ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV)

What this rule requires your agency to do

• 1The EVV system must electronically verify: the individual receiving the service; the individual providing the service; date of service; location of service delivery; time the service begins and ends; and type of service performed (EVV System Requirements).(ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV))
• 2Non-compliant providers may be denied payment and subject to sanctions including audit and recovery, no new referrals/authorizations, payment suspension, pre-payment review, corrective action plan, fraud referral, and/or termination of provider status (Non-Compliance).(ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV))
• 3QSPs must choose an EVV vendor upon enrollment; if a QSP changes vendors after enrollment they must notify Adult and Aging Services at dhshcbs@nd.gov and allow at least three weeks for the change to be implemented (Open EVV Model).(ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV))
• 4Manual/corrected EVV entries consisting of 20% or more of submitted claims during a review period may be deemed non-compliant; required exception notes matching the exception code must be included or the claim will be denied or recovered (Manual Corrections; Non-Compliance).(ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV))
• 5Providers must bill in 15-minute units, may never increase billed hours beyond actual hours worked, and may not span-bill between two days (shifts must be split at 11:59 pm) (Billing and Reimbursement Methodology).(ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV))
• 6Providers must keep legible medical and financial records fully justifying services billed and retain them at least 7 years after the last date the claim was paid or denied; billed EVV data must match documented services (Documentation Requirements).(ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV))
• 7EVV coverage is required for Medicaid-covered personal care and related services (as of Jan. 1, 2021) and home health services (as of July 1, 2023); providers subject to EVV include Agency QSPs, Individual QSPs, DD providers, self-directed providers, 1915(i) respite providers, and home health agencies (Applicability).(ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV))
• 8Providers using an alternate (non-Therap) EVV vendor must use the state's data aggregator (Sandata), ensure valid data is provided to the aggregator, and are responsible for interface costs and for reviewing the state Alternate Vendor EVV specifications/addendum (Open EVV Model).(ND Medicaid Billing and Policy Manual - Electronic Visit Verification (EVV))