Section 354.4009 - EVV Visit Transaction and EVV Claim(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.1 Tex. Admin. Code § 354.4009
Adopted by Texas Register, Volume 45, Number 51, December 18, 2020, TexReg 9179, eff. 12/23/2020; Adopted by Texas Register, Volume 48, Number 49, December 8, 2023, TexReg 7171, eff. 1/1/2024