Electronic Visit Verification Program Manual

Official guidance for the Colorado Electronic Visit Verification (EVV) Program

Back to Inclusions List

1. EVV Program Glossary

   1. Participants

      1. Member
         Member is an actively enrolled Health First Colorado (Colorado's Medicaid program) recipient of EVV-required services. The member is called the 'Client' in the State EVV Solution and Provider Choice System.
          
      2. Direct Care Worker
         Direct Care Worker, also known as Caregiver, is the person providing a service to a member. The Direct Care Worker is often an employee of a Provider.
          
      3. Provider
         Provider is an actively enrolled Health First Colorado provider billing for EVV-required services.
         
         Back to Top

   2. General

      1. The 21st Century Cures Act

         The 21st Century Cures Act, also known as the Cures Act, is a Federal statute "to accelerate the discovery, development, and delivery of 21st-century cures, and for other purposes." Section 12006 of the Cures Act mandates State Medicaid agencies to use Electronic Visit Verification.

      2. Electronic Visit Verification (EVV)

         EVV means the use of technology, including mobile devices, telephony, or web-based portals, to verify the required data elements related to the delivery of Health First Colorado services as mandated by the 21st Century Cures Act and CCR 2505-10 Section 8.001.

      3. Colorado "Open Choice" or "Hybrid" Model

         An Open Choice or Hybrid EVV model means that in Colorado a provider agency may choose to use the State EVV Solution at no cost or utilize a Provider Choice System. Providers who choose to utilize a Provider Choice System must ensure that their system is configured to Colorado EVV rules and requirements.

      4. State EVV Solution

         State EVV Solution means the portion of the Colorado hybrid implementation model made available by HCPF. The State EVV Solution includes the Mobile Visit Verification (MVV) Application, Telephonic Visit Verification (TVV) System, the Provider EVV Portal, and the optional Scheduling module. Refer to the Technical Definitions section. HCPF utilizes Sandata for the State EVV Solution and the solution is offered at no cost to providers.

      5. Provider Choice System

         Provider Choice System means the portion of the Colorado hybrid implementation model chosen by providers to submit EVV data. In some cases, providers may choose to add an EVV component to an administrative technology already in use. All contracted technologies must complete interface testing with Sandata and providers must complete Data Aggregator training. Provider Choice Systems are paid for by the Provider, satisfy all requirements as defined in rule, are compatible with the State EVV Solution interfacing, and are consistent with Federal and State law.

      6. Verification Data Points

         Verification Data Points are the essential points of data that all EVV records must have to be considered a viable EVV. The federally required points and their corresponding definitions in Colorado are:

         Federally Required Point of Data	Corresponding Definition in Colorado
         The type of service performed	EVV Type of Service is a designation given to a group of appropriate codes for a type of service delivered. Full information is in the EVV Type of Service section of this manual.
         The individual receiving the service	The individual receiving the service is the Member as clarified in the Participant Definitions of this manual
         The date of the service	The date of the service
         The location of service delivery	A location may be a mailing address, GPS coordinates, or a uniquely identified location. A uniquely identifiable location example is "Colorado State Capital Building", recording "Doctor's office" is not uniquely identifiable and is therefore not an acceptable location record.
         The individual providing the service	The Direct Care Worker is clarified in the Participant Definitions of this manual. Direct Care Workers are affiliated with a Provider as clarified in the Participant Definitions of this manual.
         The time the service begins and ends	The time that a service begins and the time that a service ends, as recorded utilizing EVV technology at the time of service.

          

         EVV records also contain additional points, like sequence identifiers which indicate the order in which records are updated. All Verification Data Points are listed in the Technical Specification Documents section of the EVV Solution Information web page.

      7. Threshold

         Threshold means the HCPF-defined acceptable limit of modified and manual EVV records determined as a percent of paid claims.
         
         Back to Top

   3. Operational Use

      1. Sandata Welcome Letter

         Welcome email from Sandata sent to the provider's Service Email Address after training has been completed. The Sandata Welcome Letter includes Sandata credentials for entry into the State EVV Solution Provider EVV Portal or Provider Choice EVV Solution Data Aggregator.

      2. Unmodified EVV

         Unmodified EVV is an EVV captured by a caregiver with all Verification Data Points at the time of service and remains unmodified in any way.

      3. Modified EVV

         Modified EVV is an EVV record with one or more of the Verification Data Points captured or modified after the time of service.

      4. Exception

         Exception means an alert identifying a missing Verification Point of Data. All Exceptions must be fixed for an EVV record to be a verified visit.

         Exceptions may be fixed in the Visit Maintenance module of the State EVV Solution. For Provider Choice functionality contact your vendor.

      5. Alternate Location

         An Alternate Location means a modification that corrects the location recorded at the time of service or enters an otherwise unrecorded location. Refer to the Alternate Locations Guidance section for more information.

      6. Manual Visit Entry (Manual EVV)

         Manual Visit Entry means an EVV record input in the Provider EVV Portal after the time-of-service delivery by administratively entering all Verification Points of Data.

      7. Verified Visit

         A verified visit does not contain any exceptions, meaning either no exceptions exist, or they have been fixed, making the visit eligible for claim matching.

      8. Matched Visit

         A matched visit is an EVV record that has matched to a billed claim. A matched visit requires a verified visit EVV record and a billed claim that has no other claim errors and that has been paid correctly. EVV records that are not yet a verified visit will not match. Billed claims that have not been paid (for any reason, not just EVV matching) will not match.

      9. Incomplete
         A visit is considered Incomplete if it requires manual intervention before it can be considered closed, completed, or verified.
          
      10. In Process
          A visit is considered in process if a Call-In is received and the visit will remain in process until a Call-Out is received, or 25 hours have passed. After 24 hours, the visit will become Incomplete, assuming the Call-Out was not received.
           
      11. Omit
          A visit will be shown as omitted if the indicator on the visit is set to “do not bill.” This means that the agency does not intend to submit a claim for this particular visit and it will not match to a claim.
          
          Back to Top

   4. Program Integration

      1. Remittance Advice (RA)

         The RA contains a weekly summary of all claims submitted and is available the Monday following the end of the claim submission cycle. Visit the Provider Web Portal Quick Guides web page for more information on reading and downloading your Remittance Advice.

      2. Service Email Address

         Email contact is located in the Gainwell Technologies Provider Portal titled "Service Email Address". The Service Email Address is utilized for sending the Sandata Welcome Letter containing Sandata credentials for entry into the system. Visit the Provider Web Portal Quick Guides web page for guidance on updating this email in the Gainwell Technologies Provider Web Portal.
         
         Note: The service email address will be used for credentials and cannot be the same email address for multiple enrollments. Ensure that you have a unique service email address for each enrollment within the Gainwell Technologies Provider Portal.

      3. Mailing Email Address

         Email contact is located in the Gainwell Technologies Provider Portal titled "Mailing Email Address". The Mailing Email Address is utilized for sending Gainwell Technologies communications including updates on the EVV Program. Visit the Provider Web Portal Quick Guides web page for guidance on updating this email in the Gainwell Technologies Provider Web Portal.

      4. Explanation of Benefits (EOB) 3054

         Informational message on provider-specific RA designating that a claim billed with an EVV-required code does not have a corresponding and verified visit recorded through an EVV system. 
         
         Back to Top

   5. Technical Definitions

      1. Direct Care Worker ID

         Direct Care Worker ID, or Employee ID, identifies the Direct Care Worker providing services and is automatically generated for the State EVV Solution. Refer to the Colorado Addendum for a specific value for Provider Choice systems. Refer to the Training Participant Guide for usage.

      2. Exception ID

         Exception IDs identify Exceptions that are created in the EVV systems. Specific Exception IDs are located in the supplemental training materials for the State EVV Solution and the Colorado Addendum for Provider Choice Systems.

      3. Sandata EVV Portal

         The web-based administrative tool is used to manage EVV activity, add Manual Visit Entry data elements, and monitor all activity recorded in the State EVV Solution.

      4. Data Aggregator

         Data Aggregator is the read-only portal for Provider Choice System users. Visit data will be reflected in the Provider EVV Portal. Information in the Data Aggregator can only be updated by submitting new EVV information to HCPF.

      5. Mobile Visit Verification (MVV App/SMC App)

         Mobile Visit Verification is a smartphone or mobile device application used by the Direct Care Worker to record visit data at the start and end of the visit.

      6. Reason Code

         Reason Codes are standard codes established by HCPF used to explain (or, as stated in the Sandata training manuals, "acknowledge") an Exception. Reason Codes are located in the supplemental training materials for the State EVV Solution and the Colorado Addendum for Provider Choice Systems.

