27 Nov Ohio EVV Claims Adjudication

Ohio Electronic Visit Verification Claims Adjudication to Begin in Early 2025

EVV claims adjudication in the state of Ohio is on the horizon, with a potential implementation date as early as January 1^st, 2025 for Medicaid FFS claims. The Ohio Department of Medicaid (ODM) is continuing to roll out additional materials to ensure agencies are prepared.  

QUICK TAKE

The first phase of the claims adjudication process begins with home health service claims billed to the Ohio Department of Medicaid. Claims for these services only will require complete EVV visit data to receive payment. These changes will occur in phases and will not impact claims with a service date before January 1, 2025.

In unison with the requirements initially set forth bv the 21^st Century Cures act Your claim will match if you have an EVV record with these six data points:

1. The name of the recipient receiving the service
2. The employee providing the service
3. The type of service performed
4. The location where the service was provided
5. The date the service was performed
6. The start and end date of the service

ODM DIRECT OUTREACH

In late October, the ODM began sending out EVV error message emails to any home health care agencies who had claims with visits that were not verified. These emails were delivered separately for those who used Sandata as well as those who use an alternate approved EVV system for Ohio. The emails included error messages identified when attempting to match claims:

1. Provider ID does not match.
2. The recipient ID does not match.
3. Service code does not match; and
4. Unmatched units.

Throughout the remainder of the year, the ODM is reported to continue sending these messages so long as the errors continue. These email messages will include directions on how to resolve the identified errors. Visit the ODM web page to explore other resources including quick links to resolving the errors or information on contacting Sandata, where providers can receive technical assistance and one-on-one support.

ODM has publicly stated its commitment to ensuring home health care agencies and other vested organizations are aware of these upcoming changes to the Electronic Visit Verification (EVV) claims adjudication process. The organization will continue its phone outreach to some providers impacted by these changes and intends to provide technical assistance if requested. Agencies can ensure their information is up to date to receive these communications as well as updated information by completing the EVV Claims Adjudication Provider Contact Information Form

Helpful Links:

• ODM Website
• EVV Claims Adjudication Provider Contact Information Form

ODM-APPROVED EVV SYSTEM FOR OHIO 

Alora has simplified Electronic Visit Verification (EVV) for Ohio home health care agencies. Thousands of Ohio caregivers appreciate the ease of Alora’s ODM Certified EVV Software, using it daily to streamline their work. This significantly enhances operational efficiency for the agencies while ensuring compliance with the ODM.

Alora was among the first Ohio home health software vendors approved and certified by the ODM for EVV in the state. Alora’s integrated EVV system covers all mandated payers in Ohio, including the Ohio Department of Medicaid (ODM), Ohio Department of Aging (ODA), Ohio Department of Developmental Disabilities (DODD), Aetna, Buckeye, CareSource, Molina, Paramount, and United Healthcare.

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