Provider Update: July 6, 2016
Electronic Visit Verification (EVV) Transition Preparedness
BULLETIN NO. 8
Topic: Mandatory 835 Upload
This is a reminder that 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. The postposed EVV transition does not change the requirement to upload 835 remittances.
Those not currently receiving electronic 835s 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. Please begin uploading 835 remittances into the Sandata system until a transition occurs. Providers who previously had the EVV provider as the recipient should transfer the receivership of the document to the agency. Providers should 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 EVV 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 EVV 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.
MSU has added this as a mandatory requirement for providers due to the following:
- 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 the EVV system is performing properly. This also fulfills a CMS performance measure as it pertains to the State's EVV, or billing system.
- The 835 remittance data can be used to reconcile units used, and the new EVV system plans to automatically reconcile units used when the file is imported into the system. This would afford 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.
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