Best Practices for Integration and EVV Compliance

Validation: Ensure that any transmitted diagnosis code is valid, billable, and adheres to CMS billing guidelines.

• Required Data: An EVV-compliant visit must include:

  • A valid clock-in and clock-out time

  • The method used to confirm the visit, such as:

    • Call-In/Out Phone Number (for Telephony confirmation)

    • Call-In/Out Latitude and Longitude (for Mobile App confirmation)

    • Service Address In/Out

• Manual Confirmation: If the visit record is missing one or more of the above confirmation methods, it is considered manually confirmed, and visit edits should be transmitted.

• Matching Visit and EVV Times: The visit start and end times should match the EVV (Electronic Visit Verification) start and end times. If there are discrepancies, transmit visit edits to align the data.

• Invoicing Same Service Code: Visits with the same service code on the same day should be consolidated into a single third-party invoice.

• Invoicing Different Service Codes: Consecutive shifts on the same day with different service codes should be billed on separate third-party invoices.

• Invoicing Visits with Separate Authorizations: Visits billed for the same billing period on

• Batching Visits: Ensure visits are invoiced in accordance with payer billing guidelines to maintain compliance. Visits billed through third-party integration will be batched together on the claim as they are received via the interface.

Avoid Overlaps: Schedule and visit times are validated for overlapping errors, though EVV times can overlap. Ensure that the schedule and visit start and end times do not overlap. Overlapping visits may encounter errors. It is recommended that the agency's third-party system detects and addresses overlapping issues before visits are transmitted.

• General Recommendation: It is recommended that visits crossing multiple calendar days should split at midnight. Specifically, visits should end at 11:59 pm on the initial day and resume the following day at midnight.

• State-Specific Requirements: Note that some states, such as NC, may have special requirements where visits are required to resume at 12:01 am on the following day.

In managing rates for billing purposes, it's important to adhere to specific guidelines depending on how rates are managed:

• Providers Managing Rates via the API or V5 Integration:

  • Adjustment for Billing: If the total units billed are less than the total billed hours, adjust the hours to match the total units billed. The schedule times can be edited to match the visit times, bypassing the need to edit the visit times.

  • Units Billed: The units transmitted via the integration must reflect the total units for the confirmed visit record.

  • Whole Numbers Only: Units should be sent in whole numbers, as billing partial units is not permitted.

• Payer-Managed Rates:

  • If rates are managed by the payer, the application will bill the lesser of the scheduled and visit duration.

  • To avoid billing discrepancies, ensure that the scheduled duration matches the confirmed visit duration.

For users in the V5 interface, it is crucial not to resubmit visits with the submission type field left blank under the following conditions:

• Previously Imported Visit: The visit was successfully imported with a third-party invoice.

• No Changes: No changes have been made to the visit details.

• Payment Received: Payment for the visit has already been received.

Ensure that the submission type accurately reflects whether the visit should be processed as an original, adjustment, or voided claim, based on changes and payment status.

Additional Guidelines:

• First-Time Billed Visit: Leave the submission type field blank when submitting a visit for billing the first time.

• Add Shifts: When adding an additional shift to a claim for a billing period already invoiced in HHAeXchange, append it to the originally imported invoice to prevent duplicate billing and comply with Medicaid requirements.

• Update Unpaid Visits: If a visit has been edited (e.g., changes to schedule, visit times, manual confirmation, or caregiver adjustments) after being imported with a third-party invoice and remains unpaid, set the submission type field to original.

• Update Paid or Denied Visits: For visits that have already been paid or denied, set the submission type field to adjustment and include the TRN (claim) number.

• Void Paid or Denied Visits: To void a visit that has already been paid or denied, set the submission type field to void and include the TRN (claim) number. This action deletes the visit from the HHAeXchange application.

• TRN Usage: Include the first claim number assigned by the payer for visits requiring adjustment or voided claims.

• Manual Confirmation: If visit edits are submitted, the visit will be stored as manually confirmed.

• When to Edit: Visit edits should be transmitted in the following cases:

  • Discrepancies between visit and EVV start and end times.

  • If the visit is manually confirmed due to missing confirmation methods:

    • Call-In/Out Phone Number (for Telephony confirmation)

    • Call-In/Out Latitude and Longitude (for Mobile App confirmation)

    • Service Address In/Out

  • If the visit falls outside the Geo Fence guidelines. The agency's third-party system should capture and address visits that are outside these guidelines.

• When Not to Edit: Do not transmit visit edits if only the Schedule In/Out times are edited.