      7. Telephonic Visit Verification (TVV)

         TVV is a functionality for Direct Care Workers to record an EVV visit by calling in with a telephone. Each provider agency using the State EVV Solution is provided with two toll-free telephone numbers for use by Direct Care Workers to record visit data at the start and end of a visit. For Provider Choice System functionality please contact your vendor.

         Colorado allows the use of both landlines and cell phones to submit TVV records. EVV systems (either State Solution or Provider Choice System) must automatically record a specific address as the telephone is used and locations must be updated to reflect the actual location of service delivery as needed.
         
         Back to Top

2. EVV Program Overview

   1. Colorado EVV

      Electronic Visit Verification (EVV) is mandated (effective August 3, 2020) in Colorado by 10 CCR 2505-10 Section 8.001 and Section 12006(a) of the 21st Century Cures Act. Federal guidance requires EVV for Home and Community Based Services (HCBS) that include an element of Personal Care Services and State Plan Home Health Care Services. Colorado requires the use of EVV for several other services that are similar in nature and delivery to the federally mandated services. These additional services are included to enhance care coordination, promote quality outcomes for members, and streamline requirements for providers. Specifically, EVV will be required for the following:

      EVV requirements are the responsibility of providers billing services to HCPF. The impact on most members is minimal, however, members who utilize CDASS and employ attendants are required to complete training and comply with EVV requirements.

      The Colorado EVV Program has implemented an Open Choice Model, meaning that providers may use the State EVV Solution or a Provider Choice EVV System.

      HCPF has worked with providers and other stakeholders throughout the design of the EVV Program and has made several changes both to the system and policy to incorporate stakeholder feedback. HCPF established an Electronic Visit Verification web page to share policy and system updates and engagement opportunities, held multiple stakeholder meetings from September 2017 through the present, and held specific engagement sessions for Code of Regulations feedback. Visit the EVV Stakeholder Workgroup web page for additional information on stakeholder engagement.

      • Behavioral Therapies
      • Consumer Directed Attendant Support Services (CDASS)
      • Home Health
      • Homemaker
      • Independent Living Skills Training (ILST) and Life Skills Training (LST)
      • In-Home Support Services (IHSS)
      • Occupational Therapy
      • Pediatric Behavioral Therapies
      • Pediatric Personal Care
      • Personal Care
      • Physical Therapy
      • Private Duty Nursing
      • Respite and Youth Day
      • Speech Therapy
         
      • State EVV Solution: HCPF provides an EVV system for provider use at no cost. The State EVV Solution is built specifically to collect EVV records and may be (optionally) used for scheduling care.
         
      • Provider Choice EVV System: Providers may choose to use a Provider Choice EVV system that interfaces their choice of technology with the Data Aggregator. This is especially useful for providers that already use an administrative suite of technology that can incorporate EVV records into existing records and practices. Any costs associated with using a different EVV system will be borne by the provider.
        
        Back to Top

   2. Colorado EVV Exclusions

      EVV is intended to be used for the services mentioned above when provided in a visit-based fee-for-service setting. While EVV records may still be collected (meaning HCPF does not prohibit the collection of records in these circumstances), EVV records are not required when services are delivered through the following ways:

      • Child Health Plan Plus (CHP+): CHP+ is public low-cost health insurance for certain children and pregnant women. It is for people who earn too much to qualify for Health First Colorado, but not enough to pay for private health insurance.
         
      • Live-in Caregivers: HCPF recognizes the unique nature of service delivery for Live-in Caregivers. For an EVV exemption, Live-in Caregivers must meet all requirements as stated in HCPF Operational Memo 20-051 "Electronic Visit Verification Live-In Caregiver Exception" and the Live-in Caregiver Attestation Form, available on the EVV Live-In Caregiver Attestation Form located on the Electronic Visit Verification Resources web page under the Live-in Caregiver Resources section in English and Spanish.
         
      • Non-Fee for Service: Members receiving care through capitated payment models including through the Regional Accountable Entities (RAEs), Managed Care Organizations (Denver Health Medicaid Choice and Rocky Mountain Health Plan's Prime), or capitated behavioral health benefits administered by the RAEs.
         
      • Program of All-Inclusive Care for the Elderly (PACE): The PACE program provides comprehensive medical and social services to certain frail individuals 55 years of age and older. The goal of PACE is to help individuals live and stay in their homes and communities through comprehensive care coordination.
         
      • State Supported Living Services (State SLS): State SLS services mirror SLS waiver services for normally ineligible members and do not use normal billing methodology.
         
      • Select Outpatient Therapies delivered via telehealth/telemedicine: Outpatient Occupational Therapy (OT), Outpatient Physical Therapy (PT), Outpatient Speech Therapy (ST), and Pediatric Behavioral Therapy (PBT) services provided via telehealth do not require EVV. Telehealth/telemedicine may be billed as Place of Service 02 or 10. Refer to the billing manual for billing guidance related to telehealth/telemedicine. Home Health Agencies providing OT, PT and ST services via telehealth continue to require EVV records when billing.
      • Hospice: Hospice services do not require EVV. Hospice services are reimbursed using a unique per-diem payment structure.  This differs from other EVV-mandated services which use a fee-for-service payment structure. Hospice providers are instructed to cease EVV collection for Medicaid billing purposes on July 1, 2024.
        
        Back to Top

   3. Colorado EVV Restrictions

      EVV helps ensure that care is delivered at the time of service by collecting six points of data. HCPF, in coordination with stakeholders, has developed restrictions enforced in both system design (the State EVV Solution can not violate these restrictions and Provider Choice Systems must be set up to not violate these restrictions) and policy (these restrictions are specified in 10 CCR 2505-10 8.001, known as the "EVV Rule"). Providers or technology systems are encouraged to contact HCPF (EVV@state.co.us) for clarifications about these restrictions. Restriction violators should be reported to HCPF for enforcement. The following practices are prohibited in the Health First Colorado EVV Program:

      • HCPF will not allow or accept biometric data, pictures, video, or voice recordings to identify members or substantiate Health First Colorado visit data.
         
      • HCPF will not allow or accept visit data that includes continual GPS tracking during a visit and will only accept location information at the beginning and/or end of a Health First Colorado visit.
         
      • HCPF will not utilize geo-fencing to restrict the location of Health First Colorado service delivery.
        
        Back to Top

3. Enrollment

   1. Member Enrollment

      Members receiving services that require EVV must be administratively entered into the Provider EVV Portal for each Provider Agency collecting EVV records. Members and Providers must work together to ensure that information is correct and viable. Provider agencies are responsible for the maintenance of all caregiver information. CDASS members should work directly with their FMS vendors.

      Back to Top

   2. Caregiver Enrollment

      Caregivers utilizing EVV must be administratively entered into the Provider EVV Portal by each Provider Agency collecting EVV records for services rendered. Caregivers and providers must work together to ensure that information is correct and viable. Provider agencies are responsible for the maintenance of all caregiver information.

      Back to Top

   3. Provider Enrollment

      Providers billing for EVV services must be enrolled with the EVV program for each unique Provider Health First Colorado ID (Medicaid ID). EVV enrollment may be automatically included in your new Medicaid enrollment depending on the nature of the codes regularly billed by the provider type and specialty. Provider types and specialties who do not have EVV enrollment automatically included in their Medicaid enrollment but are planning to bill or are already billing EVV codes (refer to the EVV Types of Service - Service Code Inclusions section), may submit an Electronic Visit Verification Attestation Form to have EVV enrollment added to their Medicaid enrollment. Providers may use this Electronic Visit Verification Attestation Form during initial enrollment or as a maintenance update to their current enrollment. Visit the Provider Forms web page under the Provider Enrollment & Update Forms drop-down for the Electronic Visit Verification Attestation Form. Visit the Provider Web Portal Quick Guides web page for more information on Provider Maintenance to a current enrollment.

      1. Multiple EVV enrollments

         Agencies with multiple Health First Colorado Provider (Medicaid) IDs can bypass additional training for each ID associated with the agency. This can be done if one Health First Colorado Provider (Medicaid) ID has fully completed training and received credentials for the State EVV Solution or the Data Aggregator (Provider Choice EVV Solution Training).

         For those who would like to bypass additional training and have already completed training for one Provider Health First Colorado ID (Medicaid ID), additional credentials can be requested by contacting Sandata at CoCustomerCare@sandata.com or (855) 871-8780.
         
         Note: The service email address will be used for credentials and cannot be the same email address for multiple enrollments. Ensure that you have a unique service email address for each enrollment within the Gainwell Technologies Provider Portal.

      2. Training

         Providers enrolled in the EVV program must complete the necessary training to receive EVV credentials. Training must be completed for both the State EVV Solution and Provider Choice EVV Solution. Visit the Electronic Visit Verification web page for more information on training.
         
