Provider Update: Transition to New IVRA/EVV Software System, Sandata

IMPORTANT EVV TRANSITION BULLETIN #4

DHS is very excited at the opportunities that are coming with the new IVRA/EVV System through our new contracted vendor, Sandata.  We look forward to improvements to the system that will result in higher assurances of our Member's health & safety, as well as for our Providers.  This communication offers critical information for providers to successfully transition to the use of the new IVRA software system, although frequent emails and important updates will follow. The heading of every communication going forward will be numbered in a series, and should be kept for future reference.  In addition to communication from the AA, Sandata, the new IVRA Contractor, will begin to correspond with providers as well. 

Please notice the change in terminology to Electronic Visit Verification (EVV), from IVRA.  The system can be considered an IVRA; however EVV is the term most recognized in the industry as it relates to the use of telephony and other software features to capture and verify visits to a Members home. For all intents and purposes, the term EVV and IVRA will be considered synonymous.   

In accordance with OAC 317:35-17-22, all Case Management and Home Care Providers will begin using the new IVRA/EVV software September 1, 2014. The importance of this communication is to alert providers of the compressed time table for implementing the use of the new software and the necessity of meeting crucial milestones in order to mitigate the burden to the provider, and to prevent billing delays/complications. The specific purpose of this communication is to outline necessary action steps providers should begin taking in planning for this expedited process.

Overall there are three phases of this transition where providers are urged to pre-plan and to re-align internal business flows where necessary.  The phases of this transition include the following: 

TRAINING

ENROLLMENT

CLAIMS

TRAINING

Providers are encouraged to be prepared for the planned IVRA/EVV training that will occur during the last two (2) weeks of August, 2014. In a prior communication from the AA, providers were advised that training will be hands-on classroom training.  This limits the number of staff that can be effectively trained; however, the AA will reach out to providers where necessary to ensure staff that needs to be trained, will be. [Training is mandatory in order for providers to comply with OAC 317:35-17-22.] In addition to staff designated to attend the IVRA/EVV training, providers may want to consider pre-planning internal training sessions for staff to be trained that cannot attend the training. Scheduling training just prior to the cutover was intentional, as it will likely result in retaining the material presented. In order to most effectively transfer the knowledge gleaned from the training offered, it might be beneficial for other agency staff to be “trained-by-the-trainer” within 24-48 hours following the formal Sandata sponsored training sessions. 

SCHEDULING AND ENROLLMENT OF WORKERS

SCHEDULING: Scheduling through the IVRA/EVV system will become mandatory effective September 1, 2014. This feature is mandatory due to the following:

1. Aligning a schedule with claims and billing is an essential component of an EVV system, and by disengaging the scheduling function the system is significantly diminished in what it is intended to do. The system will no longer be underutilized. 
   The IVRA/EVV system Contractor, Sandata, is required to provide the State Medicaid Services Unit (MSU) with an “electronic scheduling, tracking, reporting and billing software system for in-home care providers”.  These features have been a functional aspect of the IVRA system since the first implementation in 2009.
   
   
2. A Member’s Service Plan is the guide that should always be used when developing a Member’s schedule. The Service Plan should ensure that health and safety needs are met, partly based on planned service encounters.  Scheduling drives the alerting system function of the IVRA/EVV that is supposed to warn and document for the provider when the visit as prescribed by the Service Plan has been fulfilled.  It is therefore critical that the scheduling feature become active for the benefit of all Members.
   
   The recent death by murder of a Member has only served to strengthen the resolve to be more vigilant in finding ways to ensure health and safety measures are applied where ever possible. The new IVRA/EVV system is designed to ensure compliance in meeting health and safety needs, and will not allow a claim to be created where there is no assurance that a visit was completed as scheduled.  hero
   
   
3. In recent months, the AA has received reports from providers who have undergone SURS auditing. In response to the feedback received, it appears that engaging the full functionality of the system may have offered the providers some benefit in providing documentation that could have addressed identified issues.  hero
   
   
4. Providers should be prepared to enter staff schedules into the IVRA/EVV system beginning September 1. Delays in entering schedules will result in unconfirmed claims amassing in the system that will not be exported for payment. Ultimately, the new IVRA/EVV will be configured to allow providers who currently have scheduling software to upload staff schedules from the software they may be using.  hero ul
   
   In general, it may now be necessary for providers to review internal billing practices/processes currently in use to ensure they will remain effective in facilitating data entry and claims reconciliation where necessary. hero ul
   
   The new system will allow the provider to create and save a template schedule that can be automatically resubmitted as long as the staff serving the Member remains the same. Obviously, Members require flexibility where scheduling is concerned, and the system will allow for substitution and modifications when necessary. 

CLAIMS

CLAIMS PROCESSING: There is variability in the frequency and interval by which providers confirm and submit billing. Providers are encouraged to be vigilant in billing in regular and frequent intervals in the upcoming weeks through the IVRA/EVV transition.  When there is a transition of this magnitude, billing delays can occur, and it is a probability that should be planned for.    PENDING CLAIMS:  To the greatest extent possible, reconcile all pending claims and submit for processing no later than July 31, 2014. It would be most advantageous for Providers to reconcile, to the degree possible, all pending claims prior to the September 1 cutover date. 

Again, providers will continue to receive frequent communication concerning this transition. Please adhere to the recommended guidelines.  If you have any questions regarding the information provided above, please feel free to contact us via Smarter Mail at: