Electronic Visit Verification (EVV): FAQs
EVV hard launch
The following are FAQs the Wisconsin Department of Health Services (DHS) has received from stakeholders through public forums, the EVV email box, and the Wisconsin EVV Advisory Workgroup.
The answers provided in the FAQs are specific to the Wisconsin DHS EVV system and may not be representative of alternate EVV systems.
This page will be revised with new information as it becomes available.
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 submits EVV data using any of the Sandata solutions, the six required data points are encrypted. The data can be viewed by the provider agency in the Sandata portal in near-real time. Sandata also transmits to DHS the encrypted data points for each visit to match it with a future claim/encounter and for validation.
Although DHS does not require EVV use for live-in workers, health maintenance organizations (HMOs), managed care organizations, and provider agencies may independently require live-in workers to use EVV. A worker’s live-in status must be verified if their payer and provider agency do not require live-in workers to record EVV visit data. The name and address of the live-in worker should exactly match the information contained in the submitted supporting documentation.
- IRIS participant-hired live-in workers must use IRIS Participant-Hired Worker Relationship Identification, F-01201A (Word).
- Fee-for-service live-in workers must use Electronic Visit Verification Live-in Worker Identification, F-02717 (Word).
HMOs and MCOs may have their own guidelines. IRIS (Include, Respect, I Self-Direct) fiscal employer agents (FEAs) cannot require participant-hired live-in workers to use EVV.
Refer to ForwardHealth Update 2021-05 (PDF) for more information about live-in workers.
Policy requires Medicaid and BadgerCare Plus fee-for-service members receive personal care services in their home. EVV does not change this requirement.
For services provided through BadgerCare Plus and Medicaid SSI HMOs, provider agencies should continue to work with their HMO regarding place of service details.
For all services provided through Family Care or IRIS, EVV should be used for services authorized to be provided outside the home. +
EVV identifies the location at the start and end of the visit. It does not track location before, after, or during the visit.
At this time, the GPS location data 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.
This functionality will not change with hard launch.
DHS is rolling out EVV in two phases—a "soft launch" and "hard launch."
Soft launch is an implementation period during which EVV is required for some services and programs. During this period, missing EVV data will not result in denied claims, and encounters will continue to be included in future rate setting.
The soft launch is a time to cooperatively overcome any initial hurdles and help establish good processes. Soft launch began in Wisconsin on November 2, 2020.
DHS is rolling out EVV in two phases—a "soft launch" and "hard launch."
The hard launch date for personal care and supportive home care services is May 1, 2023. After hard launch, the following standards will take effect. For more details, see Forward Health Update 2022-48, “Personal Care Services Electronic Visit Verification Hard Launch Announcement.”
Fee-for-service personal care service claims will be 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 will likely 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 the employer, are responsible to make sure their non-live-in participant-hired workers are using EVV to remain enrolled in the IRIS program. 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 agency claims without matching EVV data.
Hard launch of Wisconsin’s electronic visit verification (EVV) requirement for personal care services will begin on May 1, 2023. After hard launch, DHS will impose consequences when EVV information is not captured for required personal care and supportive home care services (service codes T1019, T1020, S5125, and S5126). Consequences include claim denial, exclusion from future capitation rate setting development, and possible IRIS (Include, Respect, I Self-Direct) participant disenrollment.
Hard launch is required by the federal government for Wisconsin to continue to receiving its full federal funding.
For more details, see Forward Health Update 2022-48, “Personal Care Services Electronic Visit Verification Hard Launch Announcement.”
Visit the DHS EVV training webpage and scroll to the "How do workers, provider agencies, FEAs, and program payers get trained?" heading. Select the appropriate dropdown menu for training information.
EVV affects all personal care and home health services, including services provided through Wisconsin Medicaid and BadgerCare Plus fee-for-service (ForwardHealth card), BadgerCare Plus and SSI HMOs, Family Care, Family Care Partnership, and IRIS.
DHS has determined the following procedure codes that will be impacted by EVV:
BadgerCare Plus Fee-For-Service and BadgerCare Plus and SSI HMOs
- T1019 (personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/IID or IMD, part of the individualized plan of treatment [code may not be used to identify services provided by home health aide or certified nurse assistant]).
Family Care and Family Care Partnership
- T1019 (personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/IID or IMD, part of the individualized plan of treatment [code may not be used to identify services provided by home health aide or certified nurse assistant]).
- T1020 (personal care services, per day)
- S5125 (attendant care services, per 15 minutes)
- S5126 (attendant care services, per day)
IRIS
IRIS will be updating procedure codes with the waiver renewal on January 1, 2021. Therefore, beginning with EVV's soft launch, the impacted procedure code for IRIS is T1019 (personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/IID or IMD, part of the individualized plan of treatment [code may not be used to identify services provided by home health aide or certified nurse assistant]).
After the IRIS waiver is renewed effective January 1, 2021, the impacted procedure codes for IRIS will also include:
- S5125 (attendant care services, per 15 minutes)
- S5126 (attendant care services, per day)
Members and participants
DHS does not require member or participant verification and signature. Provider agencies or IRIS FEAs can choose to incorporate client verification and signature into their business processes for EVV.
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 or participant’s address and phone number has not changed with EVV.
The member or participant has the responsibility to keep this information up-to-date.
Members or 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.
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.
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 member can report changes to their local income maintenance agency or tribe, online on the ACCESS website, or by using the Information Change Report.
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 care team in Family Care and Partnership can us use Form F-02404 (Word).
