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Electronic Visit Verification (EVV): FAQs and Resources

General

Section 12006(a) of the 21st Century Cures Act mandates that states implement EVV for all Medicaid personal care services and home health services that require an in-home visit by a provider. This applies to personal care services provided under sections 1905(a)(24), 1915(c), 1915(i), 1915(j), 1915(k), and Section 1115 and home health services provided under Section 1905(a)(7) of the Social Security Act or a waiver. States that do not implement EVV will experience financial penalties from the federal Centers for Medicare & Medicaid Services.

The confidentiality of the information is protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). When a worker captures EVV data using any of the Sandata solutions, the six required data points are encrypted. The data can be viewed by the provider in the Sandata EVV portal in near-real time. Sandata also sends the encrypted data points for each visit to DHS and payers. Payers match them with a future claim/encounter for validation.

Note: EVV systems are required to capture location information at the beginning and end of visits. Currently, DHS will not deny a claim because of GPS information, however, other divisions within DHS, such as the Office of the Inspector General, may use GPS location data to ensure providers bill accurately for covered services.

Providers using alternate EVV systems should contact their vendors for information about HIPAA and other data processes.

DHS does require live-in workers to use EVV for home health care services. DHS also requires EVV use for the RN supervisory visit using code 99509.

DHS does not require EVV use for live-in workers for personal care and supportive home care services. HMOs, managed care organizations (MCOs), and providers may independently require live-in workers to use an EVV system. Refer to the “Live-in Worker Required by DHS to Capture EVV Information” column on the DHS EVV: Service Codes that Require Use of an EVV System in Wisconsin webpage for a list of applicable codes.

In order to be exempt from capturing EVV, a personal or supportive care worker’s live-in status must be verified. The name and address of the live-in worker should exactly match the information contained in the submitted supporting documentation.

IRIS fiscal employer agents (FEAs) cannot require participant-hired live-in workers to use EVV.

Fee-for-service providers should refer to the Live-in Workers topic (#21777) of the BadgerCare Plus and Medicaid ForwardHealth Online Handbook for more information. Family Care and Family Care Partnership providers should refer to the Live-in Workers topic (#22957) in their respective service areas. IRIS providers should reference IRIS EVV Policy, P-03053, or your HMO or MCO.

For personal care services and supportive home care services, workers are only exempt from using an EVV system with the member or participant they live with. There is a process to verify live-in worker status between each member or participant and worker.

Note: MCOs, HMOs, and providers may independently decide if their live-in workers are required to capture EVV information. Fee-for-service providers should refer to the Live-in Workers topic (#21777) in the BadgerCare Plus and Medicaid service area of the ForwardHealth Online Handbook for more information. Family Care and Family Care Partnership providers should refer to the Live-in Workers topic (#22957) in their respective service areas.

For home health care services and personal care nurse supervisory code 99509, DHS is requiring all workers, including live-in workers, to capture EVV information.

EVV does not change policy regarding place of service:

EVV does not change existing policy expectations surrounding prior authorization for out-of-state travel, as described in Wisconsin Admin Code § DHS 104.01(6)(d) and ForwardHealth Online Handbook topic #279.

Fee-for-service providers should refer to the Place of Service topic (#2466) in the BadgerCare Plus and Medicaid service area of the ForwardHealth Online Handbook for more information.

For Family Care, Family Care Partnership, and IRIS, members and participants must seek prior approval for out-of-state provision of a non-emergency service from the MCO or IRIS consultant agency.

If care is approved for out-of-state provision, EVV must be captured for EVV-required services. If EVV capture is not possible while outside of Wisconsin, administrators may instead enter visit data manually, along with documentation of why EVV is being captured manually.

The DHS-provided Sandata EVV system identifies the worker's location at the start and end of the visit. It does not track location before, after, or during the visit. Alternate EVV systems may work differently. Please check with your vendor.

At this time:

  • GPS location data that displays in the Sandata EVV portal is informational only.
  • GPS location data does not prevent the EVV visit data from going to a “verified” status or sending to DHS and payers.
  • GPS data does not currently prevent claims from being paid.
  • DHS does not currently use GPS data to deny claims, but data may be used for compliance review by the Office of the Inspector General.

DHS is rolling out EVV in two phases—a "soft launch" and "hard launch."

On January 1, 2024, the soft launch period of EVV for home health care services and personal care nurse supervisory code 99509 began. During soft launch, use of an EVV system is required for services billed under the required codes, but DHS will not impose financial consequences when EVV information is missing or incomplete.

Soft launch is a time for DHS and providers to cooperatively overcome hurdles during implementation, to establish processes, and to troubleshoot problems and barriers. DHS recognizes that integrating a new process takes time and results in errors. Soft launch is offered as a period for providers to train their staff and get real-world practice using their EVV system before it will affect claims.

