On March 1, 2025, Claims Validation Will Begin for EVV Phase 1 (Home Health Services Claims Billed to Ohio Medicaid)
Over the past several months, the Ohio Department of Medicaid (ODM) has been working with Sandata, ODM’s Electronic Visit Verification (EVV) vendor, to prepare providers for changes coming to the EVV claims adjudication process. As ODM previously announced, to make this transition as smooth as possible for providers, ODM will stagger the roll out of claims validation by phases. The first phase will consist of home health services claims billed to ODM.
Phase 1 consists of the following service codes:
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Service Code
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Service
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G0156
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Home health aide
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G0151
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Home health physical therapies
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G0152
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Home health occupational therapies
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G0153
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Home health speech language pathology therapies
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G0299
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Home health nursing registered nurse (RN)
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G0300
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Home health nursing licensed practical nurse (LPN)
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Beginning on March 1, 2025, for phase 1 providers, claims with the service codes above must have a matching EVV visit record. Please note that this will apply only to dates of service March 1, 2025, onward. Claims with dates of service prior to March 1, regardless of the date when the claim is submitted, will not require a matching EVV visit record. Impacted claims (i.e., phase 1 claims with dates of service on or after March 1, 2025) that do not have EVV matching data will be denied.
ODM will stagger other providers and services in future phases. ODM is working with CMS to finalize the schedule and will provide more information as soon as possible. Thank you for your patience as we work through this process.
ODM will provide ample notice to providers before claims validation begins for each phase.
We are Here to Help You and Provide Support
Since August, ODM and Sandata have been offering training sessions, holding help desk office hours, and reaching out directly to phase 1 providers. To sign up for 1:1 assistance, simply click Zoom to sign up. Office hours are available daily on Zoom.
ODM has also launched the EVV Provider Lookup Dashboard. There, providers can view a summary of claims validations in one place and measure progress as they continue to train staff on the EVV system. Please spend some time familiarizing yourself with this dashboard and exploring its functionality. This dashboard will be a valuable tool for providers as we move forward during the transition.
The Ohio Department of Medicaid also has additional resources available to you on the EVV website. For immediate help, please contact the EVV Provider Hotline at 855-805-3505.
REMINDER: Beginning on March 1, 2025, claims validation will be implemented in phases. On that date, claims in Phase 1 that require EVV must have a matching EVV visit record. Claims that do not match will be denied.
