Medicaid Home Health Care Services (HHCS) Electronic Visit Verification (EVV) Project Update
Download PDF
The Department of Medical Assistance Services (DMAS) will implement Electronic Visit Verification (EVV) requirements for Home Health Care Services (HHCS) on July 1, 2023 in accordance with the requirements of the federal 21st Century CURES Act of 2016. DMAS will implement soft edits on July 1, 2023, followed by hard edits on 12/1/2023. Please note this is a change, the start of hard edits was extended from 10/1/2023 to 12/1/2023. Soft edits will allow claims to pass through the system even if EVV data is incomplete, giving the provider feedback on errors. Once the hard edits are in place on 12/1/2023, claims will deny for missing or incomplete EVV data on the 837I. DMAS has published an 837I companion guide on DMAS MES website at https://www.dmas.virginia.gov/for-providers/long-term-care/programs-and-initiatives/electronic-visit-verification. This guide is important for your billing system to submit HHCS claims compliant with Virginia’s EVV requirements. DMAS will conduct additional training on June 22, 2023. Providers, EVV vendors and clearinghouses can register for this training here.
If you have any questions, please send your inquiry to EVV@dmas.virignia.gov.
|
PROVIDER CONTACT INFORMATION & RESOURCES |
|
|
Virginia Medicaid Web Portal Automated Response System (ARS) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
|
|
Medicall (Audio Response System) Member eligibility, claims status, payment status, service limits, service authorization status, and remittance advice. |
1-800-884-9730 or 1-800-772-9996 |
|
KEPRO Service authorization information for fee-for-service members.
|
|
|
Provider Appeals DMAS launched an appeals portal in 2021. You can use this portal to file appeals and track the status of your appeals. Visit the website listed for appeal resources and to register for the portal. |
|
|
Managed Care Programs Medallion 4.0, Commonwealth Coordinated Care Plus (CCC Plus), and Program of All-Inclusive Care for the Elderly (PACE). In order to be reimbursed for services provided to a managed care enrolled individual, providers must follow their respective contract with the managed care plan/PACE provider. The managed care plan may utilize different guidelines than those described for Medicaid fee-for-service individuals. |
|
|
Medallion 4.0 |
|
|
CCC Plus |
|
|
PACE |
|
|
Magellan Behavioral Health Behavioral Health Services Administrator, check eligibility, claim status, service limits, and service authorizations for fee-for-service members. |
www.MagellanHealth.com/Provider For credentialing behavioral health service information, visit: www.magellanofvirginia.com, email: VAProviderQuestions@MagellanHealth.com,or Call: 1-800-424-4046 |
|
Provider Enrollment |
In-State: 804-270-5105 Out of State Toll Free: 888-829-5373 Email: VAMedicaidProviderEnrollment@gainwelltechnologies.com |
|
Provider HELPLINE Monday–Friday 8:00 a.m.-5:00 p.m. For provider use only, have Medicaid Provider ID Number available. |
1-804-786-6273 1-800-552-8627 |
|
Aetna Better Health of Virginia |
www.aetnabetterhealth.com/Virginia 1-855-270-2365 1-866-386-7882 (CCC+) |
|
Anthem HealthKeepers Plus |
1-833-207-3120 1-833-235-2027 (CCC+) |
|
Molina Complete Care
|
1-800-424-4524 (CCC+) 1-800-424-4518 (M4) |
|
Optima Family Care |
1-800-643-2273 1-844-374-9159 (CCC+) |
|
United Healthcare |
1-844-284-0149 1-855-873-3493 (CCC+) |
|
Virginia Premier |
1-800-727-7536 (TTY: 711), www.virginiapremier.com |
|
Dental Provider DentaQuest |
1-888-912-3456 |