EVV Aggregation Transaction Manager Rule Holds and Resolutions

The HHAeXchange EVV Aggregation Transaction Manager under Admin > EVV Aggregation Transaction Manager allows providers to manage visits related to the linked payer placements that have been approved, rejected, or are pending export to the Texas Medicaid and Healthcare Partnership (TMHP) EVV Aggregator. The TMHP EVV Aggregator is a centralized database maintained and operated by TMHP that collects, validates, and stores statewide EVV visit transaction data transmitted by the HHAeXchange system.

This topic contains all hold reasons found in the Texas EVV Aggregation Transaction Manager, and the recommended actions to resolve them in the HHAeXchange system.

Complete all steps listed in the How to Resolve column and then resubmit all EVV visits on Hold for validation by the TMHP EVV Aggregator.

To resubmit an EVV visit to the TMHP EVV Aggregator, locate the EVV visit transaction in the HHAeXchange EVV Aggregation Transaction Manager, click the Actions button then select Validate and Submit to Aggregator.

HHAeXchange Hold Reason(s)

HHAeXchange Rule Check(s)

How to Resolve

Consumer Directed Services Employer First Name is too long.

Consumer Directed Services (CDS) HCPCS selected on visit. CDS Employer First Name is missing.

Populates for consumer-directed services (CDS) Healthcare Common Procedure Coding System (HCPCS) codes.

Consumer Directed Services (CDS) Employer First Name cannot exceed 50 characters.

This field cannot be empty for a CDS visit.

Go to Member > Search Member to locate and select the Member.

If the Member is the CDS Employer, go to the Profile page, click the Edit button, and update the First Name field. Save.

If the Member has a different CDS Employer, go to the General page, click the Edit button, and update the CDS Employer of Record field. Click Save.

Consumer Directed Services Employer Last Name is too long.

Consumer Directed Services (CDS) HCPCS selected on visit. CDS Employer Last Name is missing.

Populates for CDS HCPCS codes.

Consumer Directed Services Employer Last Name cannot exceed 50 characters.

This field cannot be empty for a CDS visit.

Go to Member > Search Member to locate and select the Member.

If the Member is the Consumer Directed Services (CDS) Employer, go to the Profile page, click the Edit button, and update the Last Name field. Click Save.

If the Member has a different CDS Employer, go to the General page, click the Edit button, and update the CDS Employer of Record field. Click Save.

Consumer Directed Services (CDS) HCPCS selected on visit. CDS Employer Electronic Visit Verification Identification is missing.

Populates for CDS HCPCS codes.

Consumer Directed Services Employer of Record EVV Identification Number cannot be empty for a CDS visit.

Go to Member > Search Member to locate and select the Member.

Go to the member’s General page, click the Edit button, and update the CDS Employer of Record EVV Identification Number field. Click Save.

Employee ID is missing.

Cannot be empty.

Go to Service Provider > Search Service Provider to locate and select the Service Provider. On the Profile page, click the Edit button and update the Employee ID field. The Employee ID is an identifier assigned to the Service Provider by his or her employer for HR and payroll purposes. Click Save.

EVV Call In Address Type has incorrect value.

EVV Call Out Address Type has incorrect value.

 

EVV Call In/Out Address Type must be one of the following:

  • Member Home

  • Community

  • Family Home

  • Neighbor Home

Cannot be empty.

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button. Verify that the member address is assigned an Address Type and Save.

If a phone number is assigned in the member’s profile, verify Home, Family Home, or Neighbor Home is entered in the Phone Location field.

If the member is configured for the use of an alternative device , ensure the Alternative Device Location field located on the General page displays the member home address.

After the steps above are completed, this resolves future instances of this hold. To correct past instances, locate the visit in the member’s calendar, click the Visit Info tab, and click the Edit button for Clock Out. Select the Visit Location Address and Visit Location Type. Enter a Reason for Editing then, click Save.

EVV Call In Phone is not in correct format for IVR method.

EVV Call In Phone is missing for land line (IVR) Method.

EVV Phone is not a 10-digit number for the land line method (IVR method).

