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Provider Update: February 18, 2020

To:      ADvantage Case Management/Home Care Providers, and State Plan Personal Care Providers

Subject:EVV Service Billing Changes

In order to meet requirements of the 21st Century Cures Act the following billing changes for EVV services will go into effect as of April 1, 2020.

  • Initial claims for the following services must be billed through AuthentiCare. Claims will deny if billed directly through the OHCA portal.
    • T1016 – Case Management
    • T1016:TN – Case Management – VR
    • T1016:TN:U3 – Transitional Case Management – VR
    • T1016:U3 – Transitional Case Management
    • T1002 – RN Assessment/Evaluation
    • G0299 – RN Skilled Nursing
    • G0299:TF – RN Extended State Plan Skilled Nursing
    • G0300 – LPN Skilled Nursing
    • G0300:TF – LPN Extended State Plan Skilled Nursing
    • T1019 – Personal Care
    • S9125 – In Home Respite (8+ hours)
    • T1019:TF – Advanced Supportive/Restorative
    • T1005 – Respite In-Home
  • The OHCA portal will be used to back out any billing as needed. There is no change in this process.
  • Re-billing less than 6 months from the Date of Service (DOS) will require the claim to be billed through AuthentiCare.

Resubmission of Denied Claim (Replace Claim) in AuthentiCare: The Provider Claim web page allows Providers to select claims that are denied or where no 835 information was received for resubmission.

AuthentiCare will create a new claim with the original claim information and allow the Provider to make corrections, note the reasons for resubmission, and confirm the claims for submission.

In AuthentiCare the user will select the Replace Claim option as shown below to start the resubmission process.

  • Re-billing greater than 6 months but less than 12 months from DOS will be done through the OHCA portal following the steps below. This is a new process that will allow EVV to be used as proof of timely filling.

    User Selects "Yes" next to EVV Timely Filing.

    User will add at least one attachment to the claim to show the billing that was done in the AuthentiCare System. 

    User will complete the rest of the required claims details.

    User will select "Submit".

Please send any questions regarding the information above through the Harmony PQ chapter.

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