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Massachusetts EVV - What you need to know!

This article is to provide generalized overview and information on Massachusetts EVV relevant to eCaring customers. It will also include links to other articles.

Overview

Massachusetts has a few KEY EVV rules which, if not known, can create a LOT of frustration and submission failures. However, once the rules are understood, the submission process becomes significantly easier.

Key Rules

  1. Providers MUST know who the STATE views as the "Payer" for a given client to determine which Identifier is require for submission, it's NOT necessarily who is paying the provider.

    1. This is especially important since the ASAPs function as "Providers" under many models of care in Massachusetts. However, in reality they are really the "Coordinators of Care" who contract a network of Providers to complete services.
    2. The general rule of thumb:
      1. MassHealth, CCA, and ALL SCO/OneCare enrolled members have a Medicaid ID and it must be used for EVV submission, regardless WHO is paying you for providing the services.
      2. ASAP Managed clients who are NOT enrolled in a SCO plan and are served under the "AGE"/EOHHS programs use their ASAP ID (SIM ID) for Billing and EVV.
  2. eCaring Determines which "Qualifier" and "Identifier" to submit to Sandata for a given client based on the Billing ID configuration.
    1. If the Client Profile contains a value in the "Medicaid ID" field, eCaring will send the qualifier of "Medicaid ID" and the value from the Medicaid ID field on the profile will be sent as the identifier.
    2. If the Client Profile does NOT contain a "Medicaid ID" then eCaring will send the Qualifier of "Client ID" or "Client Custom ID" (depending on your state) and the Value in the Billing ID field associated with the payer for that visit will be sent as the Identifier.
  3. What you need to get from each of your payers.
    1. Commonwealth Care Alliance - CCA
      1. The client's "Masshealth ID" (AKA Medicaid ID) CCA client IDs which are used for billing are NOT relevant for EVV submission.
      2. Which "EVV Payer ID" is needed for each client based on plan enrollment, Massachusetts treats CCA as two different "Payers" from an EVV perspective and each has their own EVV Payer ID.
    2. ASAPs
      1. If this an "AGE" client or a SCO client?
      2. EVV Payer ID, Payer Program and Medicaid ID (if applicable).

Workflow Overview

  1. For Sandata (all states) the integration requires eCaring to send a "Client Record" and a "Staff Record". These two records must be "Approved" before any visits can be "Approved".
    1. This is an automated process. However, if a client or caregiver record is rejected, all visits that are sent related to the rejected profile will also be rejected until the client or staff rejection is resolved and the visits are re-submitted.
  2. Visit Rejections often reflect an issue with a client or staff profile, NOT with the visit itself.
  3. ONLY visits with a clock-in and clock-out are transmitted to Sandata.
    1. Mobile App, IVR, or Manual
    2. Visits that do not have an electronic time and are just "verified" will not be sent to Sandata. You MUST add a Manual clock-in/out if your caregiver fails to use one of the EVV methods during the shift and provides you with visit documentation.
  4. If the caregiver clocks-in or out incorrectly, do NOT just add a pay or billing override. You MUST adjust the clock-in/out time to reflect what was actually served. Doing so will automatically resubmit the visit to Sandata with updated information.

Sandata Matching Logic

Clients

While there are a number of required fields that have to be sent to Sandata, there are three key fields used for matching Clients submitted by eCaring to the record provided by the state.

  • Client Qualifier - the client qualifier that is sent is determined by eCaring based on whether or not the client has a value in the "Medicaid ID" field on their profile.
  • Client Identifier - If the client has a Medicaid ID, the value in the Medicaid ID field in eCaring is sent.
  • Date of Birth - Sent from the client's profile.

Visits

Visits include information about both the Client and Caregiver, meaning, those records must already exist in Sandata and be "Approved" for a visit to be accepted. When they are, errors related to visits are generally due to two categories.

  • Service Related Errors
    • Invalid "Service" combination - "EVV Payer ID", "Payer Program" and "Procedure Code" need to be a valid combination found in the Sandata Implementation guide.
  • Business Rules Related Errors
    • Visit times are in the future.
    • Visit exceeds 24 hours.

Most Common Errors

  1. Client Not Found - Can show on a client or visit - the client record that was sent was NOT able to be matched to a record from the state.
    1. Most commonly seen when a client was provided to the state with a Medicaid ID but the provider does NOT have a Medicaid ID on the client's profile.
    2. Also seen when it's a new client, normally with ASAPs, where the client has not been provided to the state at all yet.
  2. Worker Not Found - Can show on a visit - normally this happens when the staff profile is missing required information or has special characters in the first or last name field.
  3. Total visit time cannot exceed 25 hours. - Most likely the caregiver forgot to clock-out of the visit, the agency did NOT realize and manually clock them out and the caregiver clocked out on a future visit to the same client.
    1. Add A Date Adjustment to correct the Clock-out time and the visit will automatically be re-submitted with the proper override code.
  4.  Error during retrieving service service_id entered - This means the "EVV Payer ID", "Payer Program" and "Procedure Code" combination is NOT a valid service offering, the issue could exist because of a wrong value in any of the 3 fields.

EVV, Billing and Payroll

Beyond the submission of EVV data to the state with the key information like Client, Staff, Service, Location, etc. EVV data is used for Claims Matching. When your payer is NOT able to match your billed services to a valid EVV record, your claim can be denied.

That's great, what does that really mean?

  1. Your EVV records and your billing should match.
    1. Have your staff clock-in and clock-out for all visits.
    2. When a clock-in or out is incorrect, use the "Date Adjustment" feature in eCaring to correct the incorrect value.
    3. Don't make separate adjustments to billing.
  2. When you submit a visit to Sandata they use the EVV reported start and end time (electronic, actual value) to calculate a visit duration. They then use that duration to calculate a number of allowable billing units for that Payer and Service.
    1. If a date adjustments is done to the visit, they then use the adjusted time to calculate the total visit duration for billing purposes.
  3. When you bill your payer, they compare each visit you bill for (units) to the EVV records in Sandata for a matching visit based on Client, Staff, Service, and Date of Service. They then compare the number of Units in your billing to the number of Units that Sandata calculated based on the EVV times.
    1. If your billing units exceed the EVV units, the claim will be denied.
    2. If your billing units are LESS than the EVV units, the claim will normally be paid but will have a Remittance note/Code.
    3. If your claim matches the billing units, it will be paid.

Other Resources