DHS is rolling out EVV in two phases—a "soft launch" and "hard launch."

Hard launch is when DHS will begin imposing consequences when claims are missing required EVV information. Consequences for providers include claim denial. Consequences for HMOs and MCOs include exclusion of non-compliant claims from future capitation rate-setting development.

Hard launch for the required home health care service codes begins on October 1, 2024. 

The following standards are in effect:

  • Fee-for-service personal care service claims are required to have a corresponding EVV record. If there is no corresponding EVV record for a claim detail, the detail will be denied.
  • HMOs and MCOs have the authority and may deny provider agency claims without EVV data.
  • HMO and MCO encounters that do not have a matching EVV record for personal care services or applicable supportive home care services may be excluded from future capitation rate development.
  • IRIS participants, as employers of record, may be disenrolled if their participant-hired workers are not using an EVV system. For more information, refer to the IRIS EVV for Personal Care Services webpage. IRIS FEAs will pay participant-hired worker claims in a timely manner and work with participants and participant-hired workers to resolve inaccurate EVV data.
  • IRIS FEAs will deny provider claims without matching EVV data.

Hard launch for the required home health care service codes begins on October 1, 2024.

Hard launch for the required home health care service codes and personal care supervisory code 99509 begins on October 1, 2024. 

Hard launch of Wisconsin’s EVV requirement for personal care services and applicable supportive home care services (service codes T1019, T1020, S5125, S5126) began on May 1, 2023. DHS will impose consequences when EVV information is not captured.

For more details about policy:

Visit the DHS EVV training webpage and scroll to the "How do workers, providers, FEAs, and program payers get trained?" heading. Select the appropriate dropdown menu for training information.

DHS has compiled a list of personal care services and home health care services codes that require workers to capture EVV information in Wisconsin.

Members and participants

DHS does not require member or participant verification and signature to verify an EVV visit. Providers or IRIS FEAs can choose to incorporate client verification and signature into their business processes for EVV.

However, if a personal care worker is using an EVV system to document record of care, a signature will be necessary. Refer to the Personal Care Worker Guidelines for Completing a Record of Care topic (#2500). Providers or IRIS FEAs may choose to incorporate client verification and signature into their business processes for EVV.

Home health care workers, including independent nurses, do not need to select individual tasks or collect a member's signature in the Sandata EVV system.

Sandata upholds rigorous standards for HIPAA privacy and data protections and uses strategies such as encryption to ensure protected health information is secure. Sandata is certified by the Health Information Trust Alliance (HITRUST), conducts regular mandatory training, and sends frequent communications to all Sandata employees regarding best data security practices.

The process for changing a member’s address and phone number has not changed with EVV.

The member has the responsibility to keep this information up to date.

The member can report changes to their local income maintenance agency or tribe, online on the ACCESS website, or by using the Information Change Report, F-10183.

Members who also need to update their address with the Social Security Administration should request an address change specifically in the "SSI record." This will ensure the address change transfers correctly. Social Security Administration address changes may take a few weeks to process completely.

The process for changing a member’s address and phone number has not changed with EVV.

The member has the responsibility to keep this information up to date.

The member can report changes to their local income maintenance agency or tribe, online on the ACCESS website, or by using the Information Change Report, F-10183.

Members who also need to update their address with the Social Security Administration should request an address change specifically in the "SSI record." This will ensure the address change transfers correctly. Social Security Administration address changes may take a few weeks to process completely.

The process for changing a member’s address and phone number has not changed with EVV.

The member has the responsibility to keep this information up to date.

The care team in Family Care and Partnership should submit the Family Care, Partnership, PACE, and IRIS Change Routing Instructions form, F-02404 (Word).

The member can report changes themselves by contacting their local income maintenance agency or tribe, online on the ACCESS website, or by submitting the Medicaid Change Report, F-10137.

Members who also need to update their address with the Social Security Administration should request an address change specifically in the "SSI record." This will ensure the address change transfers correctly. Social Security Administration address changes may take a few weeks to process completely.

The process for changing a participant’s address and phone number has not changed with EVV.

The participant has the responsibility to keep this information up to date.

The participant can do one of the following:

  • Contact their IRIS consultant, who can update that information in the DHS IRIS Care Management system. The IRIS consultant should also support the participant in reporting the address change to the income maintenance agency or the Social Security Administration, whichever is appropriate.
  • Contact the IRIS Call Center for assistance at 888-515-4747.

IRIS participants who also need to update their address with the Social Security Administration should request an address change specifically in the "SSI record." This will ensure the address change transfers correctly. Social Security Administration address changes may take a few weeks to process completely.