         Back to Top

4. Provider Guidance

   The following guidance may be used to implement EVV successfully:

   1. Alternate Locations

      A modification that corrects the location recorded at the time of service or enters an otherwise unrecorded location is defined as an Alternate Location. Alternate Locations are used in the following situations:

      Provider Responsibilities

      Provider agencies must ensure the location for an EVV record is correct. A location may be a mailing address, GPS coordinates, or a uniquely identified location. (A uniquely identifiable location example is "Colorado State Capitol Building", however, recording "Doctor's office" is not uniquely identifiable and is therefore not an acceptable location record.)

      Provider agencies must maintain records supporting both the validity and appropriate use of Alternate Locations.

      Alternate Location in State EVV Solution

      Refer to Appendix A: Alternate Location Guidance for State EVV Solution for detailed methodology.

      Alternate Location in Provider Choice EVV Solutions

      Providers utilizing a Provider Choice EVV Solution must ensure that a correct location of service delivery is submitted to HCPF. Providers should ask their EVV vendor how to correct or input the location of service delivery within their EVV system. Providers are responsible for reviewing and ensuring the accuracy of EVV data submitted to HCPF through the Data Aggregator.

      • Correcting any method of EVV collection that recorded the location incorrectly.
      • Modifying an existing EVV record to update a previously entered location.
      • Entering a Manual Visit into the Provider EVV Portal.
        
        Back to Top

   2. Billing Integration

      EVV records do not bill HCPF directly. Claims should still be submitted to HCPF according to HCPF guidance. EVV records collected by the State Solution or transmitted to the State Solution by a Provider Choice system will be transmitted to HCPF's fiscal agent to match against claims during adjudication. EVV records will then match to claims lines submitted to HCPF as an additional requirement for claims to be processed correctly.

      If an EVV record is modified after a claim line is matched for payment, the provider is responsible for voiding the matched claim and resubmitting it for payment to ensure the correct EVV matches the billed claim. Visit the Provider Web Portal Quick Guides web page for information on how to void and resubmit a claim.

      Visit records in the State Solution are transmitted nightly. Visits are available for matching in the Gainwell Technologies Claims System the day after a visit is recorded and verified. Please be aware that claims must be billed after service has been completed and a visit has been recorded to ensure proper matching. If a visit has been adjusted, those changes will be available for matching in the Gainwell Technologies Claims System the day after the adjustment to the visit has been made.

      Refer to the Billing Training - Resources drop-down on the Provider Training web page for more information on the Gainwell Technologies payment processing schedule.

      Providers may review Remittance Advice for EOB 3054 to ensure that claims will be paid as intended. Visit the Provider Web Portal Quick Guides web page for more information on reading and downloading your Remittance Advice.

      If as a billing provider, the claim does not match a visit, one of the points of data being captured in the EVV system was incorrectly entered, or the claim was submitted prior to having a visit available for matching. Refer to the Provider Web Portal Quick Guide - Reading the Remittance Advice (RA) and notice which claim lines did not have a matching visit to see why this occurred. Refer to the Provider Web Portal Quick Guide - Pulling Remittance Advice (RA) to download your Remittance Advice.

      Next, log into the Sandata Provider Portal (for State Solution users) or the Data Aggregator (for Provider Choice systems) and find the visits that were logged for those claim lines. Then check the following points of data to see which is the cause of the missing visit(s):

      1. Billing Provider Medicaid (Location) ID - Does the claim location ID match the location ID for your STX account? If you're unsure which ID was used to train, you can contact Sandata and confirm this information. The billing provider ID used to submit the claim must match the billing ID for your STX account where the visit is logged. Note: If you have more than one billing ID, you will need additional STX accounts for unique matching.
      2. Client Medicaid ID - Does the Client Medicaid ID on the claim match the Client Medicaid ID on the visit? If the Client's Medicaid ID on the visit is mistyped, the visit will not match the claim.
      3. Dates of Service - Do the first and last dates of service match the visit's start and end dates?
      4. Service Grouping - Does the claim procedure or revenue code (and any applicable modifiers) match the correct grouped code on the visit? If you're unsure which group code you need to select, see the EVV Service Code List and EVV Crosswalk of Codes to find the grouped code you should select. Note: Verify you are looking at the right code as some groupings sound similar. Ex. 'HHOT' (Home Health - Occupational Therapy) will be a different service than 'OT' (Occupational Therapy)
      5. Submission Date - When was the claim submitted? Visits are sent nightly for claims matching and only verified visits can match to claims. Ensure that claims are billed the day after a visit has been verified. Note: If you fix an exception and the visit becomes verified, you still need to wait until the next day to bill for that claim.
      6. ICN Claim Number - To find your ICN claim number, pull your Remittance Advice (RA) and search for the services that you received EOB 3054 for. Refer to the Provider Web Portal - Pulling Remittance Advice (RA) Quick Guide and the Provider Web Portal - Reading the Remittance Advice (RA) Quick Guide for direction on pulling and reading your RA.

      7. Visit ID - To find your visit ID, log into the Data Aggregator (if using Provider Choice System) or Sandata Portal (if using State Solution) and navigate to the Reports section on the left-hand side. Choose 'Date Range Reports' in the report type and choose 'Detail Visit Status'. Select the timeframe for the visit and run the report. The first column on the report will be the visit ID. Find the visit in question and the corresponding visit ID.
         
         The term Third-Party Liability (TPL) describes circumstances when a Health First Colorado member has health insurance in addition to the Health First Colorado program that may pay for medical services. Health First Colorado is the payer of last resort, meaning all other payment methods should be used first. TPL claims are required to be submitted according to HCPF guidance in the Provider Web Portal - Submitting a Claim with Other Insurance or Medicare Crossover Information Quick Guide and have matching EVV records for payment. State Solution users must ensure that all visits are appropriately logged in the EVV portal prior to billing secondary claims. Provider Choice users must work with EVV vendors to ensure that all visits are sent to the Data Aggregator prior to billing TPL claims.

         Back to Top

          

   3. Compliance Timeline

      HCPF utilized a tiered implementation strategy to familiarize providers with the use of EVV before incorporating claims adjudication to minimize long-term administrative burden and reduce the financial impact when claims required EVV records.  Beginning on October 1, 2019, the Colorado EVV Program made both the State EVV Solution available and allowed providers to use Provider Choice Systems to submit EVV records. 

      On August 3, 2020, the use of EVV was mandated by the Colorado Code of Regulations per 10 CCR 2505-10 8.001. Beginning February 1, 2021, HCPF implemented a pre-payment claim review process.  As discussed in Operational Memo 21-075: "Over the past year, there have been significant improvements with EVV compliance. Accordingly, beginning February 1, 2022, all claims requiring the use of EVV will encounter a pre-payment review. Claims without necessary EVV records will be denied.

      Up until February 1, 2022, claims that are missing EVV or have incomplete EVV records will show in the provider’s Remittance Advice as EOB 3054 “EVV Record Not Found” and the claim will be paid. After February 1, 2022, claims missing or having incomplete EVV records will show in the provider’s Remittance Advice as EOB 3054 “EVV Record Required and Not Found” and the claim will be denied."
       

      Provider Options for Compliance

      Providers may utilize multiple strategies to assure compliance at appropriate times and are advised of options that may be useful in implementing EVV in a timely manner.

      • The EVV Rule (10 CCR 2505-10 8.001.3.E.1.a) states: "Providers that fail to comply with this rule after August 3, 2020, may be subject to Compliance Monitoring and a Request for Written Response in accordance with Section 8.076."  Beginning August 3, 2020, all claims submitted to HCPF that require EVV records are being reviewed for corresponding EVV.  Providers that are not using EVV after August 3, 2020, must submit a written plan to HCPF outlining their intent to utilize EVV and when compliance is expected.
         
      • The EVV Rule (10 CCR 2505-10 8.001.3.E.1.b) states: "Providers that fail to comply with this rule after October 1, 2020, may be subject to Compliance Monitoring, Request for Written Response, or Overpayment Recovery." Beginning October 1, 2020, in addition to the August 3, 2020 enforcement requirements, all claims submitted to HCPF that require EVV records will be reviewed for corresponding EVV. All claims subject to EVV requirements will be paid initially, even if no EVV record is on file to match the claim. Paid claims that do not have valid matching EVV records may be subject to HCPF review and recoupment as Over-Payment Recovery.
         
      • The EVV Rule (10 CCR 2505-10 8.001.3.E.1.c) states: "Providers that fail to comply with this rule after January 1, 2021, may be subject to Compliance Monitoring, Request for Written Response, Overpayment Recovery, Denial of Claims, Suspension, Termination, or Nonrenewal of their Colorado Medicaid Provider Agreement in accordance with Section 8.076." In accordance with Operational Memo 21-075, beginning February 1, 2022, all claims submitted to HCPF that require EVV records must be matched to valid EVV records to pay.
         
