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Recoupment Guidance for Managed Care Organizations (MCOs) Required to Use EVV

July 25, 2018

HHSC issues this guidance to remind MCOs of the agreed upon process to be used when determining appropriate Electronic Visit Verification (EVV) recoupments. All payers should continue to perform the following actions to determine if recoupment is appropriate for all or part of any claim previously paid without a matching EVV visit transaction:

1. Research provider visit data with the appropriate EVV vendor;

2. Perform outreach with the provider to confirm EVV visits, if necessary; and,

3. Communicate an EVV appeals process in writing to the provider.

While it is ultimately the provider’s responsibility to ensure that their EVV visit data is correct, HHSC instructs the payers to follow reasonable practices to work with both the EVV vendor and the provider prior to recoupment.

Please contact HHSC mco_evv_communication@hhsc.state.tx.us for questions regarding this notice and copy your MCCO team.