23-672 Register on EVV System Before Submitting Claims for In-Home Services

Date: 07/11/23

Who must register, links to training, contacts, and more

The Department of Health Care Services (DHCS) issued All Plan Letter (APL) 22-014 (PDF) on July 21, 2022, with direction on the federally mandated electronic visit verification (EVV) requirements.¹

The following information will help you get started on what to do to comply with this requirement and get paid for home health and personal care services you provide to Medi-Cal members. If you do not register with EVV and follow the guidelines, your claims will not be processed.

Who must register and use EVV

Medi-Cal providers who give any of the following services in a member’s home must use EVV. This includes visits that begin in the community and end with in-home care or vice versa. Home health care services (HHCS).

• Personal care services (PCS) and homemaker services.
• Day habilitation programs services.
• Respite services.
• Community-Based Adult Services-Emergency Remote Services
  (CBAS-ERS) programs.

Effective April 20, 2023, the following have been added to the EVV system:

• Physical, occupational and speech therapy services.
• Infusion services.

Services excluded from EVV requirements

The following services are not subject to EVV requirements: 

• HHCS or PCS that do not require an in-home visit.
• HHCS or PCS provided in congregate residential settings where 24-hour service is available. 
• HHCS or PCS rendered by an individual living in the member’s residence does not constitute an “in-home visit.”
• Any services rendered through the Program of All-Inclusive Care for the Elderly.

Where to register for EVV on DHCS website

Before you fill in the online CalEVV Provider Self-Registration Form, there are quick reference guides and an instruction video to help you. Go to DHCS Electronic Visit Verification Phase II and access the information under Provider Self-Registration Portal.

What support will CHWP offer

California Health & Wellness Plan (CHWP) will monitor providers to ensure compliance with these requirements with the following established guidelines:

• Monitor providers for compliance with EVV requirements, and alert DHCS of any compliance issues.
• Supply providers with technical assistance and training on EVV compliance.
• Require providers to comply with an approved corrective action plan (CAP).
• Deny payment if the provider is not complying with EVV requirements.
• Arrange for members to receive services from a provider that complies with EVV requirements.

Where to go for more information

Explore the DHCS Electronic Visit Verification Phase II page with links to more information. This page contains information about:

• Announcements.
• What is EVV?
• Does it apply to me with provider types and codes (PDF).
• Background.
• EVV policy.
• Provider Self-Registration Portal with reference guides and video.
• Fee for Service (FFS) and Individual Nurse Provider (INP) Self-Registration Process.
• Exclusions.
• Live-in Caregiver.
• Resources/training which includes frequently asked questions, adding and managing provider identifier(s), bulk upload process, and more training videos.
• CalEVV Aggregator along with a quick reference guide and webinar training.
• Requesting the business Intelligence tool powered by Domo. (Domo is a mobile, cloud-based, social, community-driven business intelligence platform to help you view data in one place.)
• Alternate EVV Specifications.
• Stakeholder Engagement / Information Webinars.
• Office Hours – DHCS EVV hosts ‘Office hours’ WebEx meetings where you can ask questions about the EVV program. Go to DHCS Electronic Visit Verification Phase II to see the schedule for July. Check back often for a schedule of future dates.
• Phases of EVV implementation.
• Resources.

Questions?

Please direct your comments, questions, or suggestions regarding the EVV Phase II, or to be added to the EVV Phase II stakeholder process interested parties e-mail list, by email.

• For technical assistance, call 855-943-6070 or email your Customer Support team.
• For Alternate EVV assistance, call 855-943-6069 or email your Customer Support team.

Additional information

Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877-658 0305.

¹  See DHCS All Plan Letter 22-014, dated July 21, 2022, at www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2022/APL22-014.pdf.

 

This information applies to Physicians, Independent Practice Associations (IPAs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.