Effective October 1, 2020, the Health and Human Services Commission (HHSC) revised the Electronic Visit Verification (EVV) Claims Matching Policy to include additional EVV claims match result codes and to identify exceptions to the claims matching process, where applicable.
All claims for services required to use EVV (EVV claims) must match to an accepted EVV visit transaction in the EVV Aggregator (the state’s centralized EVV database) prior to reimbursement of an EVV claim by the payer. The Texas Medicaid & Healthcare Partnership (TMHP), the claims administrator for the state of Texas, oversees this process.
Payers, either HHSC or a managed care organization (MCO), will deny or recoup an EVV claim that does not match an accepted EVV visit transaction. This includes fee for-service claims paid by HHSC, acute care claims paid by TMHP on behalf of HHSC and managed care claims paid by the MCO.
Program providers and financial management services agencies (FMSAs) using a third-party to bill claims must notify the third-party of the EVV claims matching policy.