Members and participants may be eligible to receive assistance with mobile phone and internet services through programs such as the Lifeline Program or Affordable Connectivity Program.

Providers (including independent nurses), workers, and associations

Review the New to EVV? flyer, P-03078, for additional information or contact Wisconsin EVV Customer Care:

833-931-2035
vdxc.contactevv@wisconsin.gov
Hours: Monday–Friday
7 a.m.–6 p.m. CT

Change of ownership steps to take for:

  • Medicaid-enrolled providers
    • Complete the change of ownership process (see below for resources). A new provider ID will be assigned.
    • After the new ID is received, follow the remaining steps on the New to EVV? flyer, P-03078.
    • Notify payers of the new ownership (see below).
  • Non-Medicaid-enrolled providers
    • Enroll as a new EVV provider.
    • Sign up for a provider ID by following steps on the New to EVV? flyer, P-03078.
    • Notify payers of the new ownership (see below).
  • Payers will need to create service authorizations with the new provider ID. This way the authorization can flow to Sandata properly and connect with claims for authorized services.

Resources:

  • Fee-for-service providers can refer to the Providers Have 35 Days to Report a Change in Ownership topic (#22257) of the ForwardHealth Online Handbook or reach out to Provider Services if they have any questions about obtaining a provider ID.
  • IRIS providers can reach out to their FEA for details about the change of ownership process.
  • Providers working with HMOs and managed care organizations (MCOs) should check with their HMO or MCO for details on change of ownership requirements.

Yes, all workers who are required to capture EVV information will need to have a unique email address. If a worker is employed by multiple providers, their email address may repeat from one provider to another but cannot be shared by another worker.

If a worker is providing one of the service codes in-scope for EVV, they are required to have a worker ID. This is true even for live-in workers who are not required to capture EVV information but are providing services in-scope with EVV.

Workers are assigned one worker ID from the secure ForwardHealth Portal. This one ID identifies the worker across any provider they work with.

The provider or FEA will enter the following worker information on the ForwardHealth Portal:

  • Legal first and last name
  • Date of birth
  • Social Security number
  • Email address
  • Worker start date (optional)
  • Gender (optional)

Refer to the How to Create and Maintain Electronic Visit Verification Worker ID video for more information. Note: Because independent nurses are both the EVV administrator and the worker who provides services, they must add themselves as a worker using this process.

Providers can avoid payment delays by confirming that EVV visits are in verified status in the Sandata EVV portal or aggregator before submitting a claim.

As long as policy, including EVV policy, is followed, claims will be paid as normal. For more information about fee-for-service claims, refer to the Fee-for-Service Claims section on the DHS EVV Training Administrators webpage.

Fee-for-service providers will receive a claim denial on their remittance advice with an explanation of benefits (EOB) message. The two fee-for-service EVV EOB messages are:

  • #1047 "EVV system visit not found"
  • #1048 "EVV system units do not meet requirements of visit"

If there is a different EOB message, then the claim was not denied because of EVV.

Providers can view EOB codes and descriptions for any claim submitted to ForwardHealth on the ForwardHealth Portal.

For all other payers, providers, including independent nurses, should contact their payer for specific information about claim denial messages on their EOB (also called remittance advice) and resubmitting claims.

As a reminder, EVV visits must be in verified status to be matched to a claim.

The message “Detail EOBs 1047” is an explanation of benefits (EOB) code. EOBs help fee-for-service providers determine why a claim was denied so they can fix the error and resubmit the claim. The EOB appears on the bottom of the screen.

EOB 1047, “EVV System Visit not found” means that ForwardHealth did not find EVV information for the date of service billed. For Sandata system users, the EVV administrator will need to log in to the Sandata EVV portal and use the Visit Maintenance tab to search for the visit. If there isn’t a visit in the EVV system, they can manually create the visit. If there is a visit, fix any exceptions. Once the exceptions have been fixed or a manual visit has been created, the administrator should confirm the visit is now in a verified status. If it is, the claim can be resubmitted.

Alternate EVV system users should check with their EVV vendor about how to correct EVV visit information in their EVV system.

The message “Detail EOBs 1048” is an explanation of benefits (EOB) code. EOBs help fee-for-service providers determine why a claim was denied so they can fix the error and resubmit the claim. The EOB appears on the bottom of the screen.

EOB 1048 “EVV system units do not meet requirements of visit” means that ForwardHealth found EVV information for the date of service billed, but the EVV units are less than the billed units. In other words, the visit the EVV system recorded was too short. For Sandata system users, the EVV administrator should compare the claim's billed units to the EVV units. If the claim's billed units are wrong, the administrator can fix the claim and resubmit. If the EVV units are wrong, the administrator can fix them in the Sandata EVV portal and confirm the visit is in a verified status. Once the billed detail units are the same as or less than the EVV units and the visit is verified in Sandata, the claim can be resubmitted.

