer than scheduled. Which is the most appropriate reason code(s) to use?

a. RC #900 – Attendant Failed to Call In – Verified Services Were Delivered and RC

#100 – Schedule Variation

RC #115 – Individual/Member Agreed or Requested Attendant Not Work Schedule

RC #100 – Schedule Variation

RC #100 – Schedule Variation and RC #905 Attendant or Assigned Staff Failed to

Call Out – Verified Services Were Delivered

b.

c.

d.

10. Attendant Michaels attempts to use the individual’s home landline phone to call into the

EVV system, but consistently receives a busy signal on all of the toll-free EVV phone

numbers. Which is the most appropriate reason code(s) to use?

a. RC #305 – Malfunctioning Small Alternative Device and/or Invalid Small


b. RC #120 – Invalid Attendant or Individual/Member ID Entered – Attendant Verified

c. RC #700 - Downward Adjustment to Billed Hours

d. RC #300 – Phone Lines Not Working – Attendant Not Able to Call – Verified


11. Attendant Carson arrives to provide services to Mr. White as scheduled from 9am to 3pm but

cannot call into the EVV system because Mr. White is on the phone with his doctor.

Attendant Carson clocks out of the EVV system at 3pm as scheduled. Which is the most


a. RC #405 – Phone Unavailable

b. RC #100 – Schedule Variation

c. RC #300 – Phone Lines Not Working – Attendant Not Able to Call – Verified


d. RC #999 - Other

12. Attendant Andrews tried to call out of the EVV system but wasn’t sure whether the call went

through successfully, so he called back to the EVV system several different times. As a

result, there are extra calls displayed in the EVV system that may cause an exception

requiring visit maintenance. Which is the most appropriate reason code(s) to use?

a.

b.

c.

d.

RC #125 – Multiple Calls For One Visit


RC #121 Attendant or Assigned Staff – No Call and No Show

None of the above

Page 3 of 5


13. Attendant Sarah has a schedule from 9am to 2pm. Sarah clocks in by using Mr. Terry’s home

landline at 9:04am and starts providing services. At 2pm Sarah leaves the home but forgets

to clock out. Around 6:30pm Sarah realizes she forgot to clock out and goes back to Mr.

Terry’s home and asks if she can use his phone to call out because she forgot to do so earlier.

Mr. Terry agrees. What is the most appropriate reason code(s) to use?

a.

b.

c.

RC #700 – Downward Adjustment to Billed Hours


RC #905 – Attendant or Assigned Staff Failed to Call Out – Verified Services were

delivered

RC #300 – Phone Lines Not Working – Attendant Not Able to Call – Verified


d.

14. The attendant transposes part of the EVV Client ID while entering a small alternative device

value into the EVV system. Which is the most appropriate reason code(s) to use?

a.

b.

RC #120 – Invalid Attendant or Individual/Member ID Entered – Attendant Verified



RC #910 – Attendant Failed to Call In and Out – Verified Services Were Delivered



c.

d.

15. Attendant Michael provides services to Mr. Rios as scheduled from 1pm to 6pm. Michael

uses the EVV system by clocking in and out with the small alternative device. Later Michael

calls in the values but they register in the EVV system as a later date and time. The provider

agency needs to make the necessary adjustments. Which is the most appropriate reason

code(s) to use?

a.

b.


RC #305 – Malfunctioning Small Alternative Device and/or Invalid Small



RC#700 - Downward Adjustment to Billed Hours

c.

d.

16. Ms. Baker informs the provider agency that she has family coming in from out of town on

Friday and does not want the attendant to come to her home to provide services that day.

Which is the most appropriate reason code(s) to use?

a.

b.

c.

d.

RC #110 – Fill-in for Regular Attendant


RC #910 – Attendant Failed to Call In and Out – Verified Services Were Delivered

RC #115 – Individual/Member Agreed or Requested Attendant Not Work Schedule

Page 4 of 5


17. Attendant Hodges is unable to provide the scheduled service to Mrs. Aldridge because there

is a flash flood in the neighborhood leading to Mrs. Aldridge’s home. Which is the most


a.

b.

c.

d.

RC #130 – Disaster or Emergency


RC #600 – Service Suspension

RC #999 – Other

18. Mrs. Jackson’s Medicaid eligibility was terminated effective June 1. On June 7, her

eligibility was reinstated effective retroactively to June 1. The provider agency chose to

continue providing services to Mrs. Jackson but used only paper time sheets to document

the time in and time out for services delivered during the period Mrs. Jackson was not

Medicaid eligible and the attendant did not clock in or clock out of the EVV system for

these visits. Which is the most appropriate reason code to use?

a.

b.

Cc

.


RC #910 – Attendant Failed to Call In and Out – Verified Services Were

Delivered

RC #999 – Other

None of the above

c.

d.

