South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024)

What this rule requires your agency to do

• 1EVV requirements apply even when the caregiver providing the service and the beneficiary live together (Quick Answers #4).(South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024))
• 2Manual entry may be used only as a last resort for no more than 25 percent of services; manually entered EVV or EVV with an exception is not considered compliant EVV (Data Collection).(South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024))
• 3Span dates cannot be billed on one claim line for claims requiring EVV; each date of service and each procedure code must be on an individual claim line (Quick Answers #2).(South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024))
• 4HOPE Waiver services (T1000 TD/TE private duty nursing, S5130 homemaker, T1019 personal care, S5135 adult companion, S5120 chore, T1005 respite) and State Plan Personal Care services are subject to EVV effective January 1, 2021 (Services Subject to EVV).(South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024))
• 5Providers must collect six data elements in near-real time: type of service, individual receiving service, date of service, location of service delivery, individual providing service, and time the service begins and ends (Data Required).(South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024))
• 6For Home Health and PDN services, a third-party EVV system must establish an interface connection to the Therap Aggregator, which is mandatory for collection and submission of EVV data to MMIS for claim adjudication (Implementation Processes).(South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024))
• 7Home Health and Private Duty Nursing services (S9123, S9124, S9122, 99503, 99506, G0151, G0152, G0153, G0155, G0156, G0299, G0300) are subject to EVV effective January 1, 2024 (Services Subject to EVV).(South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024))
• 8If a provider does not use the state-offered EVV solution (Therap or FOCOS), the provider must complete the Provider Request for Approval for Alternative IT System for EVV form and, if approved, must ensure the minimum EVV requirements are met (Implementation Processes).(South Dakota Medicaid Billing and Policy Manual — Electronic Visit Verification (Updated February 2024))