EVV Updates: Affected Claims Estimate & 24 Hour Congregate Care Settings

INARF would like to share the below EVV updates we have recieved from OMPP. Feel free to reply directly to this email if you have any questions. 

Post and Pay: OMPP is tentatively working towards full implementation by early summer 2022

EVV Claims Update

• OMPP ran a report to determine the amount of claims that would be denied if EVV hard edits were in place
• The report was based on the top three claim details: No EVV record with training (0950), no EVV record without training (0951), and EVV record amount does not match claim record amount (0952)
• Dates of service: November 29 – December 3
• Amount of claims: $2,769,957.36
• Over 357 providers were affected: most providers were affected by small amounts, but the top two providers had approximately $200,000 and $172,000 claim amounts that were affected

24 Hour Congregate Care Settings Update

• The state is currently working on a modifier for when a service is performed in a 24 hour congregate setting
• The change request was submitted in early December and is currently under review with Gainwell
• OMPP’s goal is to complete this in January with a February 1 effective date
• The change would be placed in Core in such a way that when a claim comes identifying a specific service with that modifier (either respite, residential habilitation hourly, or PAC), it would not look for an EVV record
• For billing purposes, this change will entail new billing instruction for providers to use to use a specific modifier for services provided in 24 hour congregate care settings
• INSITE will not be affected, but CoreMMIS will be impacted by change
• As a reminder, this would only affect individuals in 24 hour congregate care settings, and would not affect individuals receiving 24 hour care living alone