      • Switching to a different EVV vendor: If a Provider Choice System is not fully interfaced with Sandata to transmit EVV records to HCPF before February 1, 2022, when pre-payment claim review begins, providers may use the State EVV Solution until the interface is complete to ensure compliance.   Providers will not be exempt from using EVV while going through the interface process with Sandata. Providers can only use one system (either the State EVV Solution or their Provider Choice System) at a time. Providers may switch from using the State EVV Solution to the Provider Choice System when they are ready; there is no time limit for using the State EVV Solution. Providers must notify Sandata of the transition and complete all necessary training to use the State EVV Solution or Data Aggregator view for Provider Choice Systems.
         
      • CDASS vendor switching: Each Financial Management Service (FMS) vendor is utilizing a Provider Choice System. If a CDASS member or their authorized representative would like to utilize a different EVV system, they may change FMS vendors during quarterly open enrollment periods.
        
        Back to Top

   4. Live-in Caregivers

      HCPF does not require EVV from Live-in Caregivers for many services. However, individual Provider Agencies may choose to require EVV for Live-in Caregivers.

      Live-in Caregiver Definition

      HCPF has developed the following definition based on federal precedent and stakeholder engagement:

      Live-in Caregiver means a caregiver who permanently or for an extended period of time resides in the same residence as the Medicaid member receiving services. Live-in caregiver status is determined by meeting requirements established by the U.S. Department of Labor, Internal Revenue Service, or HCPF-approved extenuating circumstances.

      Types of Services Eligible or Ineligible for Live-in Caregiver Exemption

      Services provided by Live-in Caregivers are often delivered incrementally and without clearly defined start and end times. HCPF recognizes the unique challenges of collecting EVV for this type of care and allows providers to exempt the appropriate EVV Types of Service from EVV if provided by a documented Live-in Caregiver. The EVV Types of Service that are eligible to use the Live-in Caregiver exemption are:

      EVV Type of Service	Live-in Caregiver
      Behavioral Therapies	Eligible
      Consumer Directed Attendant Support Services (CDASS) (and CDASS SLS Health Maintenance)	Eligible
      Home Health (including CNA, Nursing, OT, PT, and ST)	Eligible
      Homemaker	Eligible
      Independent Living Skills Training (ILST) and Life Skills Training (LST)	Eligible
      In-Home Support Services (IHSS)	Eligible
      Occupational Therapy	Ineligible
      Pediatric Behavioral Therapies	Ineligible
      Pediatric Personal Care	Eligible
      Personal Care	Eligible
      Physical Therapy	Ineligible
      Private Duty Nursing	Eligible
      Respite and Youth Day	Eligible
      Speech Therapy	Ineligible

      Provider Responsibilities

      Billing providers are responsible for compiling, maintaining and validating all records justifying the status of each Live-in Caregiver for HCPF verification and auditing. The Live-in Caregiver Attestation Form, located on the Electronic Visit Verification Resources web page under the Live-in Caregiver Resources section, and all supporting documentation must be collected and validated prior to utilizing the Live-in Caregiver exemption. Documentation must be valid during the time of service and billing dates if EVV is not collected. Providers should review the instructions and requirements outlined in the Live-in Caregiver Attestation Form and Live-in Caregiver Memo for additional details.

      Billing providers are responsible for using the correct billing methodology that designates Live-in Caregiver services by claim line. Claims adjudicated as provided by a Live-in Caregiver without required Live-in Caregiver documentation or EVV records are subject to recoupment.

      Consumer Directed Attendant Support Services (CDASS) Responsibilities

      CDASS Employers of Record (EOR) are responsible for compiling, maintaining, and validating all records justifying the status of a Live-in Caregiver for HCPF verification and auditing. The Live-in Caregiver Attestation Form and all supporting documentation must be completed by the EOR and collected by the Financial Management Service (FMS) Vendor prior to utilizing the Live-in Caregiver exemption. FMS vendors must maintain records designating the status of Live-in Caregivers. Documentation must be valid during the time of service and billing dates if EVV is not collected. EOR and FMS vendors should review the instructions and requirements outlined in the Live-in Caregiver Attestation Form for additional details.

      FMS vendors are responsible for using the correct billing methodology that designates Live-in Caregiver services by claim line. This process is described in the Live-in Caregiver Memo. Claims adjudicated as provided by a Live-in Caregiver without required Live-in Caregiver documentation or EVV records are subject to recoupment. EOR are responsible for the validation of Live-in Caregiver documentation. If information is incorrect or falsified, recoupment liability is with the EOR. If Live-in Caregiver documentation is not collected by the FMS vendor, and EVV is not submitted, liability is with the FMS vendor.

      Operational Methods of Billing for Live-in Caregiver Services

      Billing providers may submit claims including both Live-in Caregiver services and services requiring EVV records at the same time. Each claim line must appropriately indicate if the service was provided by a Live-in Caregiver. If the same service is provided by both a Live-in Caregiver and a non-Live-in Caregiver, the units billed to each should be billed on separate claim lines and indicated correctly.

      For claims billed using the CMS 1500 billing methodology, Place of Service (POS) 99 must be designated for all lines where a Live-in Caregiver has delivered the service.

      For claims billed using the UB-04 billing methodology, Condition Code 23 must be designated on the claim where all lines are services delivered by a Live-in Caregiver.

      Lines representing services not delivered by a Live-in Caregiver must use the appropriate Place of Service or Condition Code as outlined in HCPF billing manuals, which may not include Place of Service 99 or Condition Code 23. Providers who have previously used POS 99 to indicate information other than Live-in Caregiver designation are advised that this POS has been repurposed to identify services provided by Live-in Caregivers. Utilizing POS 99 will require proof of Live-in Caregiver status.

      Back to Top

   5. Student/Observational Caregivers

      Clinical students, interns, fellows, and all other caregivers performing services as part of a training or educational role may collect EVV when under the direct supervision of another caregiver. Whoever is billing Medicaid is required to collect EVV, which may include the supervisor, supervisee, or both. This will not create any errors in the EVV records and will give an accurate account of care received by Health First Colorado members.

      Back to Top

   6. Contracted Caregivers

      Contracted caregivers performing services for a billing provider must collect EVV records at the time of service in the EVV format utilized by the billing provider. The billing provider is responsible for submitting EVV records prior to claims.

      Back to Top

   7. Manual Entry Guidance

      Manual Visit Entry means an EVV record input in the Provider EVV Portal after the time-of-service delivery by administratively entering all Verification Points of Data.

      Providers utilizing the State EVV Solution can find information on entering a Manual Visit Entry in the Provider EVV Portal in the EVV Agency Provider Participant Training Guide on the EVV Solution Information web page.

      Providers utilizing Provider Choice EVV Systems should reach out to vendors for information on entering a Manual Visit Entry. Provider Choice EVV Systems submit new data to HCPF which updates existing records. Providers utilizing a Provider Choice System can see the latest version of data in the Data Aggregator.

      Back to Top

   8. Minimum Necessary

      EVV records are used to verify that services have been delivered in as real-time a method as possible. EVV technologies are not prohibited from integrating into other technologies (such as service scheduling, payroll, or electronic health records), however, only information required for the collection and submission of EVV records is necessary. Many EVV technology solutions have the capacity to collect much more information than is needed to collect and submit EVV records. HCPF recognizes that some business practices may find this capacity useful but cautions that doing so may end up creating additional administrative burden in keeping all information correct.

      HCPF only receives EVV-related data through the EVV program. If providers choose to use EVV technology for other uses, that information will not be sent to HCPF through the EVV Program.

      Back to Top

   9. Modification Thresholds

      Electronic Visit Verification Record Modification Threshold Guidance

      Electronic Visit Verification (EVV) helps assure the excellence of care delivery to Medicaid Members in Colorado and requires all visit verification points of data to be collected at the time and place of service. HCPF of Health Care Policy and Financing (HCPF) considers visit details added or modified after the time of service to be visit modifications. Manual visit entry is when the entire visit is added after the time of service. While HCPF recognizes the practical need for visits to be modified, doing so should only be done as an exception to normal practice and the majority of all EVV records should remain unmodified.

      The Centers for Medicare & Medicaid Services (CMS) has directed HCPF to monitor EVV records for how many modified visits are submitted per provider and determine what an appropriate proportion of modifications is in Colorado. This appropriate proportion is referred to as a Threshold. HCPF formally defines thresholds as the acceptable limit of modified and manual EVV records determined as a percent of paid claims each month.

      After claims are paid, EVV records that have been matched to claims are reviewed in a post-payment review to determine if appropriate thresholds have been met. Modified and manually entered EVV records will not automatically stop payments and may allow claims to be paid, however, exceeding thresholds persistently and intentionally could imply a need for performance improvements that may result in a HCPF audit.

