August 18, 2022

Washington, D.C. Medicaid: EVV required for claims processing

Effective Aug. 15, 2022, health care professionals providing in-home services to District Dual Choice Program enrollees in Washington, D.C., will be required to use an 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 personal care aide (PCA) services and respite services. 

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

Code Procedure description Modifier 1 Modifier 2

T1005

Respite services

U3

 

T1019

Personal care services

NP

 

T1019

Personal care aide services

NP

U3

Health care professionals may begin using EVV for these services starting July 20, 2022. Effective, Aug. 15, 2022, we’ll reject claims for PCA and respite services if the claim is not supported by EVV transactions. 

What is EVV?
EVV electronically captures details of PCA and respite services while helping to ensure the services are billed accurately. Your EVV system will be used to record information about:

  • The enrollee receiving the service
  • The individual providing the service
  • Type of service
  • Location of the service delivery
  • Service date
  • Time the service begins and ends

What EVV system should I use?
You have the option to use: 

  • The Department of Health Care Finance (DHCF) EVV system (Sandata Technologies, LLC) 
  • An alternate system if it complies with District Medicaid requirements

Learn more
Please see District DHCF training and frequently asked questions to learn more about EVV.

Questions?
Please contact:

PCA-1-22-02374-C&S-WEB