The member can use this form to report changes themselves. 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.
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 participant can do one of the following:
- Contact their IRIS consultant, who can update that information in the DHS IRIS system. The IRIS consultant can use Form F-02404 (Word).
- Contact their IRIS Consultant Agency.
- 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.
Provider agencies, workers, and associations
Review the New to EVV? flyer for additional information or contact Wisconsin EVV Customer Care:
833-931-2035
vdxc.contactevv@wisconsin.gov
Hours: Monday-Friday
7:00 a.m.—6:00 p.m. CT
Yes, all workers who are required to capture EVV will need to have a unique email address. A worker’s email can repeat from one agency to another but cannot be shared by another worker.
Yes, all workers are required to have a worker ID even if they are not be required to use EVV.
Workers are assigned one worker ID from the secure ForwardHealth Portal. This one ID identifies the worker across any provider agency they work with.
The provider agency or Fiscal Employer Agency 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.
- Sandata Mobile Connect (SMC) (also known as Mobile Visit Verification (MVV)): A mobile application to collect visit information.
- Sandata Telephonic Visit Verification (TVV): When using a member or participant's landline or fixed VoIP phone to call in visit data.
- Sandata Fixed Visit Verification (FVV): A small, in-home device available from Sandata, when no other visit collection methods are possible or available.
- Sandata Aggregator: Allows provider agencies to use a third party EVV system as long as it meets technical requirements.
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 system, cellular, internet, and Wi-Fi availability are not required at the point of care for workers to check in and check out. Cellular, internet, or Wi-Fi are required at a later time to send the visit information.
When using the SMC app without Wi-Fi or cell data, "Offline" appears across the top of the cell phone screen in a red band. Workers will be directed by the app to start the visit with an Unknown Client. This will show as an Unknown Client exception in the Sandata EVV Portal and a provider agency administrator will need to correct it.
If the app is stalling before reaching the offline screen, it may be because the internet signal is too weak. In this case, Sandata recommends putting the cell phone in airplane mode and recording the visit data as an offline visit. If the app continues to stall, contact EVV Customer Care with the worker and client name, date, and time, and take a screen shot, if possible.
Fee-for-service provider agencies should contact EVV Customer Care.
All other provider agencies 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. The Sandata Mobile Connect Guide 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 less than 50 hours of personal care can be added to the Sandata EVV Portal. See the “Client data” section of EVV Training Other Provider Agency 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 this FAQ in the “Member and participant questions” section.
If a change to member or participant information is delayed, the provider agency 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 PowerPoint 4: Client Format shows the steps for the provider agency administrator to update the member or participant information.
In most cases, information should be received the next day. Contact 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 password
- Members with authorizations requiring EVV showing in the Sandata EVV Portal
- Alt 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 Sandata Mobile Connect 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.
No. The Sandata EVV solution includes a group visit functionality so the worker does not need to check in and out for each client one by one, as long as each client in the group has the same payer.
Refer to training videos for more information about group visits:
No, there is no charge for use of the DHS-provided EVV system through Sandata.
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 agency, 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, tasks are not required by DHS, but an HMO, MCO, FEA, or provider agency can require that tasks are included in EVV.
The Sandata app and TVV prompts offer 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 (Mandarin), 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. 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 audit trail.
Yes. Provider agencies using the DHS-provided 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 agency needs to correct check-in or check-out times to reflect an accurate visit duration, reference PowerPoint 9: 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 agency currently has on file.
Additionally, payers have their own requirements for documentation and provider agencies should use those guidelines for documentation.
The DHS-provided EVV system allows administrators at the provider agency or FEA to manually correct a visit when necessary. Provider agencies that need to correct check-in or check-out times to reflect an accurate visit duration can find instructions in PowerPoint 9: Visit Maintenance, P-02754.
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:
- Combine the duration of all EVV visits to the date of service for the member by provider agency (splitting visits that happen overnight).
- Convert visit time into units.
- Compare those units as shown in EVV against the billed units submitted through the usual billing process.
Refer to the Units of Service topic (#2479) of the ForwardHealth Online Handbook.
No. Only services billed under procedure codes T1019, T1020, S5125, and S5126 are included in EVV. Service codes for EVV use in home health (required in 2023) have not been determined yet. Provider agencies interested in including other service codes may want to use an alternate EVV system.
At this time, there is no additional funding from DHS for EVV expenses.
Please see 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, provider agencies 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. Fee-for-service provider agencies can choose to use EVV to capture some records. Workers should check with their provider agency, HMO, MCO, or FEA regarding documentation requirements.
When capturing the worker record of care within an EVV system, the worker must capture the six required EVV data elements:
- Who receives the service
- Who provides the service
- What service is provided
- Where service is provided
- Date of service
- Time in and out
The worker must also capture the following information:
- Tasks performed during the visit
- Notes that would have been put on a timesheet
- Verification (electronic signature or voice recording) from the client of the services provided
If fee-for-service provider agencies choose to use an EVV system to capture the record of care, it must be done at the agency level. All workers who use EVV must collect this information. This will keep records of care documentation consistent at the agency level.
For additional information, please refer to ForwardHealth Update 2022-38, "Documenting Record of Care and Time With Electronic Visit Verification" (PDF).
Provider agency administrators using the DHS-provided 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 EVV PowerPoint 6: Sandata Mobile Connect (PDF) for instructions on resetting passwords.
Administrators can refer to the Sandata EVV Portal Security (PDF) for password reset instructions.
Find password reset information in Issue 8 of Your Key to EVV.