      Provider Notes and Expectations

      With the initial implementation of the Colorado EVV Program, HCPF will use data collected from billing claims to evaluate the frequency of modified and manually entered EVV records.  At this time CMS does not have thresholds set for manual or modified entries and HCPF does not currently have thresholds on how many EVV records are manually entered or modified. HCPF will continue to monitor data and provide notice to EVV stakeholders of any updated guidance as it relates to thresholds. Please note the best practice is to collect EVV at the time-of-service delivery. 

      Provider Billing

      Providers are advised that exceeding thresholds surrounding modified and manual entry EVV records will not automatically stop payments. After claims are paid, EVV records that have been matched to claims are reviewed in a post-payment review to determine if appropriate thresholds have been met. If the provider modifies an EVV record already matched to a paid claim, the provider is responsible for re-billing the matched claim to ensure it still matches.

      Unmodified EVV Record

      Providers are responsible for maintaining accurate service delivery records. If the provider merges multiple EVV records and no points of the visits were modified, the record will remain an Unmodified EVV Record.

      If the provider updates EVV records indicating an alternate location and no other verification data points are modified, the record will remain an Unmodified EVV Record.

      If the provider modifies an EVV record already matched to a paid claim, the provider is responsible for re-billing the matched claim to ensure it still matches.

      Back to Top

   10. Telemedicine/Telehealth and EVV

       Telemedicine and Telehealth are remote delivery options for Health First Colorado services that utilize interactive audio, interactive video, or interactive data communication instead of in-person contact.

       Providers delivering services requiring EVV through Telemedicine or Telehealth are responsible for the capture and reporting of EVV to HCPF, regardless of whether the provider is utilizing a Provider Choice System or the State EVV Solution. Providers utilizing Telemedicine or Telehealth should refer to the EVV Types of Service - Service Code Inclusion List located on the EVV Resources web page under HCPF Guidance section to determine if EVV is required.

       Many EVV-required services have expanded to include Telemedicine and Telehealth which may be designated by a Place of Service 02 Telehealth in Other and Place of Service 10 Telehealth in Home (for CMS 1500 methodology), or a Modifier GT (for UB-04 methodology). All EVV-appropriate services delivered through Telemedicine or Telehealth require EVV to be collected by the caregiver. Many EVV technologies automatically record the location of the caregiver providing services through Telemedicine or Telehealth, the location in the EVV record must indicate the location of the member receiving services through Telemedicine or Telehealth. Provider Agencies may utilize Alternate Location methodology as needed.

       Telemedicine and Telehealth are emerging fields and continue to develop in Colorado. Future guidance will be posted in Telemedicine resources, posted on the EVV website, and sent to affected providers as needed.
       
       Back to Top

   11. Consumer Directed Attendant Support Services

       Consumer Directed Attendant Support Services (CDASS) Members are required to submit Electronic Visit Verification (EVV) records and beginning January 1, 2021, all services submitted to HCPF through your Financial Management Service vendor (FMS) must have an EVV record. HCPF has prepared this guidance specifically for CDASS Members to clarify what this means in practice here in Colorado.

       CDASS Members/Authorized Representatives (AR) are responsible for the following:

       • Ensuring Attendant collection of EVV records at the time of service. The Attendant may manually enter EVV records if the record was not collected at the time of service.
       • If an EVV record that has been submitted needs to be modified, the CDASS Member/AR is responsible for rejecting the record so that the attendant may make updates.
       • Ensuring that EVV records precede all approved service hours submitted to the FMS vendor by the designated FMS billing deadlines. This allows billing to be compared to existing EVV records.
       • If an issue arises from incorrect billing (for example, approving service hours without associated EVV records), then the CDASS Member/AR must update the EVV record and re-bill. FMS vendors are not responsible for the re-billing of incorrectly filed claims.
       • EVV is only a visit record component, it does not complete the other billing requirements for attendant reimbursement. CDASS Members/ARs are required to follow all normal business, contractual, and HCPF requirements for billing, including correct coding, timely filing, and any other HCPF requirements.
       • CDASS Members/ARs are also advised to communicate and coordinate with the FMS vendor in the case of an EVV record dispute or experiencing issues.

       Responsibilities of the CDASS Attendant:

       • Collecting EVV at the time of service by utilizing the FMS EVV App and/or Telephony options.
       • If EVV is not collected at the time of service, notify the CDASS Member so they may add or update the EVV records as needed.

       Responsibilities of the FMS vendor:

       • FMS vendors are responsible for having a system that submits required EVV records correctly to HCPF that may be billed against by CDASS Members/ARs.
       • All technical support questions regarding this system may be directed to the FMS vendor directly.

       In addition to the defined roles and responsibilities of using EVV for CDASS, please also be aware of the following:

       Thresholds refer to the proportion of manual or modified EVV entries to unmodified EVV entries.

       • Any record not collected at the time of service and then manually entered after the time of service is considered a manual entry.
       • Any record that has been modified after the time of service is considered a modified entry.
       • Any record that has not been modified in any way since the collection at the time of service is considered an unmodified entry.

       The appropriate proportion, or threshold limits, has not yet been determined as of November 2020 and CDASS Members/ARs are encouraged to focus on complying with the collection and submission of EVV records to bill correctly.

       At this time HCPF wants to ensure that those utilizing EVV are sending the necessary records and are not focused on threshold violations.

       Thresholds will not be used to deny payments but CDASS Members/ARs with abnormally high proportions of EVV records not recorded at the time of service may be subject to corrective action plans by HCPF in the future.

       • Technical use support of the FMS system should be referred to the FMS vendor for training and assistance.
       • EVV does not change the nature of CDASS and all program rules for CDASS still apply with the addition of the collection of EVV for visits.

       CDASS Members/ARs are again reminded that they act as the Employer of Record and must bill the FMS vendor correctly. Specifically, Members/ARs must bill against an EVV record on file by the FMS billing deadlines. CDASS Members/ARs may update EVV records within the CDASS Program rule timely filing and re-bill if needed as allowed within CDASS Program rules.

       Refer all EVV use questions directly to your FMS vendor to expedite issue resolution.

       Back to Top

   12. Correcting Client IDs

       State EVV Solution: The provider will need to end date the client ID with the incorrect Medicaid ID and re-enter the client. Then, fix any visits associated with the client. 

       If additional assistance is required, contact Sandata and give the following information when requesting help with a client ID that was entered incorrectly in Sandata:

       • STX Account Number
       • Client First/Last Name
       • Client ID (Santrax ID)
       • Wrong Medicaid ID
       • Correct Medicaid ID

Back to Top
 

1. Home Health Agency Parent/Branches and EVV

   In instances where a Home Health Agency (HHA) has multiple branches affiliated with a single tax identification number, Medicare allows for billing from a single ("Parent") NPI, and Colorado Medicaid requires billing from each branch NPI. Providers are advised that when billing from each branch NPI, all corresponding documentation, including Electronic Visit Verification (EVV), must reflect the branch NPI billing for services.

   Back to Top

2. EVV Types of Service

   Similar services are grouped into Colorado EVV Types of Service to reduce administrative burden during service delivery. Rather than having caregivers record each billing code at the time of service, only the "Type of Service" is needed. This drastically reduces the administrative burden for both caregivers working with Medicaid Members as well as provider administrators responsible for maintaining EVV records.

   Caregivers and Administrators interested in each type of service should refer to the "EVV Types of Service Summary Table" below.

   Billing providers interested in which billing codes are included in each Type of Service, as well as the specific circumstances in which they apply, should refer to the next section "EVV Types of Service Billing Conditions and Code Inclusions.

   Back to Top

   1. Colorado EVV Types of Service Summary Table

      The following Types of Service are used by caregivers at the time of service and administrators maintaining EVV records:

      TVV Code	Group Code	Telephony Prompt for Read back	Service Text Selection for Mobile
      101	CDASS	Consumer Directed Attendant Support Services (CDASS)	CDASS
      102	SLSHM	Consumer Directed Attendant Support Services SLS Health Maintenance	CDASS SLS HMA
      103	BHSVC	HCBS Behavioral Services	Behavioral Services
      104	HMKR	Homemaker	Homemaker
      105	IHSS	In-Home Support Services	In-Home Support Services (IHSS)
      106	PRSNL	HCBS Personal Care	Personal Care
      107	RSPT	Respite	Respite
      108	LST	Skills Training ILST/LST	Independent Living Skills Training (ILST) and Life Skills Training (LST)
      109	HHNUR	Home Health - Nursing	Home Health - Nursing
      110	HHBAS	Home Health - Basic	Home Health - Basic
      111	HHPT	Home Health - PT	Home Health - Physical Therapy
      112	HHOT	Home Health - OT	Home Health - Occupational Therapy
      113	HHSLT	Home Health - S/LT	Home Health - Speech/Language Therapy
      114	PDRN	Private Duty Nursing	Private Duty Nursing
      117	PEDPC	Pediatric Personal Care	Pediatric Personal Care Services
      118	PEDBT	Ped Behavioral Therapies	Pediatric Behavioral Therapies
      119	PT	Physical Therapy	Physical Therapy
      120	OT	Occupational Therapy	Occupational Therapy
      121	SLT	Speech Therapy	Speech Therapy

       

      Back to Top

   2. Colorado EVV Types of Service Billing Conditions and Code Inclusions

      This section lists all billing conditions and codes included in each corresponding Colorado EVV Types of Service. All service descriptions are for reference only. If there is a difference in descriptions between this manual and reference coding books or Health First Colorado billing manuals located on the Billing Manuals web page, providers must adhere to that advice.

