State Medicaid officials brief committee on EVV rollout, warn of Dec. 1 claim denials

Elizabeth Pittman, Director for the Division of Medical Services, told the committee that implementing electronic visit verification (EVV) is required by the federal 21st Century Cures Act and is intended to verify services, reduce fraud and improve claim payments. "There was a federal mandate, the 21st Century Cures Act," Pittman said during the briefing.

Pittman summarized the rollout timeline: an initial provider notification went out Sept. 30; beginning Nov. 1 the state started suspending claims for one week to identify providers still submitting direct claims; and on Dec. 1 the state plans to stop allowing direct claim submission and begin denying noncompliant claims. Pittman said the department will deploy a tactical response team to assist providers whose claims are denied to help them get paid through the EVV system.

Pittman said most personal care, attendant care under the ARChoices waiver and respite services are being moved to EVV and that claims routed through the EVV system (Authenticare) are showing a higher percentage of paid claims than those submitted directly to MMIS. She told the committee that about 26 of more than 100 provider agencies were still not using EVV and that the department had been conducting reminder emails, weekly technical calls, face-to-face outreach and social media messaging to increase uptake.

Martina Smith, Division Director for Provider Services and Quality Assurance, described outreach to self-directed clients: of approximately 2,300 self-direction clients, only three remained using paper timesheets; 87 clients had begun the EVV process but had not completed it (for example, by obtaining a Medicaid PIN), and the department planned additional mailings and visits to complete conversions.

Committee members had no further questions in the hearing record. Medicaid officials reiterated resources for providers who need technical help, including a phone line and online tutorials, and said the tactical response team will be fully staffed when denials begin to ensure providers can resolve issues and submit claims through EVV.