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Provider Update: October 21, 2019

To:                  ADvantage Case Management and Home Care Providers

Subject: ADvantage EVV System Utilization

In order to continue to comply with the 21st Century Cures Act, the ADvantage Administration is issuing the following guidelines for Electronic Visit Verification (EVV) utilization.

1. Claims creation and generation for the following service codes must take place through the EVV system.

Service Code Service Code Modifier Service Name Unit Type
T1016   Case Management - Standard 15 minutes
T1016 TN Case Management - Very Rural 15 minutes
T1016 U3 Transitional Case Management - Standard 15 minutes
T1016 TN U3 Transitional Case Management - Very Rural 15 minutes
T1001   State Plan Skilled Nursing Per Visit
T1002   RN Assessment/Evaluation 15 minutes
G0299   RN Skilled Nursing 15 minutes
G0299 TF RN Extended State Plan Skilled Nursing 15 minutes
G0300   LPN Skilled Nursing 15 minutes
G0300 TF LPN Extended State Plan Skilled Nursing 15 minutes
G0151   Physical Therapy 15 minutes
G0152   Occupational Therapy 15 minutes
S9125   In-home Extended Respite 15 minutes
T1005   In-home Respite 15 minutes
T1019   Personal Care 15 minutes
T1019 TF Advanced Supportive/Restorative Assistance 15 minutes

2. EVV utilization (check in/check out for service in the Member's home) must be conducted in one of two ways:

A.      EVV Mobile App with GPS location collection enabled.

B.      IVR (telephone) used via participating Member's landline touchtone phone. Call in/call out must not be used on the Member's cell/mobile phone.

Direct entry of claims into the Authenticare software is established by the Administrator of the provider agency according to the assigned access roles for office staff. Web-based claims are appropriate for work completed in the office by Case Managers and Nursing, however claims for all personal care service types (respite, personal care, AS/R) must always occur in the member's home via either IVR or EVV.

Case Managers have a view only role in Authenticare for those Members assigned to their caseload.

3. Scheduling of In-home Case Management services is not mandatory in the EVV system.

MSU strongly recommends scheduling of in-home Case Management services as a best practice to manage units and for overall service monitoring, however it does not require Case Management services to be scheduled.

4. MSU monitors the utilization of the EVV system in accordance with Oklahoma Administrative Code 317:30-5-764.

Recent reports have revealed that some agencies do not appear to be utilizing EVV appropriately and in the spirit of the policy.  Please ensure all PCS are utilizing Authenticare as the sole source for claims submission

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