In This Issue:
Healthcare authorizations are valuable as they ensure recipients receive the right treatments, procedures, or medications they need while also meeting specific regulatory and billing requirements.
Recently, providers have contacted ODM seeking clarity on EVV authorizations.
“EVV authorization” is a term that identifies specific EVV services a provider is planning to render to a Medicaid recipient. While EVV visits can be created without an EVV authorization in the system, entering the authorization in advance is best practice to streamline processes, reduce follow up work, and support smoother, more efficient visit management.
As a rule, EVV authorized services noted in Sandata must match the medically necessary care and services approved by a medical provider and confirmed by a payer through a prior authorization notice.
If you have any questions about medical necessity or prior authorization, please contact those entities directly. You can also find more information on the topic by referencing Sandata’s Creating Recipient Authorizations user guide.
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March 19 Town Hall Designed Specifically for You
Ohio Medicaid and HHA Exchange will hold a virtual town hall for certified Ohio Medicaid alternate EVV vendors on March 19, at 11 a.m. Eastern. The session will cover:
- EVV Background and Claims Validation
- Review of Alt EVV Specifications and Services
- April 1 Enforcement of Reason Code 99 requirements
If you are using a certified alternate EVV system please encourage your vendor to attend the Alt EVV town hall. Registration is open now through March 19, 10:45 a.m.
APRIL 1 REMINDER
Alt EVV systems must be configured to use Reason Code 99 for services provided on or after April 1 that are manually edited. This includes manually created visits. Failure to implement this requirement will trigger Sandata aggregator rejections for manually created or edited visits, delaying reimbursements for the care provided. Encourage your vendors to review guidance outlined in Appendix H of the Alternate EVV Technical Specifications.
Starting March 1, Next Generation MyCare providers billing for services subject to EVV were required to submit claims with a matching EVV record in the Sandata Aggregator. Claims without a match will be denied.
On April 1, Ohio’s Next Generation MyCare Program rolls out to 10 additional counties, enabling MyCare health plans to support EVV requirements for their members.
To help providers and partners prepare for this expansion, we have a few important reminders:
Medicaid members may switch from PASSPORT to MyCare beginning April 1. Local AAAs should be working with members and their health plans before the expansion to coordinate program transitions.
Providers and AAA representatives supporting members transitioning to MyCare need to update the Recipient Program, payer, services, and EVV authorization within the EVV system. These updates can be made today in the Sandata EVV recipient record, allowing the system to automatically change the member’s status to “Active” on April 1. See Automation Simplifies Recipient Record Management from our February newsletter and refer to How to Future Date Recipient Records for guidance.
EVV authorizations must be updated in the EVV system when a member's payor changes. Review Creating Recipient Authorizations for guidance.
Please review the services and procedure codes affected by the April MyCare expansion.
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Ohio Medicaid is introducing a new series of brief, topic-specific online video guides giving you an easy-to-use resource for tackling common challenges with system uses, requirements, and interfaces.
Three microvideos are currently available from the Resources menu on Ohio Medicaid’s Electronic Visit Verification webpage. More are in the works.
If you need assistance with the Sandata system, help is available. Check out the resources below.
Sandata also offers technical support office hours daily, answering providers’ questions and resolving issues you encounter. To take advantage of these small-group sessions register here and select a date that works with your schedule.
Ohio Medicaid will host the next EVV Stakeholder Workgroup meeting on March 23, from 2:30-4 p.m. To join us, register here. You can also review the February 23 presentation to catch up on our latest discussion.
Ohio Medicaid and HHA Exchange (formerly Sandata Technologies) are ready to assist providers and agencies in meeting claims validation requirements and more.
Click here to see who to contact for your specific needs.
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