Cannot be empty.

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the Home Phone field. Click Save.

EVV Call Out Time is not on the same day of the EVV Call In Time

EVV Call In and EVV Call Out must take place on the same day. EVV Call Out must be no later than 11:59 pm or earlier. The minimum duration for HHAeXchange to automatically split overnight shifts is 15 minutes past 12 am.

Go to Member > Search Member to locate and select the Member. Find and open the visit in the member’s calendar. Click Visit Info, remove the Bill Time Out, select a New Reason and Action Taken and click Save.

Now that the Bill Time Out is blank, enter 11:59 pm in the Bill Time Out and change the date to match the date of the Visit Start, select a New Reason and Action Taken and click Save.

Consumer Directed Services (CDS) HCPCS selected on visit. EVV CDS Selection is missing.

Populates for CDS HCPCS codes.

CDS Selection cannot be empty.

Go to Member > Search Member to locate and select the Member.

Go to the member’s General page, click the Edit button, and update the CDS Selection field. Click Save.

EVV Service Delivery Address, City, State, or Zip Code In is missing.

EVV Service Delivery Address, City, State, or Zip Code Out is missing.

EVV Service Delivery Address In/Out cannot exceed 50 characters.

One or more of the EVV Service Delivery In/Out fields are missing.

EVV Service Delivery Location is not listed below:

  • Member Home

  • Community

  • Family Home

  • Neighbor Home

Cannot be empty

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button. Verify that the member address is assigned an Address Type and save.

If a phone number is assigned in the member’s profile, verify Member Home, Family Home, or Neighbor Home is entered in the Phone Location field.

If the member is configured for the use of an alternative device , ensure the Alternative Device Location field located on the General page displays the member home address.

After the steps above are completed, this resolves future instances of this hold. To correct past instances, locate the visit in the member’s calendar, click the Visit Info tab, and click the Edit button for Clock In. Select the Visit Location Address and Visit Location Type. Enter a Reason for Editing then, click Save.

EVV Service Delivery Address In is too long.

EVV Service Delivery Address (or City, State, Zip Code) In is missing.

EVV Service Delivery Address In cannot exceed 50 characters.

One or more of the EVV Service Delivery In fields are missing.

Cannot be empty

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the Address fields.

Verify that the member Phone Location is selected.

If a member is configured for Alternative Device EVV, ensure that the member home address is selected on the General page, Alternative Device Location field.

After the steps above are completed, this resolves future instances of this hold. To correct past instances, locate the visit in the member’s calendar, click the Visit Info tab, and click the Edit button for Clock In. Select the Visit Location Address and Visit Location Type. Enter a Reason for Editing then, click Save.

LTC Provider Number on the LTC Authorization has incorrect format.

Long-Term Care (LTC) Provider Number must be a 9-digit number.

Cannot be empty.

Go to Member > Search Member to locate and select the Member. On the Auth/Orders page, click ... under Actions and then click View/Edit. Verify the LTC Provider Number is entered correctly and is 9 digits.

LTC Provider Number is missing from associated LTC Authorization.

LTC Provider Number is required for LTC EVV visits. The following must match between the EVV Visit and authorization:

  • TIN

  • NPI

  • Service Code

  • Service Group

  • Auth Start/End Date

Go to Member > Search Member to locate and select the Member. On the Auth/Orders page, click ... under Actions and then click View/Edit. Add the 9-digit LTC Provider Number in the Provider Number field. Click Save.

Medicaid ID is not in correct format.

Medicaid ID is missing.

Medicaid ID must be 9 digits.

Cannot be empty.

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the Medicaid Number field. Click Save.

Member’s Date of Birth missing.

Member’s Date of Birth cannot be empty.

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the Date of Birth field. Click Save.

Member First Name is not in correct format.

Member First Name is missing.

Member First Name cannot exceed 50 characters.

Cannot be empty

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the First Name field. Click Save.

Member Last Name is not in correct format.

Member Last Name is missing.

Member Last Name cannot exceed 50 characters.

Cannot be empty

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the Last Name field. Click Save.

Member Primary Phone is not in correct format.

