Electronic Visit Verification Provider Choice Systems Information
Welcome Provider Choice Users!
The 21st Century CURES Act, passed in December 2016, requires state Medicaid programs to implement an Electronic Visit Verification (EVV) system for Personal Care and Home Health services. 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 and documents the precise time services begin and end, ensuring that members receive authorized services. To be in federal compliance, 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
On late summer 2020, the Department of Health Care Policy & Financing (the Department) will require Health First Colorado (Colorado's Medicaid Program) providers of EVV mandated home and community-based and state plan services to use EVV. Colorado is implementing EVV for federally required services and additional services that are similar in nature and service delivery. A list of services that require EVV in Colorado is listed below.
Participation in the EVV is mandatory for the following programs and services. Provider agencies not in compliance with EVV by late summer 2020 may experience a disruption in reimbursement.
|Services Mandated for Colorado EVV Implementation*|
Behavioral Therapies (provided in the home or community)
Life Skills Training
* Services subject to change
* Facility Based Per Diem Services, Managed Care, PACE, and other Capitated Services
* Please refer to the CO EVV Service Types document for detailed billing/service code information
The Colorado EVV program has deployed a hybrid model. A hybrid model means that a provider agency may choose to use the State EVV Solution at no cost or an utilize an alternate EVV vendor. Providers who choose to utilize an alternate EVV solution must ensure that their system is configured to Colorado EVV rules and requirements. A list of vendors who have interfaced with Sandata in other states is available. Interface time may be reduced by choosing a vendor from this list. The Department does NOT endorse any vendor or recommend using a vendor from this list.
The Department strongly recommends that providers decide if they will utilize an alternate EVV vendor to ensure adequate time for interface testing. It is each provider's responsibility to have a functional EVV solution by late summer 2020.
Timeline for Electronic Visit Verification (EVV)
Providers Must Begin Using EVV Solution
|Pre-Payment Claims Review|
|July 2019||August 2019||September 2019||October 2019||August 3, 2020||January 1, 2021|
*Pre-payment claims review means claims that are submitted without a corresponding EVV are subject to denial
Provider Choice System
How to Interface with State Solution
Technical Specifications Documents
As part of the Colorado Choice EVV program, providers who will be utilizing a third-party EVV vendor will receive two documents with instructions for interfacing with the Sandata Aggregator:
- Requirement Specification for Receipt of Alternate Electronic Visit Verification Systems Data (altEVV)
- This document contains the generic specification which documents the requirements for using the Sandata Real time Interface (part of the Open EVV Series of Interface), for receiving information from third-party EVV Vendors into the Sandata Aggregator. This interface includes clients, employees, visits, and their associated calls as well as the ability to send data related to visit modifications.
- Colorado HCPF Third Party EVV - Companion Guide to Third Party Alternate EVV System Specification
- EVV Alternate Vendors Connected with Sandata List
Providers choosing to use an alternate EVV vendor are encouraged to review these technical specifications documents.
Provider Choice User Training for the Aggregator
- Training is free and mandatory for Medicaid Provider Agencies using a Provider Choice System to receive aggregator log-in credentials.
- Aggregator training is available to start now, and can be completed before or after interface testing.
- Aggregator log-in credentials will be provided via email by Sandata within two days of training completion.
Register for Provider Choice System Training - This training is intended for Provider Choice System Providers only
EVV Self-Paced Training Supplemental - December 2019
Questions about Training?
Phone: (855) 871-8780
Provider Choice System Process
Phase 1: Outreach
- Providers review technical specifications
- Providers coordinate with contracted EVV vendor
- Providers determine if they will use the State solution or an alternate EVV vendor
- Provider Choice Systems reach out to Sandata to begin testing process.
Phone: (855) 871-8780
Phase 2: Setup for Interface Testing with Sandata
- Providers register with Sandata to request test credentials
- Sandata sends testing guide and checklist to providers
- Sandata creates an account to support testing efforts
- Sandata will provide contact information for Sandata’s technical interface support team for questions and issues
Phase 3: Interface Testing
- Test files are uploaded by vendor and checklist is filled out
- Provider sends in completed checklist from vendor to Sandata and requests validation. If unsuccessful, the checklist marked with erroneous files/scenarios is sent back to provider. The corrected checklist can be resubmitted until all errors are corrected.
Phase 4: Production-Ready
- Provider testing is successful
- Sandata sends production credentials to provider