Alternate EVV system users should check with their EVV vendor about how to correct EVV visit information in their EVV system.

Before resubmitting a denied claim, fee-for-service providers using the Sandata system should make sure the EVV visit information is accurate and verified in the Sandata EVV portal.

Alternate EVV system users should check with their EVV vendor about how to correct EVV visit information in their EVV system.

Additional Fee-for-Service Claims Resources

  • The ForwardHealth Portal Claim Status Information (P-00969a) explains how to search for a claim and the statuses a claim can have, including pay, deny, suspend, and adjust.
  • The ForwardHealth Portal Resubmitting a Denied Claim (P00969b) walks through how to search for a denied claim, make changes, and resubmit a claim.
  • For EVV claim denials, the EVV Customer Care team is the best resource for questions. Providers may contact them at 833-931-2035 or vdxc.contactevv@wisconsin.gov Monday–Friday, 7 a.m.–6 p.m. Central time (CT).
  • For general claim submission or resubmission support, providers may contact ForwardHealth Provider Services Call Center at 800-947-9627, Monday through Friday, 7 a.m. to 6 p.m. CT to speak with a call center representative or any time to speak with a virtual agent.
  • For complex questions specific to fee-for-service claims and billing, providers should contact the assigned field rep from this map.

For all other payers, providers, including independent nurses, should contact their payer for specific information about claim denial messages on their EOB (also called remittance advice) and resubmitting claims.

Providers can find more information about EVV and claims in:

  • The EVV Lifecycle flyer, P-03124 – A snapshot of how EVV visit records fit into the general claims process.
  • Fee-for-Service EVV Administrator Training: Claims Edits written presentation or video – A detailed presentation explaining how EVV fits in the claim process, explanation of benefit (EOB) codes for EVV, how to resolve edits to resubmit a claim, span billing, and best practices.

  • Sandata Mobile Connect (SMC) app – the preferred method
    • Works on a smart phone or tablet
    • Can be used on Android or Apple devices
    • Works even if cell service or Wi-Fi is unavailable during the visit
    • Americans With Disabilities Act (ADA) 508 and WIPAA compliant
    • GPS captured only at check in and check out
    • Most efficient and accurate method
  • Telephonic visit verification (TVV) – second best method
    • Uses the member or participant's home phone
    • Uses the same technology as 911 to determine location
    • Requires use of a landline or a fixed Voice over Internet Protocol (VoIP) phone, like a phone service provided by a cable company
    • May not use a cell phone
  • Fixed visit verification (FVV) – the method of last resort
    • Uses a small device that is “fixed” or attached in the member or participant’s home
    • Generates codes at check in and check out that have to be recorded for entry later
    • Captures the visit information but doesn’t report it—the information will still need to be called in when the worker has access to a phone
    • Provider must attest that SMC and TVV use are not possible
    • Most cumbersome method and most prone to errors
  • Sandata Aggregator: Allows providers to use an alternate EVV system as long as it meets technical requirements. Providers using alternate EVV can log in to the aggregator to ensure EVV visits are in a verified state. Providers can refer to the Alternate EVV webpage to learn more about alternate EVV requirements.

Workers can view their visits from the last seven calendar days by opening the SMC app's menu, tapping Visits, then tapping Past.

A fixed Voice over Internet Protocol (VoIP) phone sends voice communications over the internet. Fixed VoIP phones are like a traditional landline, with a base plugged in to the wall or modem.

A fixed VoIP line can be used for TVV because it is associated with an address, like a landline. A non-fixed VoIP line, however, is not associated with an address and cannot be used for TVV.

In the DHS-provided Sandata EVV system, cellular, internet, and Wi-Fi availability are not required for workers to check in and check out. The worker will need to log into the app once they have cellular, internet, or Wi-Fi connection at a later time for the captured visit to appear in the Sandata EVV portal.

If the app seems stuck and won’t progress to the next screen, but there is no spinning circle or band at the top of the screen with the word “Offline,” the worker should make sure that their device’s location services setting is turned on. The SMC app requires location services to be on to record visits.

If a spinning wheel appears on the SMC app, it means that the internet signal is too weak to load the app. Some troubleshooting steps to follow are:

  1. Connect to a Wi-Fi network if possible.
  2. Restart the device.
  3. Uninstall and reinstall the app.

The SMC app will automatically shift into offline mode when it can’t find a signal. The worker should then record the visit for an Unknown Client. “Offline” will show in a band across most screens for the visit.