19. Attendant Grace was scheduled to work from 12pm to 5pm. She clocks in at 12pm and starts

providing services. Close to 5pm Attendant Grace is assisting Ms. Garcia with toileting. She

then clocks out at 5:09pm. Which is the most appropriate reason code(s) to use?

a.

b.

c.

d.


RC #130 – Disaster or Emergency

RC #700 – Downward Adjustment to Billed Hours

RC #905 – Attendant Failed to Call Out – Verified Services Were Delivered

20. Mr. Holloway has a small alternative device (SAD). Attendant Riojas provides services to

Mr. Holloway and writes down the SAD values at the beginning and ending of the visit.

However, when Attendant Riojas tries to enter the SAD values into the EVV system, she

receives an error message. Which is the most appropriate reason code(s) to use?

a. RC #305 – Malfunctioning Small Alternative Device and/or Invalid Small




RC #135 Confirm Visits with No Schedule

b.

c.

d.

Page 5 of 5


HHSC EVV Reason Code Scenarios Answer Key

For Training Purposes Only

Must be Used with the October 2017 HHSC EVV Reason Code

Scenarios

1. A.) RC #100 – Schedule Variation

Note: When the attendant shows up at the time scheduled but was not able to start

providing services the attendant is not able to claim that time. Since the attendant

went in later to provide services and worked to her scheduled end time, the attendant

worked fewer hours than scheduled.

B.) RC #600 – Service Suspension

Note: The EVV systems allow a provider agency to delete visits scheduled to take

place the future. Please contact your EVV vendor for more information on deleting

future schedules that will not be worked. However, scheduled visits in the past that

were not provided due to a service suspension can have visit maintenance completed

using RC #600. All situations that require documentation must still be documented

according to program policy.

D.) RC #910 – Attendant Failed to Call In and Out – Verified Services Were Delivered

Note: Free text is required in the Comment field when RC #910 is used. The provider

agency must record the actual time service delivery begins and ends in the Comment

field. At a minimum, two actual times must be entered in the Comment field for RC

#910, such as “9:45 am – 3:12 pm”. If the required times are not entered in the

Comment field, the visit may be subject to recoupment.

A.) RC #100 – Schedule Variation

Note: When the attendant works fewer hours than scheduled, this causes a variation

to the schedule.

A.) RC #200 – Small Alternative Device Has Been Ordered – (Initial or Replacement

Order)

Note: RC #200 does not have a time guideline associated with it for provider

agencies because provider agencies cannot control how long it takes an EVV vendor

to provide a small alternative device. However, EVV vendors are expected to deliver

small alternative devices to provider agencies or CDS employers within 10 business

days of receipt of the completed Medicaid EVV Small Alternative Device Agreement

Form.

2.

3.

4.

5.

Page 1 of 4 HHSC Reason Code Scenarios Answer Key - October 2017 For Training Purposes Only - October 2017

6. B.) RC #300 – Phone Lines Not Working – Attendant Not Able to Call – Verified


Note: RC #300 is the most appropriate reason code to use in this situation because the

landline phone service disruption is temporary and brief. However, if this becomes a

recurring or long-term issue, then a small alternative device should be ordered. If the

individual indicates that the home landline phone service will not be reinstated, then

RC #400 should be used and a small alternative device should be ordered promptly.

A.) RC #110 – Fill-in for Regular Attendant

Note: Some EVV systems may not cause an exception requiring visit maintenance

when someone other than the scheduled attendant provides services. Please contact

your EVV vendor for more information about fill-in or substitute attendants.

B.) RC #305 – Malfunctioning Small Alternative Device and/or Invalid Small Alternative

Device Value – Verified Services Were Delivered

Note: If the small alternative device is not working properly and the attendant is not

able to write down the values for the clock in but is able to get the values for the

clock out or vice versa, RC #305 would be used and only the missing time will need

to be entered in free text.

A.) RC #900 – Attendant Failed to Call In – Verified Services Were Delivered and RC

#100 – Schedule Variation

Note: The EVV system allows up to 10 reason codes to be used for one visit. In this

scenario, the attendant failed to call in and worked longer than scheduled. RC #900

and RC #100 would be used to explain the situation. Anytime a non-preferred reason

code is saved in conjunction with a preferred reason code, the visit is a non-preferred

visit.

7.

8.

9.

10. D.) RC #300 – Phone Lines Not Working – Attendant Not Able to Call – Verified


Note: RC #300 is the most appropriate reason code to use in this situation because the

attendant cannot call the EVV system due to a technical problem that prevents the

phone call from connecting to the EVV system. The possible source of the technical

problem (which could be the EVV vendor, the telephone company, or the individual’s

telephone itself) does not change the fact that the phone lines are not working to let

calls through.

