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Electronic Visit Verification (EVV)

Electronic Visit Verification (EVV) electronically verifies that service visits occur and documents the date and time service delivery begins and ends.

EVV Proprietary Systems

Last updated on 9/11/2023

An Electronic Visit Verification (EVV) proprietary system is an HHSC-approved EVV system that a program provider or Financial Management Services Agency (FMSA) may opt to use instead of an EVV vendor system from the state vendor pool that:

  • Is purchased or developed by a program provider or an FMSA.
  • Is used to exchange EVV data with the EVV Aggregator.
  • Complies with HHSC EVV Policy as it relates to EVV Proprietary Systems.
  • Complies with HHSC EVV Business Rules for Proprietary Systems.
  • Complies with the requirements of Texas Government Code Section 531.024172 or its successors.

An EVV Proprietary System Operator (PSO) is a program provider or FMSA that is approved to operate an EVV proprietary system.

Refer to the EVV Policy Handbook including Section 5000 EVV Proprietary System for more information.

EVV PSO Process Instructional Videos

The EVV PSO Process Instructional Video links below will provide a summary and key takeaways that will help you navigate the PSO Process.

EVV Proprietary System Operator (PSO) Onboarding Process

The PSO Onboarding Process Overview and Timeline document outlines the steps and required timeframes for a program provider or FMSA to onboard their proprietary system in the Texas EVV operating environment managed by HHSC and the state Medicaid claims administrator, TMHP.

Program providers and FMSAs must complete, sign, and submit the EVV Proprietary System Request Form to start the approval process to become a PSO.

Program providers and FMSAs must select from the following onboarding paths based on the system they have chosen:

  • The Standard Path is for requesting approval to use an EVV system that has not been previously approved by HHSC.
  • The Expedited Path is for requesting approval to use an existing operational EVV system that HHSC has previously approved.
  • Please refer to the EVV Proprietary Systems Approved by HHSC document for further information.

HHSC reviews submitted EVV Proprietary System Request Forms to assign an Operational Readiness Review (ORR) session. The ORR session is a validation process to determine approval for a PSO. ORR sessions are assigned based on the date of receipt of a complete and signed EVV Proprietary System Request Form.

In order to use the automated features of the EVV Proprietary System Request Form (including the ability to select responses, the ability to use an electronic signature to sign the form, and the ability to submit the form to TMHP as an email attachment using the “Submit” button):

a) The user must successfully download/install Adobe® Reader to their local computer.

b) The user must download and open the EVV Proprietary System Request Form in Adobe® Reader.

If the user is unable to download the EVV Proprietary System Request Form, or is unable to successfully download/install Adobe® Reader, the user may fill out the PDF form as before and print the completed form to manually sign and date the form.

The program provider or FMSA must complete, sign, and submit the EVV Proprietary System Request Form to EVV_PSO@tmhp.com.

EVV Operational Readiness Review (ORR)

Session 4 ORR Schedules

Program Providers and FMSAs must contact their selected proprietary system vendor before submitting an EVV Proprietary System Request Form (Request Form) to discuss expected timelines for compliance of their system to Business Rules v3.0, to coordinate all onboarding activities, and to submit required documentation by the published deadlines below.

HHSC has developed a special abbreviated PSO onboarding Path, Session 4 Operational Readiness Review (ORR), to enable program providers and financial management services agencies (FMSAs) to onboard with a previously approved proprietary system. Please refer to the EVV Proprietary Systems Approved by HHSC (PDF) document and the EVV Proprietary Systems Undergoing ORR (PDF) document.

Session 4 ORR requirements and deadlines in the Session 4 ORR PSO Onboarding Overview and Timeline document.

Currently, all scheduled onboarding sessions are full; however, HHSC encourages anyone interested to submit their request form to be added to the waitlist.

Please continue to check back here for information and schedules of future PSO ORR sessions.

HHSC EVV Business Rules for Proprietary Systems

The Business Rules document outlines the set of standards that a PSO must comply with as a condition of participation in the Texas Medicaid EVV Program. The standards cover guidelines for business processes related to EVV, and compliance with them is critical to producing successful outcomes for the program.

The guidelines govern the system set up (onboarding) for PSOs, the documentation and verification of services requiring EVV, the maintenance of the visit data, and transmission of the data to TMHP for inclusion in the EVV Aggregator.

The Business Rules document refers to several appendices that can be accessed through the links in the document or accessed directly below:

PSO Business Rules v3.0

Published: 01/02/2023 | Effective Date: 08/01/2023

EVV Business Rules Proprietary Systems v3.0

Appendix A – HHSC EVV Reason Codes

Appendix B – EVV PCS Service Bill Codes Table

Appendix B – EVV HHCS Service Bill Codes Table

Appendix C – EVV Visit Transaction File

Appendix D – EVV Master Provider Web Service

Appendix E - Medicaid Eligibility Companion Guide

Appendix F – EVV Prior Authorization File

Appendix G – EVV Standard System Reports

Appendix J – Service Delivery Locations

Appendix K – Texas-EVV Specific Terms

Appendix L – Payer Plan Code Web Service

Appendix M – EVV Visit Data Layout Edits Crosswalk

Appendix N – EVV Data Transfer Guide

Appendix O – Visit Maintenance

Appendix P – Auto Verification

Appendix Q – CDS Process Flow

Appendix S – EVV Visit Batch Submission and Response Process

ORR Compliance Documents for EVV Business Rules for Proprietary Systems v3.0

EVV Proprietary System Compliance Method – Certification (Example)

EVV Proprietary System Compliance Method – Trading Partner Testing

EVV Proprietary System Compliance Method – Demonstration

EVV Proprietary System Compliance Method – Documentation

PSO Business Rules v2.0

EVV Business Rules Proprietary Systems v2.0

Effective Date: 05/31/2022

Refer to the EVV Business Rules Proprietary Systems v2.0 for the Appendices.

To view archived appendices for the HHSC EVV Business Rules for Proprietary Systems, click here.

EVV Data Transfer

Vendors and program providers/FMSAs should use the EVV Data Transfer Guide to transfer data between vendors, between a vendor and a PSO, and between a PSO and a PSO.

EVV Proprietary System Maintenance

Approved PSOs are fully responsible for ongoing maintenance of the EVV proprietary system.

The PSO may not make changes to its approved EVV proprietary system that conflict with any state-defined EVV standards and requirements. In addition, the PSO must inform HHSC within two business days of discovery if the PSO is not compliant with any state-defined standards and requirements.

HHSC may periodically change or update EVV standards, policies, and requirements, including the HHSC EVV Business Rules for Proprietary Systems. HHSC will notify the PSO of updates to standards and requirements. The PSO assumes full responsibility to make updates to the EVV proprietary system and gain HHSC approval when HHSC publishes new standards or requirements.

HHSC will allow the PSO 90 calendar days to make the modifications necessary to comply with updated standards and requirements unless otherwise instructed by HHSC. In the event HHSC requires an emergency system or policy change, HHSC and the PSO will mutually agree upon an earlier effective date.

The PSO must notify HHSC of any planned system changes which alter a component of the system which the PSO tested, demonstrated, or documented during the ORR. Based upon the nature of the change, HHSC may require approval prior to the PSO implementing the change.

For any system changes HHSC requires, or changes HHSC approves, HHSC will specify ORR steps that the PSO must complete prior to deployment.

TMHP will assist the PSO in resolving production problems in their EVV proprietary system related to data exchange with the EVV Aggregator as needed.