When using the SMC app without Wi-Fi or cellular data, a band appears at the top of the screen with the word "Offline.” Offline Mode allows the SMC app to be used without cellular service or a connection to the internet, as long as location is enabled on the device. The app will direct workers to start the visit for an Unknown Client, and enter in the client’s name and Sandata ID or Medicaid ID. Entering this information will make sure the visit matches up with the client’s file later.

If a visit is captured while in Offline Mode, it will not upload until the next time the worker opens the SMC app and the device is connected to the internet. When the device is connected and the worker has logged back in, the visit information will upload to the Sandata EVV portal. The Sandata system will attempt to match the information entered with the client information in the Sandata portal. If it finds a match, no exception will be generated.

Some of the common reasons why a worker can’t start a new visit in the SMC app are:

  1. A previous visit is still in progress.
  2. Location Services is not turned on.
  3. The app needs to be refreshed.

Either the EVV administrator or the worker can take action.

An EVV administrator can look in the Sandata EVV portal to make sure no previous visits are still in progress. If a visit is in progress, the administrator can end the visit from the Sandata EVV portal. The worker can then start a new visit in the SMC app.

If no visits are in progress and the worker still can’t start a new visit, the worker should try each of the following steps:

  • Download the latest version app in their app store if they haven’t already.
  • Make sure the Location Services setting is on in their phone or tablet’s settings.
  • Clear their device’s cache and cookies.
  • Remove the app and reinstall it.

As an administrator, you can also show your worker how to use the SMC app to check whether a previous visit is still in progress. If it is still in progress, they can end the visit from the app:

  • Tap the three horizontal lines in the upper left corner of the device screen to open the navigation menu. Tap Visits on the menu, then the Upcoming tab.
  • If a visit is in progress, they’ll see the client’s name and clock-in time. They can tap on the visit to open it. From there, they can either:
    • Complete the visit by tapping the Complete button at the bottom of the screen.
    • Abandon the visit by tapping the trash can in the top right and pressing Yes to confirm. This will allow them to start a new visit.

For Sandata EVV system users:
When several independent nurses provide private duty nursing (PDN) services to a member, one of the nurses sharing the case is required to serve as the PAL. Only the PAL’s national provider identifier (NPI) or Medicaid ID (MA ID) is listed in the billing provider field on the prior authorization (PA) form.

The Sandata EVV portal automatically receives PA information based on the billing provider field on a member’s PA. This means the authorization only transfers to the PAL’s Sandata EVV portal account.

PAL Pathway

Step 1

PAL's NPI or MA ID is listed in the billing provider ID field on the PA.

Step 2

DHS transfers the PA information to the PAL's Sandata EVV portal.

Step 3

PAL begins logging visits.

Any independent nurse who is not the PAL for their client will need to manually enter authorization information in their Sandata EVV portal. This will allow them to check in and out of their EVV system during a visit without errors. They only need to complete this process one time for each client they support in a non-PAL role.

The manually entered authorization information entered in the Sandata EVV portal does not create an actual PA. The manually created authorization ID will not match the actual PA number (issued by the payer) that the PAL will see in their Sandata EVV portal.

Non-PAL Pathway

Step 1

Non-PAL's NPI or MA ID is not listed on the billing provider ID field on the PA.

Step 2

Non-PALs manually enter authorization information on their Sandata EVV portal once for each client.

Step 3

Non-PAL begins logging visits.

Non-PAL independent nurses should follow the steps in the Adding Required Authorization Information in the Sandata EVV portal training, P-03550 (PDF), to add this client information.

For alternate EVV system users:
Providers using an alternate EVV system should check with their vendor.

No, as long as both are true:

  • The service code you are authorized to provide remains the same
  • The end date for the manually entered authorization information in the Sandata EVV portal has not expired

Fee-for-service providers should contact Wisconsin EVV Customer Care at vdxc.contactevv@wisconsin.gov or 833-931-2035, Monday–Friday from 7 a.m. to 6 p.m. CT.

All other providers should contact their payer.

A worker using the SMC app should double-check the client ID and make sure it is entered correctly. If the client still is not in the system, the worker should click “Start Unknown Visit” and enter the information. EVV Sandata Mobile Connect Essentials covers these steps.

A worker can complete a TVV call as usual, and the provider agency administrator may need to clear an Unknown Client exception.

The worker should let their administrator know this occurred. The administrator can check the EVV system and make sure the worker has the correct client ID. If the client is missing, the administrator can follow up with EVV Customer Care. A fee-for-service client who has under 50 hours of personal care can be added to the Sandata EVV portal. See the “Client data” section of EVV Training Other Provider Administrators for helpful resources.

The process for changing a member's or participant's address and phone number has not changed with EVV. It is the responsibility of the member or participant to keep this information up to date. Instructions to update this information are provided in the “Members and participants” section of these FAQs.

