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TITLE 1 - ADMINISTRATION
PART 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354 - MEDICAID HEALTH SERVICES
SUBCHAPTER O - ELECTRONIC VISIT VERIFICATION
SECTION/RULE §354.4009 - EVV Visit Transaction and EVV Claim
Chapter Review Date 11/08/2024

(a) A program provider and an FMSA must:(1) ensure that an EVV visit transaction contains the data elements required by the EVV system, including:(A) the first and last name of the member who received the service;(B) the type of service provided;(C) the date the service was provided;(D) the time the service began and the time the service ended;(E) the first and last name of the service provider who provided the service;(F) the location, including the address or geolocation, where the service was provided; and(G) other information HHSC determines necessary to ensure the accurate payment of a claim for services, as described in the EVV Policy Handbook; and(2) ensure the data elements required by paragraph (1) of this subsection are accurate.(b) A CDS employer who elects to complete visit maintenance on the HHSC Employer's Selection for Electronic Visit Verification Responsibilities form must:(1) ensure that an EVV visit transaction contains the data elements required by the EVV system, including those listed in subsection (a)(1) of this section; and(2) ensure the data elements required by paragraph (1) of this subsection are accurate.(c) A program provider and an FMSA must:(1) before submitting an EVV claim:(A) ensure that the EVV visit transaction is transmitted to and accepted by the EVV Portal; and(B) ensure that the data elements on the EVV claim match the data elements in the accepted EVV visit transaction; and(2) submit the EVV claim in accordance with HHSC or MCO billing requirements and the EVV Policy Handbook.(d) HHSC or an MCO denies an EVV claim or recoups a payment made to a program provider or an FMSA if the EVV claim does not meet requirements described in the EVV Policy Handbook, including if:(1) the EVV claim does not match the accepted EVV visit transaction; or(2) there is no accepted EVV visit transaction that supports the EVV claim.

Source Note: The provisions of this §354.4009 adopted to be effective January 1, 2024, 48 TexReg 7171.

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