Member Primary Phone must be 10 digits.

Cannot be empty.

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the Home Phone field. Click Save.

Member Secondary Phone is not in correct format.

Member Secondary Phone must be 10 digits.

Cannot be empty.

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the Phone 2 field. Click Save.

Member Tertiary Phone is not in correct format.

Member Tertiary Phone must be 10 digits.

Cannot be empty.

Go to Member > Search Member to locate and select the Member. On the Profile page, click the Edit button and update the Phone 3 field. Click Save.

Payer Member Plan Code is missing.

Cannot be missing when member payer is Managed Care Organization (MCO): AET, AGP, BCB, CFC, CHS, CKC, CMC, DRC, MOL, SHP, TXC, UHC, CHC, SET, EP1, PRK, SCW, FCR

Cannot be empty.

Go to Member > Payers/Insurance. Review the member payer placement for any errors. Add a new payer placement if eligibility changed for the member. Correcting the payer placement will prevent holds moving forward.

To resolve the visits on hold, go to Member > Calendar > Visit > Bill Info. Select Plan Code and then click Save. Repeat for each affected visit.

Provider API has incorrect format.

Provider NPI or Provider API is missing.

If only the Atypical Provider Identifier (API) is populated, then it must have 10 characters.

Provider National Provider Identifier (NPI) or Provider API cannot be empty at the same time.

Go to Admin > Office Setup > Search Office to locate and select the office. On the Edit Office page, update the API field and click Save.

Provider Legal Name is too long.

Provider Legal Name is missing.

Provider Legal Name cannot exceed 50 characters.

Cannot be empty.

Go to Admin > Office Setup > Search Office to locate and select the office. On the Edit Office page, update the Office Name field and click Save.

Provider NPI is invalid or not enrolled with TX Medicaid.

NPI must be enrolled with TMHP. HHAeXchange confirms NPI enrollment through the TMHP web service.

Verify Office NPI is valid and confirm NPI enrollment with TMHP.

Go to Admin > Office Setup > Search Office to locate and select the office. Verify the NPI is entered correctly in the NPI No. field.

Provider NPI has incorrect format.

Provider NPI or Provider API is missing.

If only the NPI is populated, then it must have 10 characters.

Provider NPI or Provider API cannot be empty at the same time.

Cannot be empty

Go to Admin > Office Setup > Search Office to locate and select the office. On the Edit Office page, update the NPI No. field and Save.

Provider TIN has incorrect format.

Provider TIN is missing.

Provider Taxpayer Identification Number (TIN) is not 9-digit number.

Provider TIN cannot be empty.

Go to Admin > Office Setup > Search Office to locate and select the office. On the Edit Office page, update the Tax ID field and Save.
Service Code of the HCPCS on the visit does not match the member's authorization. Verify HCPCS and payer selected is for the correct LTC program.

The LTC Service Code does not match the member's FFS authorization on file with TMHP.

Go to Member > Search Member to locate and select the Member. Open the visit in the member's Calendar.

On the Schedule tab confirm that the correct payer is selected in the Bill To field and the correct HCPCS is selected in the Primary Healthcare Common Procedure Coding System (HCPCS) field.

The Service Group of the HCPCS on the visit does not match the member's authorization. Verify HCPCS and payer selected is for the correct LTC program. The LTC Service Group does not match the member's FFS authorization on file with TMHP.

Go to Member > Search Member to locate and select the Member. Open the visit in the member's Calendar.

On the Schedule tab confirm that the correct payer is selected in the Bill To field and the correct HCPCS is selected in the Primary Healthcare Common Procedure Coding System (HCPCS) field.

There are no FFS authorization found for this Medicaid ID. Verify the Medicaid ID. The visit details do not match the member's FFS authorization on file with TMHP. Go to Member > Search Member to locate and select the Member. On the Profile page, verify that the Medicaid ID entered is correct, and check that the member has an FFS authorization on file with TMHP.
No active FFS authorization found for the visit date of service. The visit does not fall within the start and end dates of the member's FFS authorization on file with TMHP. Verify that the member has an FFS authorization on file with TMHP for the date of the visit.
The Provider NPI/API on the visit does not match the member’s FFS authorization. The NPI/API associated with the visit does not match the member's FFS authorization on file with TMHP.