      All billing codes listed in this document will require the corresponding EVV Type of Service on file as part of a verified EVV to correctly bill Health First Colorado. If a service code or condition of service delivery is not mentioned in this section, it does not require an EVV record at the time of publication. All billing codes and conditions are subject to change.

      The EVV Types of Service in Colorado below are found in this manual:

      1. Behavioral Therapies
      2. Consumer Directed Attendant Support Services (CDASS)
      3. Consumer Directed Attendant Support Services (CDASS) SLS Health Maintenance
      4. Home Health - Basic (Certified Nurse Aid)
      5. Home Health - Nursing
      6. Home Health - Occupational Therapy
      7. Home Health - Physical Therapy
      8. Home Health - Speech/Language Therapy
      9. Homemaker
      10. Independent Living Skills Training (ILST) and Life Skills Training (LST)
      11. In-Home Support Services (IHSS)
      12. Occupational Therapy
      13. Pediatric Behavioral Therapy
      14. Pediatric Personal Care
      15. Personal Care
      16. Physical Therapy
      17. Private Duty Nursing
      18. Respite and Youth Day
      19. Speech Therapy
           
   • Behavioral Therapies Used by HCBS Providers (Billing Provider Type 36). Applicable in all locations except Place of Service 11 (Office). Behavioral Consultations and Behavioral Plan Assessments billed with Place of Service 11 (Office) do not require EVV. All billing codes associated with EVV Type of Service "Behavioral Therapies" are:
     Procedure	Modifiers			Service Description
     H2019	U3			Behavioral Line Staff (Developmental Disabilities Waiver)
     H2019	U8			Behavioral Line Staff (Supported Living Services Waiver)
     H2019	U3	22	TG	Behavioral Consultation (Developmental Disabilities Waiver)
     H2019	U8	22	TG	Behavioral Consultation (Supported Living Services Waiver)
     H2019	U3	TF	TG	Behavioral Counseling (Developmental Disabilities Waiver)
     H2019	U8	TF	TG	Behavioral Counseling (Supported Living Services Waiver)
     H2019	U3	TF	HQ	Behavioral Counseling, Group (Developmental Disabilities Waiver)
     H2019	U8	TF	HQ	Behavioral Counseling, Group (Supported Living Services Waiver)
     T2024	U3	22		Behavioral Plan Assessment (Developmental Disabilities Waiver)
     T2024	U8	22		Behavioral Plan Assessment (Supported Living Services Waiver)

      

     Back to Inclusions List

     Consumer Directed Attendant Support Services (CDASS) Used by HCBS Providers (Billing Provider Type 36). Applicable in all locations. All billing codes associated with EVV Type of Service "Consumer Directed Attendant Support Services (CDASS)" are:
     Procedure	Modifiers		Service Description
     T2025	U8		Consumer Directed Attendant Support Service - Enhanced Homemaker, Homemaker, Personal Care (Supported Living Services Waiver)
     T2025	U1		Consumer Directed Attendant Support Service - Health Maintenance, Homemaker, Personal Care (Elderly, Blind, and Disabled Waiver)
     T2025	UA		Consumer Directed Attendant Support Services - Health Maintenance, Homemaker, Personal Care (Community Mental Health Supports Waiver)
     T2025	U6		Consumer Directed Attendant Support Service - Health Maintenance, Homemaker, Personal Care (Brain Injury Waiver)
     T2025	U1	SC	Consumer Directed Attendant Support Service - Health Maintenance, Homemaker, Personal Care (Complementary and Integrative Health Waiver)

     
     Back to Inclusions List

     Consumer Directed Attendant Support Services (CDASS) SLS Health Maintenance Used by HCBS Providers (Billing Provider Type 36). Applicable in all locations. All billing codes associated with EVV Type of Service "CDASS SLS Health Maintenance service" is:
     Procedure	Modifiers		Service Description
     T2025	U8	SE	Consumer Directed Attendant Support Services - Health Maintenance (Supported Living Services Waiver)

      

     Back to Inclusions List

     Home Health - Basic (Certified Nurse Aid) Used by Home Health Agencies (Billing Provider Type 10). Applicable in all locations. All billing codes associated with "Home Health - CNA" services are:
     Revenue	Service Description
     570	Home Health Aide Basic (Acute)
     571	Home Health Aide Basic (Long-Term)
     572	Home Health Aide Extended (Acute)
     579	Home Health Aide Extended (Long-Term)

      

     Back to Inclusions List

     Home Health - Nursing Used by Home Health Agencies (Billing Provider Type 10). Applicable in all locations. All billing codes associated with "Home Health - RN" services are:
     Revenue	Service Description
     550	RN/LPN Standard Visit (Acute)
     551	RN/LPN Standard Visit (Long-Term)
     590	Uncomplicated Nursing (Brief Visit 1st of Day)
     599	Uncomplicated Nursing Visit (Visit 2+ of Day)

      

     Back to Inclusions List

     Home Health - Occupational Therapy Used by Home Health Agencies (Billing Provider Type 10). Applicable in all locations. Occupational Therapists providing services that are billed with procedure codes instead of revenue codes through a Home Health Agency are advised to refer to the Occupational Therapy Service Type All billing codes associated with "Home Health - Occupational Therapy" services are:
     Revenue	Service Description
     430	Occupational Therapy (Acute)
     431	Occupational Therapy (Long-Term)
     434	Occupational Therapy for HCBS Home Mod Evaluation

      

     Back to Inclusions List

     Home Health - Physical Therapy Used by Home Health Agencies (Billing Provider Type 10). Applicable in all locations. Physical Therapists providing services that are billed with procedure codes instead of revenue codes through a Home Health Agency are advised to refer to the Physical Therapy Service Type All billing codes associated with "Home Health - Physical Therapy" services are:
     Revenue	Service Description
     420	Physical Therapy (Acute)
     421	Physical Therapy (Long-Term)
     424	Physical Therapy for HCBS Home Mod Evaluation

      

     Back to Inclusions List

     Home Health - Speech/Language Therapy Used by Home Health Agencies (Billing Provider Type 10). Applicable in all locations. Speech/Language Therapists providing services that are billed with procedure codes instead of revenue codes through a Home Health Agency are advised to refer to the Speech/Language Therapy Service Type All billing codes associated with "Home Health - Speech/Language Therapy" services are:
     Revenue	Service Description
     440	Speech/ Language Therapy (Acute)
     441	Speech/ Language Therapy (Long-Term)

      

     Back to Inclusions List

     Homemaker Used by HCBS Providers (Billing Provider Type 36) Applicable in all locations All billing codes associated with "Homemaker" services are:
     Procedure	Modifiers				Service Description
     S5130	U1				Homemaker (Elderly, Blind, and Disabled Waiver)
     S5130	U1	HX			Homemaker (Elderly, Blind, and Disabled Waiver), Denver County
     S5130	UA				Homemaker (Community Mental Health Supports Waiver)
     S5130	UA	HX			Homemaker (Community Mental Health Supports Waiver), Denver County
     S5130	U1	SC			Homemaker (Complementary and Integrative Health Waiver)
     S5130	U1	SC	HX		Homemaker (Complementary and Integrative Health Waiver), Denver County
     S5130	U8				Homemaker - Basic (Supported Living Services Waiver)
     S5130	U8	HX			Homemaker - Basic (Supported Living Services Waiver), Denver County
     S5130	U7				Homemaker - Basic (Children's Extensive Supports Waiver)
     S5130	U7	HX			Homemaker - Basic (Children's Extensive Supports Waiver), Denver County
     S5130	U7	HA	HI	HX	Homemaker - Basic, Parental Provision (Children's Extensive Supports Waiver), Denver County
     S5130	U8	22			Homemaker - Enhanced (Supported Living Services Waiver)
     S5130	U8	22	HX		Homemaker - Enhanced (Supported Living Services Waiver), Denver County
     S5130	U7	22			Homemaker - Enhanced (Children's Extensive Supports Waiver)
     S5130	U7	22	HX		Homemaker - Enhanced (Children's Extensive Supports Waiver), Denver County
     S5130	U7	HA	HX		Homemaker - Enhanced, Parental Provision (Children's Extensive Supports Waiver), Denver County

