Examples of EVVV Claim Pend Timelines - Personal Care Services Providers: Billing Telehealth on CMS 1500 Claim Form
Maine Department of Health & Human Services sent this bulletin at 10/23/2020 02:53 PM EDT
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Examples of Electronic Visit Verification (EVV) Claim Pend Timelines
Personal Care Services (PCS) claims with dates of service beginning on October 1, 2020 are now subject to an EVV claim edit. Unless a verified EVV record is found, the pend time is a three-day recycle period. This means that unless claims subject to EVV requirements are denied for other reasons, they will pend first and then process to pay.
To avoid the three-day recycle period, please make sure your verified EVV record is in the Sandata or alternate EVV system prior to submitting claims.
If there is no EVV record in the Sandata or alternate EVV system and depending on the day of the week you submit your claims, there may be a payment delay for the claim. Please note: Pay close attention to the submission and payment processing dates in the table below.
Examples of the three-day pend process:
|
Day of Week Claim is Submitted |
Claim is Released from EVV Hold |
EFT Payment Sent |
Check Payment Sent |
|
Saturday, 10/10/2020 |
The following Tuesday, 10/13/2020 |
Thursday, 10/22/2020 |
Monday or Tuesday 10/26/2020 or 10/27/2020 |
|
Sunday, 10/11/2020 |
The following Wednesday, 10/14/2020 |
Thursday, 10/22/2020 |
Monday or Tuesday 10/26/2020 or 10/27/2020 |
|
Monday, 10/12/2020 |
The following Thursday, 10/15/2020 |
Thursday, 10/22/2020 |
Monday or Tuesday 10/26/2020 or 10/27/2020 |
|
Tuesday, 10/13/2020 |
The following Monday, 10/19/2020 |
Thursday, 10/29/2020 |
Monday or Tuesday 11/2/2020 or 11/3/2020 |
|
Wednesday, 10/14/2020 |
The following Monday, 10/19/2020 |
Thursday, 10/29/2020 |
Monday or Tuesday 11/2/2020 or 11/3/2020 |
|
Thursday, 10/15/2020 |
The following Monday, 10/19/2020 |
Thursday, 10/29/2020 |
Monday or Tuesday 11/2/2020 or 11/3/2020 |
|
Friday, 10/16/2020 |
The following Monday, 10/19/2020 |
Thursday, 10/29/2020 |
Monday or Tuesday 11/2/2020 or 11/3/2020 |
Please note there could be reasons that a claim would pend other than for EVV.
Please contact Provider Services with questions:
- Email MaineCare's EVV email box
- Call Provider Services at 1-866-690-5585, option 3
Personal Care Services (PCS) Providers: Billing Telehealth on CMS 1500 Claim Form, CR 96215
Telehealth PCS claims are excluded from Electronic Visit Verification (EVV) record requirements. When billing telehealth claims on the CMS 1500 Claim Form, you must use the Place of Service code 02 and include the GT modifier as this indicates you are providing services via telehealth and not in-person.
See the table below for affected codes. Please note that coming soon, UB04 claim lines submitted with telemedicine revenue code 078x will be also be exempt from EVV editing. We will advise you when that change is in the system.
|
Code |
Description |
Code |
Description |
|
G0151 |
PT services, home health or hospice, each 15 min |
S5150 |
Unskilled respite care not hospice per 15 min |
|
G0152 |
OT services, home health or hospice, each 15 min |
T1000 |
Private duty/independent nursing up to 15 min |
|
G0153 |
Speech\lang, home health or hospice, each 15 min |
T1004 |
Services of a qualified nursing aide to 15min |
|
G0155 |
Social work service, HH or hospice, each 15 min |
T1005 |
Respite care services, up to 15 minutes |
|
G0156 |
Home health aide, HH or hospice, each 15 min |
T1019 |
Personal care serv, per 15 min, not for inpat |
|
G0299 |
HHS/hospice of rn each 15 minutes |
T1502 |
Administration of oral/IM/subcut med, /visit |
|
G0300 |
HHS/hospice of lpn each 15 minutes |
T2017 |
Habilitation, residential waiver, per 15 min |
|
H2021 |
Community based wrap-around servs, per 15 min |
T2042 |
Hospice routine home care, per diem |
|
S5125 |
Attendant care services, per 15 min |
T2043 |
Hospice continuous home care, per hour |
Please contact your Provider Relations Specialist with questions.