Go to Member > Search Member to locate and select the Member. Confirm the Office that the Member is assigned to. Then, go to Admin > Office Setup > Search Office to locate and select the assigned office of the member.

Confirm the value in the NPI No. or API (Atypical Provider Identifier) fields is correct and matches the value on the member's FFS authorization on file with TMHP.
The Provider TIN on the visit does not match the member’s FFS authorization The TIN associated with the visit does not match the member's FFS authorization on file with TMHP.

Go to Member > Search Member to locate and select the Member. Confirm the Office that the Member is assigned to. Then, go to Admin > Office Setup > Search Office to locate and select the assigned office of the member.

Confirm the value in the Tax ID field is correct and matches the value on the member's FFS authorization on file with TMHP.
The Provider Number on the visit does not match the member’s FFS authorization. The LTC Provider Number on the visit does not match the member's FFS authorization on file with TMHP. Go to Member > Search Member to locate and select the Member. On the Auth/Orders page, click the Ellipses... under Actions and then click View/Edit. Verify the LTC Provider Number is entered correctly and matches the value on the member's FFS authorization on file with TMHP.
Visit Start Time and/or Visit End Time is not on the same day of the Visit Date.

Visit Start Time is on a different date than Visit Date.

Visit End Time is on a different date than Visit Date.

Visit Start Time and Visit End Time are on a different date than Visit Date .

 Go to Member > Search Member to locate and select the Member. Open the visit in the member's Calendar. Click Visit Info, edit the Visit Start Time or Visit End Time date to match the schedule date, or unlink any EVV calls on a different date than the schedule date.

Service Code is inactive for the visit date.

Visit Date must be within the HCPCS Code/Modifier effective dates defined by the Texas Health and Human Services Commission (HHSC).

Go to Admin > Payer Setup > Search Payer and select the payer. Click Billing Rates, find the HCPCS Code/Modifier in the list and review the From and To Dates. Visits must be within these dates. If the visit date is outside the From and To Dates, then select a different HCPCS Code/Modifier that is active for the visit date selected.

Service is simultaneously delivered at separate locations to multiple members by the same Service Provider.

Service Provider cannot perform overlapping services for multiple members at different addresses.

Perform visit maintenance to update the visit confirmed times to eliminate the overlap. The EVV user may confirm the overlap with Reason Code 110-D.

Service is simultaneously delivered at separate locations to the same Member.

Member cannot have multiple overlapping shifts that are serviced at different addresses.

Perform visit maintenance to update the visit confirmed times to eliminate the overlap. The EVV user may confirm the overlap with Reason Code 110-D.

Service Provider First Name is too long.

Service Provider First Name is missing.

Service Provider First Name cannot exceed 50 characters.

Cannot be empty

Go to Service Provider > Search Service Provider to locate and select the Service Provider. On the Profile page, click the Edit button and update the First Name field. Click Save.

Service Provider Last Name is too long.

Service Provider Last Name is missing.

Service Provider Last Name cannot exceed 50 characters.

Cannot be empty

Go to Service Provider > Search Service Provider to locate and select the Service Provider. On the Profile page, click the Edit button and update the Last Name field. Click Save.

Service Provider Social Security Visa Passport is not in correct format.

Service Provider Social Security Visa Passport is missing.

Service Provider Social Security Visa Passport must be last 4 numbers from SSN followed Service Provider last name (max. 50 characters).

Cannot be empty.

Go to Service Provider > Search Service Provider to locate and select the Service Provider. On the Profile page, click the Edit button and update the Social Security Number field. Click Save.

Visit does not have Valid Authorization.

Visit must have a valid authorization.

Go to Member > Search Member to locate and select the Member. On the Auth/Orders page, select Edit Auth or Add Authorization. If more units are needed to cover the visit, update accordingly.

The authorization must be adjusted to match the visit details or visits must be adjusted to match the authorization.