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Effective 12/1/23: EVV Home Health Care Services Claims Submission to TMHP Required

Date: 11/30/23

On June 1, 2023, the Texas Medicaid & Healthcare Partnership (TMHP) started receiving providers, Financial Management Services Agencies (FMSAs), and Consumer Directed Services (CDS) employers Home Health Care Services (HHCS) Electronic Visit Verification (EVV) claims for claims matching. TMHP forwarded the claims to the Managed Care Organizations (MCOs), then MCOs adjudicated the HHCS EVV claims using the EVV07 bypass code.

Claims Submission Cutover Date

The claims submission cutover date is December 1, 2023. This is the date the MCO must reject HHCS EVV claims that come directly to the MCO. Please note:

  • Providers and FMSAs must submit all HHCS EVV claims starting with dates of service on or after December 1, 2023 to TMHP using TexMedConnect, or through Electronic Data Interchange (EDI) using a Compass 21 (C21) Submitter ID.
  • MCOs must reject any HHCS claims with EVV services back to the submitter, directing them to submit the claim to TMHP for EVV claims matching.

Claims Matching

For dates of service on December 1, 2023, through December 31, 2023, providers and FMSAs submitting their HHCS EVV claims through TMHP will receive both an informational EVV claims match result (EVV07) and an actual claim match result for HHCS EVV claims (EVV01 through EVV06).

  • The actual claims match results and the informational claims match results will be viewable in the EVV portal. During this time, TMHP will forward all HHCS EVV claims received to the MCO with an EVV07 match code. MCOs must not deny the claims with EVV07 for EVV-related reasons during this period.
  • For dates of service on or after January 1, 2024, the EVV aggregator will begin sending the actual match result for HHCS EVV claims to the MCOs, and MCOs must process the claims accordingly (i.e., deny claims that receive EVV02 – EVV06 match codes).

For questions about EVV HHCS claims submission, email Superior HealthPlan’s EVV Department at SHP_.EVV@SuperiorHealthPlan.com.