Electronic Visit Verification (EVV)
What is EVV?
Electronic Visit Verification, known as EVV, is a federally mandated initiative that is designed to mitigate fraudulent billing and neglect of vulnerable persons by caregivers. The 21st Century Cures Act mandates that all states implement EVV.
EVV data is collected by the State of Wisconsin’s EVV provider (Sandata). This data is sent by to Community Care on a regular basis. This data is then matched with claim data prior to claim processing. Claims that do not have a corresponding EVV visit will be denied.
What Community Care Programs Require EVV?
EVV is ONLY required for Family Care and Family Care Partnership members. It is NOT required for PACE members.
When searching for Community Care members within the Sandata system, please select the correct member’s program. If the correct program is not chosen, results will not be accurate.
What Services Require EVV At This Time?
Code Service
T1019 Personal Care Services per 15 minutes
T1020 Personal Care Services per day
S5125 Supportive Home Care per 15 minutes
S5126 Supportive Home Care per day
How Are EVV Visits Validated?
Community Care receives data from the State’s EVV provider (Sandata) on a regular basis which is matched with claim data. The data is matched using provider Medicaid ID or EVV ID, member Medicaid ID, date of service, and type of service, along with other data elements.
Will Community Care Deny Services Missing EVV Validation?
Yes. Claims received with dates of service 5/1/2023 and later that are missing the EVV record will deny.
Wisconsin DHS has rolled out EVV in two phases—a "soft launch" and "hard launch."
Hard Launch – dates of service 5/1/2023 and later: any claims received without a matching EVV record will deny.
If the EVV Visit is Not Verified When Community Care Receives the Claim, Will It Deny Right Away?
No. When a claim is received and Community Care cannot immediately match it to an EVV, the claim will be held for up to 10 days. If the EVV is received during this time period, the claim will then move forward for further processing. If the EVV does not come in during this time period, the claim will then deny after the 10 day hold period.
This 10 day hold period allows time for any EVV records to be validated within the Sandata system and sent to Community Care to be matched.
As with all claims, providers should allow up to 30 days for processing of clean claims.
What Can Providers Do to Avoid Any Delays in Claim Payment?
Community Care asks that providers submit EVV claims 2-3 business days after submitting and verifying the EVV information in the Sandata system. This small delay allows appropriate time for the EVV data to be sent from Sandata to Community Care. As long as Community Care has received the EVV visit when the claim is received, the claim will process as normal without delay.
Does Community Care Require EVV for Each Service if Multiple Services Are Provided During the Same Visit?
Yes. Each service provided requires a separate EVV
Example: if a worker performs supportive home care and personal care services, a separate EVV is required for each code. If EVV is not completed for both services, the service without the EVV may be denied.
Can Multiple EVV Dates Be Billed On One Claim Line (Span Billing)?
No. Claims for EVV services must be submitted separately for each date of service. EVV records cannot be matched to claims submitted using date span billing and will be denied.
Example: A member receives services on 10 days in the month of May.
Incorrect: Billing one claim line for 10 units from 5/1/2023 to 5/31/2023
Correct: Bill 10 claim lines, 1 unit each. One claim line per date of service
Does Community Care Require EVV for Live-In Workers?
No. Community Care does not require EVV for live-in workers. Providers should use the KX modifier to identify services provided by a live in home care worker. Providers will NOT see the KX modifier on the authorization, but WILL need to include it on the claims.
What are the identification requirements of a Live-In Worker?
The attached link provides the DHS definition of Live-in work under Identification:
What Can Providers Do if a Claim is Denied For Missing EVV?
Providers should first submit/validate the EVV record. If an EVV visit was already submitted but contained incorrect information, Providers must correct the data in the EVV system. For assistance with modifying EVV records, please contact the Wisconsin EVV Customer Care team.
After making sure the EVV is correct and validated within the Sandata system, provider should submit a new claim. New claims should only contain the previously denied EVV services, any services that have been paid should be omitted from the new claim. Do NOT send a corrected claim or request an adjustment of a claim previously denied. Once submitted, the new claim is then matched up against the EVV data.
Wisconsin DHS Resources For Providers
Wisconsin EVV Customer Care: (833) 931-2035 7 a.m. - 6 p.m., Monday - Friday
Email: [email protected]
EVV webpage: https://www.dhs.wisconsin.gov/evv/index.htm
EVV Resource Page: https://www.dhs.wisconsin.gov/evv/training.htm
Electronic Visit Verification Live-In Worker: https://www.dhs.wisconsin.gov/forms/f02717.pdf (PDF)
Community Care Provider Support
Provider Management is available to assist with contract questions and general EVV support:
Phone: (866) 937-2783 option 2, 8 a.m. - 4:30 p.m., Monday - Friday
Email: [email protected]
For any questions regarding claim payment and/or denial, contact our Claims Customer Service team:
Phone: (866) 937-2783 option 1, 8 a.m. - 4:30 p.m., Monday - Friday
