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Electronic Visit Verification (EVV): Information for Payers

Electronic visit verification (EVV) uses technology to make sure that members and participants receive the services they need. Workers check in at the beginning and check out at the end of each visit, using a smart phone or tablet, small digital device, or landline telephone. The EVV system captures six key pieces of information:

  • Who receives the service
  • Who provides the service
  • What service is provided
  • Where the service is provided
  • The date of service
  • The time the service begins and ends

The Wisconsin Department of Health Services (DHS) offers the Sandata EVV system for use with all DHS programs and providers, HMOs, managed care organizations (MCOs), Family Care fiscal employer agencies (FEAs), and IRIS (Include, Respect, I Self-Direct) FEAs who are required to use an EVV system. Providers can choose to use the DHS-provided Sandata EVV system or an alternate EVV system. All alternate EVV systems are required to integrate with the Sandata aggregator to get EVV information from the alternate EVV vendor to DHS.

Program payers play an important role in EVV in Wisconsin by acting as the bridge between providers and DHS. They are responsible for ensuring their network of providers use EVV systems efficiently and in compliance with DHS EVV policy. This ensures that members and participants receive the care they need, and providers’ claims are paid promptly.

Payer responsibilities

Payers connect providers to DHS, making sure EVV information is sent and received accurately.

  1. Payers are responsible for making sure providers use an EVV system for services that require EVV. For more information on the DHS-provided Sandata EVV system, HMOs, MCOs, and IRIS FEAs may view the provider training to understand the system. Viewing the training is not required.
  2. HMOs and MCOs are required to send accurate and timely service authorization information to DHS for services that require EVV. DHS receives IRIS service authorization information from the state case management system.
    • Sending timely authorization information allows EVV visits to flow through with minimal manual corrections by the provider. It also prevents delay in payment for the provider.
    • Payers should review the technical specifications for sending authorization information. IRIS FEAs are excluded from this authorization process (see above). The technical specifications are:
  3. Payers are responsible for receiving EVV visit information and comparing it to providers' claim records before payment.
  4. Payers are required to:

Sandata aggregator

The Sandata aggregator collects all EVV information and ensures the validity of the information before it is sent to the assigned payer. Payers can use the information in the aggregator to supplement payer records, balance files, or view information applicable to their EVV processes. This can include reviewing authorizations and visit information for their contracted providers. The Sandata aggregator is view only; no edits can be made.

Sandata’s self-paced aggregator training is available for payers and their staff. When payers first access the training, they will need to register.

  1. Go to Sandatalearn.com.
  2. Skip to the bottom and select Sign Up.
  3. Fill out the Create an account information and select Sign Up.
  4. Complete the information on the next screen:
    • Medicaid ID (required but not verified; can be any number)
    • Provider ID (required but not verified; can be any number)
    • Select a role; choose Alt-EVV User (Aggregator)
    • Select a state (Wisconsin)
    • Select Alt EVV Aggregator as the type of training needed
    • Submit
  5. SandataLearn will open. Click on the Dashboard to view options.
  6. Select View in Sandata Aggregator to open the training.

After this first registration, individuals can login with their email and password to Sandatalearn.com.

Sandata's aggregator training videos and manual cover the basics of logging in, assigning roles and passwords for new users, filtering data, and running reports for export.

All administrative users should view the aggregator training videos. The security administrator can then assign an appropriate role to each user:

  • Auditor: This role allows the user to see visits for all providers associated to the payer.
  • Jurisdictional Oversight: This role allows the user to see visits and all reports for all providers associated to the payer.
  • Security Administrator: This role allows the user to see visits and all reports for all providers associated to the payer. A user with this role may also create new users and assign them roles and privileges.

If the payer’s EVV security administrator needs to change, please contact Wisconsin EVV Customer Care for assistance in re-assigning this required role at vdxc.contactevv@wisconsin.gov or 831-931-2035, Monday-Friday, 7 a.m.-6 p.m. CT.

Note: Because the Sandata aggregator is built to function across different states, the self-paced aggregator training from Sandata refers to some features that do not apply in Wisconsin. These include:

  • Schedules
  • Payroll
  • Billing
  • Claims
  • Geofence references
  • Employee performance/supervisor/pay information
  • Employee Social Security numbers
  • EVV required services

EVV required services

EVV visit data is required for the personal care services and home health care services codes listed on the services that require EVV webpage.

Questions

Glossary

 
Last revised November 22, 2024