Electronic Visit Verification Implementation
The 21st Century CURES Act, passed in December 2016, requires state Medicaid programs to implement an Electronic Visit Verification (EVV) system. Per section 12006, all states must implement an EVV system to avoid a reduction in federal Medicaid funding. EVV is an electronic-based system that verifies when provider visits occur ensuring that members receive authorized services. All EVV systems must collect the six points of data listed below.
- Type of service performed
- Individual receiving the service
- Date of the service
- Location of service delivery
- Individual providing the service
- Time the service begins and ends
Colorado has deployed a hybrid EVV model, meaning that provider agencies may choose to use the State EVV Solution at no cost or utilize a Provider Choice EVV System by contracting with vendor of their choice.
Provider agencies must choose if they will utilize the State EVV Solution or procure and utilize a Provider Choice System. It is responsibility of each provider agency to select and implement an EVV solution by August 3, 2020.
Providers selecting the State EVV Solution should refer State EVV Solution page for additional information. Providers selecting a Provider Choice System should refer to the Provider Choice Systems page for additional information.
Beginning on August 3, 2020, providers of EVV required services are must collect EVV data prior to claims submission. This implementation date will allow providers necessary time to incorporate EVV into business practices, prior to the Federal mandate of January 1, 2021. Beginning on January 1, 2021, claims without corresponding EVV will deny during claims processing. Between August 3, 2020 and January 1, 2021, the Department will monitor provider compliance with EVV and provide technical assistance to ensure sufficient compliance by January 1, 2021.
The Department is implementing EVV for federally mandated services and other services that are similar in nature and service delivery. To determine if your agency will be required to use EVV, please review Appendix C of the EVV Program Manual on the EVV Resources page. All service codes listed in that document require EVV data prior to claims adjudication.
The implementation of EVV will not impact current service rules for EVV required services. EVV data should be collected wherever service provision occurs, whether that be in the members home or in the community. Please note, that services provided in an office or provider-owned residential setting are generally exempt from EVV. Refer to the Service Code Inclusion List for details.