     Back to Inclusions List

      

     Independent Living Skills Training (ILST) and Life Skills Training (LST) Used by HCBS Providers (Billing Provider Type 36). Applicable in all locations. All billing codes associated with "Independent Living Skills Training (ILST) and Life Skills Training (LST)" are:
     Procedure	Modifiers		Service Description
     T2013	U6		Independent Living Skills Training (Brain Injury Waiver)
     H2014	UA		Life Skills Training (Community Mental Health Supports Waiver)
     H2014	U1		Life Skills Training (Elderly, Blind, and Disabled Waiver)
     H2014	U1	SC	Life Skills Training (Complementary and Integrative Health Waiver)
     H2014	U8		Life Skills Training (Supported Living Services Waiver)

      

     Back to Inclusions List

     In-Home Support Services (IHSS) Used by HCBS Providers (Billing Provider Type 36). Applicable in all locations. All billing codes associated with "In-Home Support Services (IHSS)" are:
     Procedure	Modifiers				Service Description
     H0038	U5				In-Home Support Services (IHSS) - Health Maintenance (Children's Home and Community Based Services Waiver)
     H0038	U5	HX			In-Home Support Services (IHSS) - Health Maintenance (Children's Home and Community Based Services Waiver), Denver County
     H0038	U1				In-Home Support Services (IHSS) - Health Maintenance (Elderly, Blind, and Disabled Waiver)
     H0038	U1	HX			In-Home Support Services (IHSS) - Health Maintenance (Elderly, Blind, and Disabled Waiver), Denver County
     S5130	U1	KX			In-Home Support Services (IHSS) - Homemaker (Elderly, Blind, and Disabled Waiver)
     S5130	U1	KX	HX		In-Home Support Services (IHSS) - Homemaker (Elderly, Blind, and Disabled Waiver), Denver County
     T1019	U1	KX			In-Home Support Services (IHSS) - Personal Care (Elderly, Blind, and Disabled Waiver)
     T1019	U1	HR	KX		In-Home Support Services (IHSS) - Relative Personal Care (Elderly, Blind, and Disabled Waiver)
     H0038	U1	SC			In-Home Support Services (IHSS) - Health Maintenance (Complementary and Integrative Health Waiver)
     H0038	U1	SC	HX		In-Home Support Services (IHSS) - Health Maintenance (Complementary and Integrative Health Waiver), Denver County
     S5130	U1	SC	KX		In-Home Support Services (IHSS) - Homemaker (Complementary and Integrative Health Waiver)
     S5130	U1	SC	KX	HX	In-Home Support Services (IHSS) - Homemaker (Complementary and Integrative Health Waiver), Denver County
     T1019	U1	SC	KX		In-Home Support Services (IHSS) - Personal Care (Complementary and Integrative Health Waiver)
     T1019	U1	SC	HR	KX	In-Home Support Services (IHSS) - Relative Personal Care (Complementary and Integrative Health Waiver)

      

     Back to Inclusions List

     Occupational Therapy Used by Occupational Therapy providers (Billing Provider Types 16, 25, 28, and 48) Applicable in Places of Service 4, 12, 15, 16, 18, or 99. Occupational Therapy providers are ineligible for Live-in Caregiver designation. All billing codes associated with "Occupational Therapy" are:
     Procedure
     92526
     96112
     96113
     97010
     97012
     97014
     97016
     97018
     97022
     97024
     97026
     97028
     97032
     97033
     97034
     97035
     97036
     97110
     97112
     97113
     97116
     97124
     97129
     97130
     97140
     97150
     97165
     97166
     97167
     97168
     97530
     97533
     97535
     97537
     97542
     97545
     97546
     97597
     97598
     97602
     97750
     97755
     97760
     97761
     97763
     97799

      

     Back to Inclusions List

     Pediatric Behavioral Therapy Used by Pediatric Behavioral Therapy providers (Billing Provider Types 16, 24, 25, 37, 38, 83, and 84) Applicable in Places of Service 12 and 99. Pediatric Behavioral Therapy providers are ineligible for Live-in Caregiver designation. All billing codes associated with "Pediatric Behavioral Therapy" are:
     Revenue	Modifier	Service Description
     97153		Adaptive behavior treatment by protocol, administered by a technician under the direction of a qualified health care professional to one patient, each 15 minutes
     97154		Adaptive behavior treatment by protocol, administered by a technician under the direction of a qualified health care professional to multiple patients, each 15 minutes
     97155		Adaptive behavior treatment with protocol modification administered by a qualified health care professional to one patient, each 15 minutes
     97158		Group adaptive behavior treatment with protocol modification administered by a qualified health care professional to multiple patients, each 15 minutes
     97151		Behavior identification assessment, face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observation, and caregiver interview, interpretation of test results, discussion of findings and recommendations with the primary guardian(s)/caregiver(s), and preparation of the report.
     97151	TJ	Behavior identification re-assessment, limited to 2 units per six months, each 30 minutes

      

     Back to Inclusions List

     Pediatric Personal Care Used by Personal Care Agencies (Billing Provider Type 60) Applicable in Places of Service 2 and 12. Personal Care provided by HCBS Providers (Billing Provider Type 36) also requires EVV as well and is in the "Personal Care" section. The billing code associated with "Pediatric Personal Care" is:
     Revenue	Modifier	Service Description
     T1019		Pediatric Personal Care Service

      

     Back to Inclusions List

     Personal Care Used by HCBS Providers (Billing Provider Type 36) Applicable in all locations Pediatric Personal Care provided by Personal Care Agencies (Billing Provider Type 60) also requires EVV as well and is in the "Pediatric Personal Care" section All billing codes associated with "Personal Care" are:
     Revenue	Modifiers			Service Description
     T1019	U1			Personal Care (Elderly, Blind, and Disabled Waiver)
     T1019	UA			Personal Care (Community Mental Health Supports Waiver)
     T1019	U6			Personal Care (Brain Injury Waiver)
     T1019	U1	SC		Personal Care (Complementary and Integrative Health Waiver)
     T1019	U8			Personal Care (Supported Living Services Waiver)
     T1019	U7			Personal Care (Children's Extensive Supports Waiver)
     T1019	U1	HR		Personal Care - Relative (Elderly, Blind, and Disabled Waiver)
     T1019	UA	HR		Personal Care - Relative (Community Mental Health Supports Waiver)
     T1019	U6	HR		Personal Care - Relative (Brain Injury Waiver)
     T1019	U1	SC	HR	Personal Care - Relative (Complementary and Integrative Health Waiver)

      

     Back to Inclusions List

     Physical Therapy Used by Physical Therapy providers (Billing Provider Types 16, 17, 25, and 48) Applicable in Places of Service 4, 12, 15, 16, 18, or 99. Physical Therapy providers are ineligible for Live-in Caregiver designation. All billing codes associated with "Physical Therapy" are:
     Procedure
     20560
     20561
     90911
     96112
     96113
     97010
     97012
     97014
     97016
     97018
     97022
     97024
     97026
     97028
     97032
     97033
     97034
     97035
     97036
     97110
     97112
     97113
     97116
     97124
     97129
     97130
     97140
     97150
     97161
     97162
     97163
     97164
     97530
     97533
     97535
     97537
     97542
     97545
     97546
     97597
     97598
     97602
     97750
     97755
     97760
     97761
     97763
     97799

      

     Back to Inclusions List

     Private Duty Nursing Used by Home Health Agencies (Billing Provider Type 10). Applicable in all locations. All billing codes associated with "Private Duty Nursing" are:
     Procedure	Service Description (Physical Therapy)
     552	Private Duty Nursing -RN
     559	Private Duty Nursing -LPN
     580	Private Duty Nursing -RN (group-per-client)
     581	Private Duty Nursing - LPN (group-per-client)
     582	Blended Group rate (RN/LPN)

      

