Electronic Visit Verification (EVV) for Personal Care Services: Information for Program Payers
EVV hard launch
Wisconsin's EVV solution
The Wisconsin Department of Health Services (DHS) selected an EVV system for use within all DHS programs and impacted provider agencies, HMOs, MCOs, Family Care fiscal employer agents (FEAs), and IRIS FEAs. This eliminates the need for individual organizations to purchase an EVV solution. Organizations interested in using an alternate EVV system may use it as long as it meets DHS business and technical requirements.
MCOs, HMOs, and IRIS FEAs
DHS provided aggregator training to program payer administrative staff. The goal is for these staff to become familiar with the aggregator tool that collects the data from their contracted providers.
- Recording of the November 19, 2020, training on the aggregator tool for program payer staff
- November 19, 2020, presentation (PDF)
MCOs and HMOs may also view the provider agency training for a front-to-back understanding of the DHS EVV system, but it is not required.
DHS provides free train-the-trainer resources on the DHS EVV system to provider agency administrators across all delivery systems. Administrators from Family Care FEAs and IRIS FEAs also need this training. More information can be found on the EVV Training webpage.
Following are the presentations and file specifications for the program payer Authorization and Visit File interfaces:
- File Specification: Authorization Interface (PDF): A review of the Authorization File Specification and answers to questions received from payers
- EVV Authorization File Specification (PDF): File structure specifications for EVV data to be sent by program payers to DHS
- EVV Authorization Response File - Error Record Layout (PDF): Record layout for the EVV Authorization Response File
- EVV Authorization Error Reasons (PDF): Data file error descriptions.
- File Specification: Visit Interface (PDF): A review of the Program Payer Visit File Specification (PDF) (visit file specifications for EVV data to be sent by program payers).
EVV visit data needs to be collected for care provided under the following service codes:
|Service or Modifier||
Medicaid and BadgerCare Plus fee-for-service and BadgerCare Plus and Medicaid SSI HMOs
|Family Care and Family Care Partnership||IRIS|
|T1019: Personal Care Services per 15 minutes||Yes||Yes||Yes|
|T1020: Personal Care Services per day||n/a||Yes||n/a|
|S5125: Supportive Home Care per 15 minutes||n/a||Yes||Yes|
|S5126: Supportive Home Care per day||n/a||Yes||Yes|
|KX Modifier: identifies a live-in worker not required to collect EVV data||Yes||Yes||Yes|