Last update: February 4, 2021
UnitedHealthcare Community Plan’s (UHC) goal is to ensure that the individuals we serve are receiving services timely, based on their Person-Centered Support Plan (PCSP). To ensure that this occurs, Home and Community-Based Services (HCBS) providers whose services are captured in the EVV System must require that Direct Support Professionals (DSP) check in/out of each appointment using an approved eligible method, such as:
- EVV Tablet
- Bring Your Own Device (BYOD – EVV App on DSP’s Android or IOS Smart Phone)
- Interactive Voice Response (IVR – call from individual’s telephone)
Effective July 1, 2019, providers were required to enter the full valid Social Security Number (SSN) in the EVV System for each DSP providing care to individuals we mutually serve. Additionally, in August 2020, our EVV Vendor updated the system with additional Social Security Administration logic, as well as logic to prevent the same SSN from being entered for multiple DSPs. When identifying and managing overlapping visits, please note the following:
- The name of the DSP and unique SSN are key in detecting overlapping visits.
- Overlapping visits occur when a DSP checks in and/or out of multiple appointments at times that overlap. Overlapping visits may be true/deliberate and others may be due to administrative or keying errors.
- True overlapping visits refer to visits recorded within the EVV System by the same DSP using the same SSN with another visit allegedly performed by the DSP with the same SSN at the same time.
- An overlapping visit is when one visit, fully or partially, overlaps with another visit by one (1) or more minutes.
Our EVV Overlapping Visits Process consists of the following:
- Our EVV Vendor aggregates appointment data from all three (3) Managed Care Organizations (MCO) to detect overlapping visits based on DSP SSNs.
- UHC receives a daily report identifying all overlapping visits, which are researched in the EVV System.
- UHC will contact the provider to request additional information.
- UHC will work with the provider to address any administrative or keying errors to remedy the overlap.
- In instances where the overlapping visits occur between different providers or overlapping visits appear to be deliberate, the case is referred to our internal Special Investigations Unit (SIU) for investigation of potentially fraudulent activity.
- In addition, UHC will identify DSP or provider trends and make referrals to SIU after two (2) instances of education/re-education for overlapping visits that occurred on three different daily reports (referral will be made upon the third instance).
- UHC may request repayment or initiate recoupment of any funds paid that are viewed as deliberate overlapping activity.
Fraudulent activity is a serious offense and can be prosecuted by the State of Tennessee if the results are substantiated.