11. A.) RC#405 – Phone Unavailable- Verified Services Were Delivered

Note: In this scenario, the individual was on the phone with the doctor when the

attendant arrived and was not able to use the phone to clock in. The most appropriate

reason code is RC# 405, Phone Unavailable. The attendant should never tell the

individual or member to get off the phone so the attendant can clock in or out. If this

is a reoccurring issue a small alternative device should be ordered.


12. A.) RC #125 – Multiple Calls For One Visit

Note: While provider agencies are not required to complete visit maintenance on

extraneous calls not used to complete a visit in EVV, many provider agencies find it

helpful to remove these extraneous calls from their visit maintenance screen. RC

#125 may be used to clear the exceptions generated by these extra calls, but provider

agencies should be careful to ensure that RC #125 is only used for calls that are truly

extraneous and not needed to complete a visit. This is a preferred reason code.

13. C.) RC #905 – Attendant or Assigned Staff Failed to Call Out – Verified Services were

delivered

Note: In this scenario, the attendant did not clock out until 4hrs and 30mins later

which is considered a failure to call out even though the attendant did go back to the

individual’s home to call out. The provider agency must use RC #905 - Attendant or

Assigned Staff Failed to Call Out to confirm the visit. The provider agency will need

to adjust the pay hours to what was actually worked, which in this case was only five

(5) hours. You do not have to use RC# 700 in addition to RC #905 when making

adjustments to the pay hours in this case.

14. A.) RC #120 – Invalid Attendant or Individual/Member ID Entered – Attendant Verified

Note: RC #120 is the most appropriate reason code for this situation because the

attendant did not accurately enter the individual’s/member’s EVV ID into the EVV

system when it was required by the EVV system.

15. B.) RC #305 – Malfunctioning Small Alternative Device and/or Invalid Small Alternative


Note: There are times when the small alternative device can malfunction for multiple

reasons. If this happens, it’s best to contact your vendor to see if the small alternative

device needs to be replaced.

16. D.) RC #115 – Individual/Member Agreed or Requested Attendant Not Work Schedule

Note: In this case, the individual/member requested the attendant not work the

schedule due to family coming in to town. Please remember all situations that require

documentation must still be documented according to program policy.


17. A.) RC #130 – Disaster or Emergency

Note: Because of the flash flooding in Mrs. Aldridge neighborhood, the attendant

could not provide services due to safety risks. Free text is required in the comment

field when RC #130 is used. The provider must document the nature of the disaster

or emergency and the actual time service delivery begins and/or ends (if any services

were delivered) in the Comment field. In this case, the free text should include a

description of the disaster, “flashing flooding” and the actual time of any hours

worked. In this scenario, the attendant did not provide any services so the free text

should indicate zero pay hours. Please remember if the required free text is not

entered in the Comment field, the visit may be subject to recoupment. All situations

that require documentation must be documented according to program policy.

18. B.) RC #910 – Schedule Variation and RC #900 – Attendant or Assigned Staff Failed to

Call In – Verified Services Were Delivered

Note: If a provider agency chooses to provide services to an individual/Member

during a period of ineligibility, the attendant must still continue to call in and out of

the EVV system and the provider agency must continue to complete any required

visit maintenance prior to the visit maintenance deadline. Once the individual’s

eligibility is reinstated retroactively, the provider agency may then bill for those

services. In this scenario the attendant did not clock in and clock out of the EVV

system for these visits so RC #910 must be used and free text is required in the

Comment field when RC #910 is used. The provider agency must record the actual

time service delivery begins and ends in the Comment field. At a minimum, two

actual times must be entered in the Comment field for RC #910, such as “9:45 am –

3:12 pm”. If the required times are not entered in the Comment field, the visit may be

subject to recoupment.

19. C.) RC #700 – Downward Adjustment to Billed Hours

Note: The attendant did exactly what was expected of them. Due to going 9 minutes

over the scheduled time, the EVV system is going to round to the nearest quarter

hour. In this scenario, the total hours worked is going to be rounded to 5 hours and

15 minutes or 5.25. To downward adjust the pay hours you would use RC #700 and

adjust the 5 hours and 15 minutes down to the 5 hours that was authorized and what

billed.

20. A.) RC #305 – Malfunctioning Small Alternative Device and/or Invalid Small Alternative


Note: Free text is required in the comment field when RC #305 is used. The provider

agency must record the actual time service delivery begins and ends in the Comment

field. Only the missing time is required. In this scenario the attendant is missing both

time in and time out. What is expected in free text is the numerical time such as,

“10:30am – 1:35pm”. Page 4 of 4

HHSC Reason Code Scenarios Answer Key - October 2017 For Training Purposes Only - October 2017

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