Electronic Visit Verification Overview

What is EVV?

EVV is now required for all mandated services - See EVV Program Manual for details

Electronic Visit Verification (EVV) is a technology used to verify that home or community based service visits occur. The purpose of EVV is to ensure that services are delivered to people needing those services and that providers only bill for services rendered. EVV typically verifies visit information through a mobile application on a smart phone or tablet, a toll-free telephone number, or a web-based portal.

What is EVV?
EVV Caregiver Walk-thru
 

Why is EVV required?

Section 12006 of the 21st Century Cures Act requires all state Medicaid agencies implement an EVV solution for Personal Care and Home Health services. States that do not implement EVV will incur a reduction of Federal funding. The Department has expanded the scope of EVV in Colorado to other services similar in nature and service delivery. A full list of EVV required services is below.

 

When will EVV start?

As of August 3, 2020, EVV is now required for all mandated services. See EVV Program Manual for details. Once the claim edit is activated, EVV will be required for claims processing.  Claims without corresponding and complete EVV will deny during claims processing.  To determine which services require EVV, please review your agency's billing Remittance Advice and look for EOB code 3054.

 

What must EVV capture?

Type of Service
Performed

Individual Receiving
the Service

Date of the
Service

Location of
Service Delivery

Individual Providing
the Service

Time the Service
Begins and Ends

 

Implementation Model

Colorado has deployed a hybrid EVV model, meaning that provider agencies may choose to use the State EVV Solution at no cost or utilize a Provider Choice EVV System by contracting with vendor of their choice.

Provider agencies must choose if they will utilize the State EVV Solution or procure and utilize a Provider Choice System. It is responsibility of each provider agency to select and implement an EVV solution by August 3, 2020.

Providers selecting the State EVV Solution or Provider Choice System should refer to the respective section of the EVV Solution Information page for additional information.

 

EVV Timeline

Beginning on August 3, 2020, providers of EVV required services must collect EVV data prior to claims submission. This implementation date will allow providers necessary time to incorporate EVV into business practices, before the Federal mandate. The pre-payment claim review will mark when claims without corresponding EVV will deny during claims processing. Between August 3, 2020 and the pre-payment claim review, the Department will monitor provider compliance with EVV and provide technical assistance to ensure sufficient compliance.

 

Required Services

The Department is implementing EVV for federally mandated services and other services that are similar in nature and service delivery. To determine if your agency will be required to use EVV, please review Appendix C of the EVV Program Manual on the EVV Resources page. All service codes listed in that document require EVV data prior to claims adjudication.

The implementation of EVV will not impact current service rules for EVV required services. EVV data should be collected wherever service provision occurs, whether that be in the members home or in the community. Please note, that services provided in an office or provider-owned residential setting are generally exempt from EVV. Refer to the Service Code Inclusion List for details.

 

How is Colorado implementing EVV?

Colorado is implementing a hybrid model EVV program. This means that a provider agency may choose to use the State EVV Solution or utilize a Provider Choice Solution. The State EVV Solution is free to use, however provider agencies will be responsible for costs associated with Provider Choice Solutions. The Department has subcontracted with Sandata Technologies for the State EVV Solution. The State EVV Solution utilizes three technologies: a mobile application, toll-free telephone number, and a provider web portal. Provider Choice Solutions will often use the same EVV technologies, however other methods of verification may be used. Provider agencies who choose to utilize a Provider Choice Solution must ensure that their system is configured to Colorado EVV rules and requirements.

View a list of vendors that have already interfaced with Sandata (in Colorado and in other states). Choosing a Provider Choice Solution that has already interfaced with Sandata may reduce overall interface time. Please refer to the Provider Choice Solution section of the EVV Solution Information page for information on interfacing your preferred vendor.

 

What Types of Services Require EVV for Colorado?

The list below is an overview of types of service that requires EVV. View complete list of EVV Required Service Types in the EVV Program Manual on the Resources page.

  • Behavioral Therapies (provided in home or community)
  • Consumer Directed Attendant Support Services (CDASS)
  • Durable Medical Equipment (select services)
  • Home Health (RN, LPN, CNA, PT, OT, SLP)
  • Homemaker
  • Hospice
  • Independent Living Skills Training (ILST)
  • In-Home Support Services (IHSS)
  • Life Skills Training
  • Occupational Therapy (provided in the home)
  • Pediatric Behavioral Health
  • Pediatric Personal Care
  • Personal Care
  • Physical Therapy (provided in the home)
  • Private Duty Nursing
  • Respite (provided in the home or community)
  • Speech Therapy (provided in the home)
  • Youth Day

Service provided by a live-in caregiver may be exempt from EVV. For more information refer to Operational Memo Number: HCPF OM 20-51.

View more EVV FAQs