     Back to Inclusions List

     Respite and Youth Day Used by HCBS Providers (Billing Provider Type 36). Applicable in all locations. All billing codes associated with "Respite and Youth Day" are:
     Procedure	Modifiers			Service Description
     S5150	U6			Respite - In-Home (Brain Injury Waiver)
     S5150	U6	HX		Respite - In-Home (Brain Injury Waiver), Denver County
     S5150	U7			Respite - Individual (Children's Extensive Supports Waiver)
     S5150	U7	HX		Respite - Individual (Children's Extensive Supports Waiver), Denver County
     S5151	U7			Respite - Individual, Per Diem (Children's Extensive Supports Waiver)
     S5151	U7	HX		Respite - Individual, Per Diem (Children's Extensive Supports Waiver), Denver County
     S5151	U7	HQ		Respite - Group (Children's Extensive Supports Waiver)
     S5150	U9	HA		Individual - In Family Home (15 minutes) (Children's Habilitation Residential Program Waiver)
     S5150	U9	HA	HX	Individual - In Family Home (15 minutes) (Children's Habilitation Residential Program Waiver), Denver County
     S5151	U9	HA		Individual - In Family Home (Day) (Children's Habilitation Residential Program Waiver)
     S5151	U9	HA	HX	Individual - In Family Home (Day) (Children's Habilitation Residential Program Waiver), Denver County
     T1005	UD			Respite - CNA (4 hours or less) (Children with Life-Limiting Illness Waiver)
     T1005	UD	HX		Respite - CNA (4 hours or less) (Children with Life-Limiting Illness Waiver), Denver County
     S9125	UD			Respite - CNA (4 hours or more) (Children with Life-Limiting Illness Waiver)
     S9125	UD	HX		Respite - CNA (4 hours or more) (Children with Life-Limiting Illness Waiver), Denver County
     T1005	UD	TD		Respite - Skilled RN/LPN (4 hours or less) (Children with Life-Limiting Illness Waiver)
     T1005	UD	TD	HX	Respite - Skilled RN/LPN (4 hours or less) (Children with Life-Limiting Illness Waiver), Denver County
     S9125	UD	TD		Respite - Skilled RN/LPN (4 hours or more) (Children with Life-Limiting Illness Waiver)
     S9125	UD	TD	HX	Respite - Skilled RN/LPN (4 hours or more) (Children with Life-Limiting Illness Waiver), Denver County
     S5150	UD			Respite - Unskilled (4 hours or less) (Children with Life-Limiting Illness Waiver)
     S5150	UD	HX		Respite - Unskilled (4 hours or less) (Children with Life-Limiting Illness Waiver), Denver County
     S5151	UD			Respite - Unskilled (4 hours or more) (Children with Life-Limiting Illness Waiver)
     S5151	UD	HX		Respite - Unskilled (4 hours or more) (Children with Life-Limiting Illness Waiver), Denver County
     S5150	U1			Respite - In-Home (Elderly, Blind, and Disabled Waiver)
     S5150	U1	HX		Respite - In-Home (Elderly, Blind, and Disabled Waiver), Denver County
     S5151	U8	HQ		Respite - Group (Supported Living Services Waiver)
     S5150	U1	SC		Respite - In-Home (Complementary and Integrative Health Waiver)
     S5150	U1	SC	HX	Respite - In-Home (Complementary and Integrative Health Waiver), Denver County
     S5150	U8			Respite - Individual (Supported Living Services Waiver)
     S5150	U8	HX		Respite - Individual (Supported Living Services Waiver), Denver County
     S5151	U8			Respite - Individual - Day (Supported Living Services Waiver)
     S5151	U8	HX		Respite - Individual - Day (Supported Living Services Waiver), Denver County
     T2026	U7	HQ		Youth Day Services - Group (Children's Extensive Supports Waiver)
     T2027	U7			Youth Day Services - Individual (Children's Extensive Supports Waiver)

      

     Back to Inclusions List

     Speech Therapy Used by Speech Therapy providers (Billing Provider Types 16, 25, 27, and 48) Applicable in Places of Service 4, 12, 15, 16, 18, or 99. Speech Therapy providers are ineligible for Live-in Caregiver designation. All billing codes associated with Speech Therapy are:
     Procedure
     92521
     92522
     92523
     92524
     92507
     92508
     92520
     92526
     92597
     92605
     92606
     92607
     92608
     92609
     92610
     92611
     92612
     92614
     92626
     92627
     96105
     96111
     96112
     96113
     97129
     97130
     97755

     Back to Inclusions List

3. Appendix A: Alternate Location Guidance for State EVV Solution

   Correcting EVV Locations After the Caregiver has Completed the Visit

   All EVV records may be updated to reflect actual locations of service delivered. Providers are responsible for reporting correct EVV and billing appropriately.

   Caregiver notification (if needed)	Provider Agency creates and fixes EVV record Exception
   Report any relevant information on actual service delivery location and reasoning to the Provider Agency	Search for the visit in "Visit Maintenance" Select "Exceptions" and select "Location Required" Select the reason code, "Manual Entry" Enter the actual location in the prompted "Reason Note" field

    

   Alternate Location using Mobile Visit Verification (MVV/Mobile App)

   Though the mobile application should capture a GPS location, if service is being delivered at a location other than what is recorded, Alternate Locations may be entered.

   Caregiver notates Alternate Location from the mobile application	Provider Agency fixes MVV record Exception
   At the end of service delivery, log into MVV (the Home screen shows the visit is in progress) Select "Resume Visit" (blue button) Select "Add Tasks" (blue button) Check "Alternate Location" (check box) Select "Complete Visit" (blue button) Select "Confirm" (blue button) Report the actual location of service delivery and reasoning to the Provider Agency.	"Location Required" Exception must be acknowledged in the Sandata Portal. Of the reason code options, select "Location captured by MVV/TVV incorrect" Enter the actual location in the prompted "Reason Note" field.

    

   Alternate Locations using Telephony Visit Verification (TVV)

   Providers may enter all known phone numbers in the Client Module of the Sandata Portal. The primary address listed will link to all entered phone numbers in the Client file when TVV is used. If calling from a known phone number but service is delivered at a location other than the client's primary address (for example using the client's cell phone while in the community), an Alternate Location must be noted:

   Caregiver notates Alternate Location from a known phone number	Provider Agency fixes TVV record Exception
   During the TVV call-out process, when prompted to "enter the number of tasks" - enter "1". When prompted to "enter task ID", enter "1". (This notates an Alternate Location Exception to the Provider Agency.) When prompted for any additional tasks, enter "0".	The Exception "Location Required" must be acknowledged in the Sandata Portal. Of the Reason Code options prompted, select "Location captured by MVV/TVV incorrect".
   After completing the TVV call, report the actual location of service delivery and reasoning to the Provider Agency.	Enter the actual location of service delivery in the prompted "Reason Note" field.

    

   Caregivers may call from a phone number that is not entered in the Client Module of the Provider Portal to record EVV, however, a call from an unrecognized number will be recorded as an "unknown phone number" and will trigger an Exception that must be fixed.

   Caregiver notates Alternate Location from an unknown phone number	Provider Agency fixes TVV record Exception
   Calling from a number not associated with the client automatically creates an Exception, further notation is not needed from the caregiver. After completing the TVV call, report the actual location of service delivery and reasoning to the Provider Agency.	The Exception "Unmatched Client ID/ Phone" must be acknowledged in the Sandata Portal Of the Reason Code options prompted, select "Location captured by MVV/TVV incorrect" Enter the actual location in the prompted "Reason Note" field.

    

   Manual Visit EVV Records

   If no EVV data is recorded at the Time of Service, a Manual Visit entry may be entered. The State EVV Solution requires the location component of Manual Entries to be entered as a Reason Note:

   Caregiver requests a Manual Visit to EVV

   Provider Agency enters a Manual Visit EVV record

   Report any relevant information on actual service delivery location and reasoning to the Provider Agency

   In the Visit Maintenance screen, select "Create Call" (top right) Search for and select a client (select next) Search for and select an employee (select next) Enter the Date, Time, and Service (select finish) Find the call created in Visit Maintenance then: In the Tasks tab, select the Alternate Location task In the Exceptions tab, fix the "Location Required" Exception and select the "Manual Entry" reason code Enter the actual location in the prompted "Reason Note" field

    

   If using the optional Scheduling Module within the State EVV Solution, a scheduled visit that has not been recorded by a caregiver at the Time of Service may be entered as a Manual Visit by adding the times of service and location:

   Caregiver requests a Manual Visit EVV for a scheduled visit after completion of services	Provider Agency enters a Manual Visit EVV record for a scheduled visit after the caregiver has completed the service
   Report any relevant information on actual service delivery location and reasoning to the Provider Agency	Find the scheduled visit in Visit Maintenance Select "Call Log" Manually enter call times and select "Manual Entry" reason code when prompted Enter the actual physical location in the prompted "Reason Note" field

    

   Back to Top

4. Appendix B: EVV Live-in Caregiver Attestation

   The EVV Live-In Caregiver Attestation form is available as a fillable PDF on the EVV Resources web page under the Live-in Caregiver Resources section. The Live-in Caregiver Attestation form also may be printed from the following pages and filled out manually.

   Back to Top

5. Version History

   This program manual will be updated on the EVV Resources web page to reflect the current state of the Colorado EVV program. As items are added or modified a short note will indicate the version date.

Back to Top