EVV requirement for skilled service claims

Effective April 1, 2023, health care professionals providing in-home services for home health care aide and private duty visits to District Dual Choice Program members will be required to use electronic visit verification (EVV) system to record information about the service. 

This requirement applies to in-home services rendered to UnitedHealthcare Community Plan members in Washington, D.C., and is in accordance with the 21st Century Cures Act, which mandates that Medicaid providers use an EVV system for home health services. 

EVV should be used for the following procedure codes and modifier combinations:

During the public health emergency period any claim billed with a CR modifier is required to be supported by an EVV visit with the modifier combinations above. Claims billed for CR modifier should be within the services authorized under the modifiers above.

Health care professionals may begin using EVV for these services starting March 1, 2023. Effective, April 2, 2023, we’ll reject claims for home health care aide and private duty visits if the claim is not supported by EVV transactions.

Note: These HCPCS codes are additions to the previously announced list requiring EVV for claims processing. 

Questions?

Please contact:

• District Medicaid: evvinfo@dc.gov
• Sandata
  • Phone: 855-962-1322
  • Email: WDCCustomerCare@sandata.com

PCA-1-23-00572-C&S-News_02282023