EVV Prospective Process: what is it?

Attention:  All TCHP STAR Kids LTSS Providers Requiring EVV Subject:  TCHP EVV Prospective Process   Beginning 05/01/2018, Texas Children’s Health Plan will activate the Prospective Process for the EVV system. This process will match claims to EVV transactions prior to the claim being paid. If a matching EVV transaction is not found, the claim will be denied. It is imperative that all providers ensure that all members have the correct payor ID set up in the EVV software. If a member does not have the appropriate payor ID set up, Texas Children’s Health Plan will not receive EVV visits from Vesta or MedSys, which will result in a denial of the claim. Additionally, all EVV transactions will be matched with claims on the following attributes:

• Medicaid ID
• NPI Number
• Date of Service
• The HCPCs code and modifiers

If any of the attributes above do not match between the claim and the EVV Transaction, the claim will be denied. It is the provider’s duty to ensure that all information matches between the EVV Transaction and the submitted claim. Due to EVV Transactions and claims being matched prospectively, providers will also need to ensure that all EVV Transactions are submitted before the claim. Since Vesta and MedSys only send EVV Transaction files daily, it may take up to 48 hours before the EVV Transaction is processed in our system. Submitting a claim prior to the EVV Transaction being received will result in a denial of the claim. The Texas Children’s Health Plan EVV Team is available to answer your questions at EVVGroup@tchp.us. Thank you for partnering with Texas Children’s Health Plan to care for the needs of our members. Please visit the Provider Portal to stay up to date on the EVV process.