If a change to member or participant information is delayed, the provider can add a valid and verifiable address or phone number in the Sandata EVV Portal client profile. This will only update the Sandata system and will not update the Medicaid file in any other system.

The “Modify Clients” section in Electronic Visit Verification (EVV) Portal: Clients Module, P-02749, shows the steps for the provider administrator to update the member or participant information.

There are several reasons why a GPS exception might occur in the Sandata EVV system, for example:

  • The services were provided in the community
  • The client’s address has not yet been updated
  • The worker was more than 0.25 miles away from a known service location
  • There is an error with the device recording the visit

Unlike other exceptions in the Sandata system, a GPS exception will not prevent the visit from getting to a verified status or sending to DHS and payers. Providers may use the GPS information as part of their own quality assurance or internal audit practice.

No, workers can check out of the visit wherever they stop providing the service for that visit. EVV does not change where services are allowed to be provided per DHS policy. The worker should choose home or community based on where they are at the moment they are checking in or checking out of the Sandata EVV system, even if the visit takes place in multiple settings.

Currently, DHS will not deny a claim because of GPS information; however, other divisions within DHS, such as the Office of the Inspector General, may use GPS location data to ensure providers bill for covered services.

There are two places to review GPS data.

  1. Providers can use the GPS Distance Exception Report to view visits with GPS exceptions.
  2. Providers can see GPS location information for a specific visit in Visit Maintenance in the Sandata EVV Portal by clicking on the specific visit. On the Visit Detail screen, click the GPS button to view the location map.

In programs that allow care outside of the home, if a visit suggests a location that would be unusual for the member or participant (for example: a waterpark for a client who is afraid of water), the provider has the ability to follow up with the employee and get more details or provide client-specific information to ensure the best support.

Providers may use the GPS Distance Exception Report as part of their own quality assurance or internal audit practice. Providers could use this report to watch for irregularities.

Currently, DHS will not deny a claim because of GPS information; however, other divisions within DHS, such as OIG, may use GPS location data to ensure providers are providing care according to policy.

In most cases, information should be received the next day. Contact Wisconsin EVV Customer Care if information takes longer than three days in the following situations:

  • Employees appearing in the Sandata EVV Portal
  • Employees receiving initial Sandata/e-TRAC email and temporary passwords
  • Member or participant authorizations showing in the Sandata EVV Portal
  • Alternate EVV visits showing in the Sandata aggregator

Fee-for-service authorizations can take up to 20 days for approval. This has not changed with EVV. Fee-for-service members can be manually added to the Sandata EVV Portal, if needed.

DHS encourages workers who are providing “per day” services to log in and out when they begin and end services for each visit, as opposed to once a day. These are service codes T1020 or S5126.

Workers should check in at the beginning of each visit and check out at the end of each visit.

The SMC app will automatically end a visit after 25 hours. Workers must check out and back in for visits lasting longer than 24 hours. For visits less than 24 hours, one check-in and one check-out is sufficient, even if the visit lasts across two calendar days.

For service codes that are billed on a per-visit basis, such as 92507 (Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual; per visit) or 99509 (Home visit for assistance with activities of daily living and personal care; per visit), workers must check in and check out for each instance of the code that the provider bills.

For the purposes of EVV, DHS does not require a minimum or maximum amount of time for each visit; however, EVV systems may require a minimum amount of time to register a visit, so workers should check in when they arrive and check out when they leave as usual.

While administrative code requires the nurse to directly observe the personal care worker, EVV is not dependent on any time matching between the supervisory nurse visit and the personal care worker’s shift. The nurse supervisor should check in to their EVV system when they arrive, even if the personal care worker has not arrived yet.

For services that are provided fee for service and are using the DHS-provided Sandata EVV system, workers do not need to check out and check in again after midnight. They should check in when they arrive and check out just prior to leaving.

Providers using alternate EVV systems should check with their vendor for worker instructions. HMO and MCO providers should check with their HMO or MCO for policy details.

Independent nurses are required to use an EVV system if they provide services that require EVV. For EVV purposes, independent nurses are considered both a provider and worker. They will have some administrative as well as worker duties within EVV.

Workers may be able to use the combo code when providing self-directed personal care (service code T1019) and supportive home care services (service code S5125) to IRIS participants when all of the following are true:

  • The services are provided to an IRIS participant.
  • Both personal care and supportive home care services are being provided in a single visit.
  • The worker is being paid for both services by one entity: either the provider or the FEA.
  • The worker is using the DHS-provided Sandata EVV system.

The combo code is used to log EVV visits with the DHS-provided Sandata system. It is not used for billing.

