Policy

Effective October 1, 2020, the Health and Human Services Commission (HHSC) revised the Electronic Visit Verification (EVV) Claims Submission Policy to:
• Require program providers and financial management services agencies (FMSAs) who deliver services required to use EVV, to submit claims for EVV services (EVV claims) to the appropriate HHSC claims management system.
• Incorporate the EVV Billing policy.

All EVV services listed in the EVV Service Bill Codes Table on the HHSC EVV website are subject to this policy.
Program providers and FMSAs must follow the billing guidelines of their payer, either HHSC or their managed care organization (MCO), when submitting an EVV claim.
Each claims management system will forward the EVV claims to the EVV Aggregator for the EVV claims matching process. The EVV Aggregator will return the EVV claims and the EVV claims match result code(s) back to the claims management
system for further claims processing. Program providers and FMSAs must submit EVV claims per claim line item with
either a single date of service or a span of dates as required by the payer. See the EVV Claims Matching Policy for more information about how the EVV Aggregator performs the EVV claims match for each type of billing.
Program providers and FMSAs using a third-party claims submitter (or billing agent) must notify the third-party submitter of the EVV claims submission policy.