Electronic Visit Verification (EVV) Transition Preparedness
BULLETIN NO. 3 Topic:The 835 Remittance File
One the most significant challenges faced in implementing the EVV system is the inability to trace the full cycle of billing from end-to-end. The billing sequence initiates as follows:
Billing issues are more quickly diagnosed when the lifecycle of claims are accessible and visible to providers, the EVV contractor, and MSU. Had this information been more readily accessible during the current implementation, we might have had the ability to detect billing issues more quickly and by working in conjunction with the EVV provider, find resolution.
Effective July 1, 2016, the uploading of electronic 835 remittance files into the EVV system will be a mandatory requirement for all Case Management and Home Care Providers, both serving ADvantage and State Plan Personal Care Members. Those not currently receiving electronic 835's should apply with the Oklahoma Health Care Authority (OHCA) to receive electronic remittance advice (RA) no later than July 1, 2016. The completion of an EDI application must occur prior to receiving RA in this format. Please contact your area OHCA representative, should you need assistance in applying to receive the 835 file.
MSU has added this as a mandatory requirement for providers due to the following reasons:
- This data is necessary in order for MSU to fully comply with the CMS waiver performance measure (PM) requirement for the State to adopt methods of financial accountability in how payments for waiver services are made, ensure the integrity of these payments, and comply with applicable federal requirements concerning payments and federal financial participation.
- Having this data allows MSU to check, and validate that EVV system is performing properly, which also fulfills a CMS performance measure as it pertains to the States EVV, or billing system.
- The First Data AuthentiCare software uses 835 remittance data to reconcile units used, and the system will automatically reconcile units used when the file is imported into the system. This affords all concerned the ability to synchronize units used data as initially generated by WMIS, submitted to the EVV system and adjudicated by OHCA.
- This data provides MSU program QAI auditors the ability to complete accurate financial reviews for the delivery of program services.
- This data feeds EVV reports providers might use for payroll purposes, and for other internal business needs.
Currently 22% (22) of all providers have their 835 remittance data uploaded into the Sandata EVV system, while 78% (79) do not. All 22 providers that now have their files uploaded into the Sandata system agreed to allow Sandata to be the receiver of their 835's and the files were automatically imported into the Sandata system. The process will be managed differently for the new iteration of the AuthentiCare EVV system implementation. Providers will now need to complete an EDI request to become the receiver of the 835, and when providers receive the electronic 835 file, it will be expected that the provider will manually upload the 835 file into the EVV system.
For those that currently have their 835's uploaded into the Sandata system, please continue to do so, however upon transitioning from Sandata to First Data's AuthentiCare EVV system, you will need to do the following:
- Complete a new EDI application requesting to become the receiver of the 835 if you have not already done so.
- Manually upload the 835 into the AuthentiCare system effective July 13, 2016
Providers who are not currently uploading their 835 into the EVV system should plan to manually upload the 835 into the AuthentiCare system effective July 13, 2016. Uploading the 835 file will not be consumed by the system and the provider copy should remain intact wherever it is stored in your computer.
This is just another step for us to ensure the successful implementation of the EVV system. Thank you for your prompt attention to this matter.
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