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EVV Proprietary Systems

An Electronic Visit Verification (EVV) proprietary system is an HHSC-approved EVV system.

PSO Business Rules

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HHSC EVV Business Rules for Proprietary Systems

The EVV Business Rules for Proprietary Systems 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 setup (onboarding) for PSOs, the documentation and verification of services requiring EVV, the maintenance of the visit data, and the transmission of the data to TMHP for inclusion in the EVV Aggregator.

ORR Compliance Documents for EVV Business Rules for Proprietary Systems v3.1

The following EVV Proprietary System Compliance Method documents may be required to pass an ORR session:

PSO Business Rules v3.1

Published: 09/16/2024 | Effective Date: 03/12/2025

EVV Business Rules Proprietary Systems v3.1

Appendix A – HHSC EVV Reason Codes

Appendix B – EVV HHCS Service Bill Codes Table

Appendix B – EVV 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

Appendix T- Legacy EVV Visit Import and Submission Process

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

The following EVV Proprietary System Compliance Method documents may be required to pass an ORR session:

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