Workers using an alternate EVV system should follow the guidelines given by the provider that pays them.

For providers using the Sandata EVV system, workers can start a group visit when all of these conditions are met:

  • The worker is providing services to multiple individuals in a single visit.
  • The individuals are at the same location.
  • The individuals have the same program payer (for example, DHS, HMO, MCO or IRIS FEA)

Refer to Electronic Visit Verification: Group Visits, P-02755 (PDF) for more information about group visits.

Providers using an alternate EVV system should check with their vendor.

Yes. Workers may need to check in and check out more than once during a single visit OR use two EVV systems in one visit if:

  • The worker provides personal care services and supportive home care services that are paid by two different programs (fee-for-service Medicaid personal care [MAPC] and IRIS).
  • The worker who provides the personal care services and supportive home services works for two different providers that use two different EVV systems.
  • The provider’s EVV system requires a separate check in and check out for different services.

However, if a worker uses the SMC app to log visits, the app allows workers to switch services during a visit.

Yes. Workers might need to use more than one EVV system when:

  • The worker provides services that are paid by two different programs (for example, fee-for-service Medicaid personal care [MAPC] and IRIS).
  • The worker works for two different agencies that use two different EVV systems.

Workers might need to use the Sandata EVV system and an alternate EVV system or two different alternate EVV systems in the same visit.

No, there is no charge for use of the DHS-provided Sandata EVV system.

The FVV device itself will be paid for by DHS and does not require data or complex installation. (It is “fixed” to a surface in the member or participant’s home using an adhesive tape.)

FVV devices give codes that must be called in. This means that the provider, worker, or member or participant must have a phone. Any type of phone, from any location, may be used to call in FVV codes.

Workers choose a broad service code that covers many tasks, including helping someone bathe, get dressed, and brush their teeth. There is no need to check in and out for individual tasks.

As a reminder, capturing tasks in an EVV system is not required by DHS. However, an HMO, MCO, FEA, or provider can require that tasks are included in EVV. Also, if a worker uses the EVV system to capture record of care, they are required to include tasks, any notes, and client signature.

Workers can use the switch service button as long as:

  • They’re using the DHS-provided Sandata system.
  • The member and provider are the same.

Note: The switch service button works whether the two services have the same payer or different payers.

Workers can refer to the EVV Sandata Mobile Connect Essentials (video and pdf) presentation for step-by-step instructions on how to switch services during a visit using the SMC app.

The SMC app and TVV offers 15 language options, including those most frequently used in Wisconsin. Workers and members or participants can set their language preferences separately. Choices include English, Spanish, Hmong, Arabic (Egyptian), Burmese, Chinese (Simplified), French, Hindi, Laotian, Nepali, Russian, Serbian, Somali, Swahili, and Vietnamese.

Written training materials are available in multiple languages. Additional languages can be requested via email to dhsevv@dhs.wisconsin.gov. Please allow 30 business days for translation and delivery.

Sandata's EVV Portal for administrative processing is available in English.

No. Once a visit has been verified, its status may be changed, but visits cannot be deleted from the Sandata EVV system.

Yes. Providers using the DHS-provided Sandata EVV system have 365 days from the date of service to make changes to a visit record in the Sandata system. Claims submission timelines and requirements remain the same and are not impacted by EVV.

The DHS-provided Sandata system does not include a scheduling component to identify late shifts.

If the provider needs to correct check-in or check-out times to reflect an accurate visit duration, reference Visit Maintenance, P-02754.

The federal Centers for Medicare & Medicaid Services has not provided guidance on paper documentation requirements for EVV. Use payer guidelines for documentation.
For fee-for-service care, the ForwardHealth Online Handbook covers information about record retention.

  • Documentation is required for all changes in the Sandata EVV Portal.
  • Documentation should appropriately support the need for the change; this may be documentation the provider currently has on file.

Additionally, payers have their own requirements for documentation and providers should use those guidelines for documentation.

Sandata’s EVV Portal keeps an audit trail of manual edits. A log description of visit changes is visible within the view of each visit and also through the Visit Verification Activity Report, accessible in the Sandata EVV Portal.

The DHS Office of the Inspector General will be closely monitoring manual corrections to EVV data.

Rounding rules have not changed with EVV. DHS continues to follow these three steps for fee-for-service claims:

  1. Combine the duration of all EVV visits to the date of service for the member by provider (splitting visits that happen overnight).
  2. Convert visit time into units.
  3. Compare those units as shown in EVV against the billed units submitted through the usual billing process.

Refer to Rounding Policies topics (#21817) in the ForwardHealth Online Handbook.

HMO and MCO providers should refer to their HMO or MCO for rounding policies.

IRIS providers should refer to their FEA for rounding policies.

