 Claims Matching in Sandata EVV
When a provider submits a claim to any Medicaid payer, that payer sends the claim details to Sandata for visit matching. Sandata uses the claim information to determine if there is a matching visit in the EVV system and returns a response to the payer to let them know if there is a visit. Claims and visits are matched using the following:
- Provider Medicaid ID.
- Client (Individual) Medicaid ID.
- Start Date of Service.
- Service Code (including Payer).
- Units (the service units in the visit must be equal or greater than the number of units billed on the claim).
Sandata provides a response to each claim request letting the payer know if there is a visit matching the claim in the Sandata system. Matching visits will change from Verified to Processed within the Sandata system.
For all payers except the Department of Developmental Disabilities (DODD), there should be a separate claim detail (or claim line) for each visit completed.
DODD allows providers to roll up their visits for each calendar day into one claim detail. Therefore, Sandata does not take into account the number of units on the DODD visits and claims when changing the visit from Verified to Processed. This means a Processed status on a DODD visit does not always mean there are enough units in the EVV system to validate the claim submitted to DODD.
For questions about your DODD EVV Summary Report or EVV visits, here are the following DODD resources:
- Call the DODD call center at 1-800-617-6733 and choose either the “billing” or “other” option.
- Use the Contact Us option on the DODD webpage to create a ticket for DODD to answer: https://forms.prodapps.dodd.ohio.gov/Contact.
You can also email ODM at ODMEVV@sandata.com.
 April Webinar Recap – Alternate (Alt) EVV Update
ODM and Sandata collaboratively hosted the monthly webinar for April, which covered updates regarding Alternate (Alt) EVV and future changes that impact Alt EVV vendors and agency providers. Some of the updates and future changes involve EVV program changes and pending additions related to Ohio Medicaid Enterprise System (OMES).
ODM provided an update on the Next Generation managed care organizations, highlighting that seven MCOs have been selected. Three of the MCOs are new and need to be added as Payer options in Alt EVV Systems. The new plans are:
- AmeriHealth Caritas Ohio, Inc.
- Anthem Blue Cross and Blue Shield.
- Humana Healthy Horizons in Ohio.
Find updates about the implementation of the Next Generation Managed Care Program here.
ODM also reminded the audience that Alt Systems no longer need to send in the exceptions that are no longer required. Those exceptions are Unmatched Client/Phone, Visit Verification, Client Signature, and Service Verification.
Sandata shared their efforts to complete a full review of the Ohio Alt EVV Technical Specifications. The validation review is ongoing and includes:
- Validating every field of the specifications;
- Reviewing the specifications for clarity and readability; and
- Reformatting the Ohio technical specifications for a more similar look and feel to other state programs.
This validation project will ensure the Ohio Alt EVV interface and its supporting documentation are clear to Alt EVV vendors and providers. The project also intends to ensure the Alt EVV interface is easier to connect and understand for Alt EVV vendors. Some of the key benefits and changes in the revised Alt EVV specifications, which have resulted from the review and revised format, include:
- More clearly identified and stated rejection rules, expectations for field values, and default values for fields;
- Clarified and expanded descriptions of fields in the interface to better understand what each field represents; and
- Updated technical examples that help demonstrate how data should be formatted and sent.
Please review the webinar recording and presentation slides for additional information on future Alt EVV system changes. The updated Alt EVV Technical Specifications are now available on the ODM Alt EVV webpage. ODM will communicate updates to Alt Vendors including timing of changes and supporting details.
The Alt EVV Business Requirements have also been updated to reflect a recent policy change to allow multiple Alt EVV systems to send visit details to Sandata aggregator for a single Medicaid provider ID. Additional updates were made to make the requirements easier to understand.
For any Alt EVV questions, please reach out to ohaltevv@sandata.com. ODM program questions can be sent to ODMEVV@sandata.com.
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