No. Only services billed under the required service codes are included in EVV. Providers interested in including other service codes may want to use an alternate EVV system.

For claims for visits that occurred during a power or system outage lasting more than 24 hours, fee-for-service, BadgerCare Plus and Medicaid SSI HMO, Family Care, and Family Care Partnership providers may do one of the following:

  • Manually enter EVV visit information.
  • Use the UC modifier on detail lines for visits without EVV information. The UC modifier will allow the claim to bypass the EVV claim edits and be paid even though there is no corresponding EVV information associated to it.

IRIS providers must submit the IRIS Electronic Visit Verification (EVV) System or Power Outage Exception Notification form, F-03117 (Word), to the FEA with any invoice that includes visits on DOS to be exempted from EVV because of an extended system or power outage. Participant-hired workers should communicate directly with their FEA if an outage lasting longer than 24 hours prevents them from collecting EVV information.

For participant-hired worker claims and applicable provider agency claims where EVV information was not recorded due to a power or system outage lasting more than 24 hours, FEAs will enter an E indicator in the Support Indicator field on the detail line item when submitting encounters to DHS. The E indicator will allow the claim to bypass EVV edits during claims and encounter processing.

Providers must be able to show proof of an outage upon request. This policy does not change existing EVV-related policies or documentation requirements, including billing, record of care, or timesheets.

Providers can review a list of Sandata outages meeting the DHS outage policy criteria on the DHS EVV homepage, under the Sandata Outage Information and Provider Documentation section.

Refer to the Power Outage and Electronic Visit Verification System Outage Policy topic (#22860) in the ForwardHealth Online Handbook for more information.

Read more about the EVV power and system outage policy in the ForwardHealth Update 2023-12, "New Electronic Visit Verification Policy and Reminders for Hard Launch" (PDF).

There is no additional funding from DHS for EVV expenses.

Members and participants may be eligible to receive assistance with mobile phone and internet services through programs such as the Lifeline Program or Affordable Connectivity Program.

No, independent nurses cannot bill for the time they spend helping other independent nurses learn to use EVV. Per Wis. Admin. Code § DHS 107.12(1)(f), only medically necessary actual time spent in direct care is a covered and billable service. Administrative tasks, such as entering visit information in the EVV system or training other, are not to be billed separately.

If you are an independent nurse who is getting started with EVV, we recommend reaching out to Wisconsin EVV Customer Care. An EVV Customer Care specialist can work with you individually to set up your system and answer any questions you may have.

Wisconsin EVV Customer Care is available at vdxc.contactevv@wisconsin.gov or 833-931-2035 Monday–Friday, 7 a.m.–6 p.m. Central Time.

Providers should refer to the Department of Labor fact sheet on Deductions From Wages for Uniforms and Other Facilities Under the Fair Labor Standards Act (FLSA) for additional guidance that would be applicable to this scenario. For labor law questions, providers may wish to consult with an attorney.

EVV does not change or replace current requirements regarding the completion and retention of time sheets, record of care, or other documentation. Providers can choose to use EVV to capture some records, including record of care for personal care services. Workers should check with their provider, HMO, MCO, or FEA regarding documentation requirements.

All workers are required to capture the six key data points for EVV:

  1. Who receives the service
  2. Who provides the service
  3. What service is provided
  4. Where service is provided
  5. The date of service
  6. The time the service begins and ends

In addition, personal care workers using an EVV system are required to capture additional information:

  1. Tasks performed during the visit
  2. Notes that would have been put on a timesheet
  3. Verification (electronic signature or voice recording) from the client of the services provided

For additional information, providers should refer to Record of Care and Timekeeping topic (#22859) of the Online Handbook, or check with their HMO, MCO, or IRIS FEA.

Home health care service providers, including independent nurses, should continue their regular documentation practices outside EVV.

Provider administrators using the DHS-provided Sandata EVV system can view worker check-in and check-out times through the Sandata EVV Portal in near-real time. Information from alternate EVV vendors through the Sandata aggregator will be updated frequently, but the frequency will depend on the vendor.

A visit key, used only by the payer, is a unique number associated with each EVV visit. When a visit is captured using Sandata or an alternate EVV system, an identifying number called a visit key is automatically generated by the Sandata EVV system. All visit records and associated visit keys are sent to the appropriate payers on a daily basis.

The visit key can be found and is referred to as the Visit ID in the Date Range type – Detail Visit Status report.

Workers can refer to Electronic Visit Verification (EVV) Sandata Mobile Connect, P-02751 (PDF), for instructions on resetting passwords.

Administrators can refer to the Sandata EVV Portal Security, P-02748, for password reset instructions.

Glossary

 
Last revised August 15, 2024