Illinois Electronic Visit Verification (EVV) Updates and FAQs

Are billing codes an issue? My software does not capture all the unique codes and modifiers.

Your software should allow for visits to be scheduled with appropriate service codes and modifiers as indicated by Ilinois Department of Healthcare and Family Services (HFS).  Billing will not be generated from the HHAXeChange system, but the service codes on your claims will be considered when comparing the claim to the EVV visits entered into the system.

How many additional accounts can we create with HHAeXchange for 3rd party vendors like therapy companies or 3rd party EVV vendors under the agency main online account with HHAeXchange?

It is recommended to integrate with one vendor per portal.  However, the HHAeXchange system can accommodate integration with up to two vendors per portal.  Please reach out to EDI support to discuss further.

When will we know what % compliance we are currently?

All provider agencies, regardless of whether the agency uses a third-party EVV system, have access to HHAeXchange and may run compliance tracking reports. This topic was covered during the September 4, 2024, Illinois EVV Townhall webinar (see slides 43-50). Presentation slides and the recording may be accessed at https://hfs.illinois.gov/medicalproviders/electronicvisitverification/evvtownhallmeetings.html. EDI provider agencies who are unable to login to HHAeXchange may submit a ticker to HHAeXchange's Client Support portal (https://hhaxsupport.atlassian.net/servicedesk/customer/portals) for assist.

Can you confirm these services/modifers are not in scope? They are not in the HHA specs. T1002:TTTU T1002:U7TU T1003:TTTU T1003:U7TU

These modifiers are in scope and HHAeXchange is programming for them to be included. 

Are caregivers able to access HHAs Client Support portal through the mobile app?

Not at this time. Provider agencies are encouraged to use HHA's web-based Client Support portal.

Why is the cost of our EVV doubling because of this change?

If you're needing assistance with specific workflows or have concerns with your HHAX portal adoption, please feel free to reach out to HHAX support for assistance.

Providers currently use their EVV applications to do a number of important tasks necessary to be operational, such as billing and payroll exports to their payroll vendors or clearinghouses. How will we accomplish these tasks?

This was covered in the EVV Townhall webinar presentation on 6/18/24.  See slide 5. Please note that the State is not requiring EVV in-scope providers to use the free HHA option.  Provider agencies may maintain their current EVV systems as long as those systems are capable of capturing all six elements required under the 21st Century Cure's Act (refer to slide 41 of presentation for these elements).  Providers electing to maintain third-party EVV systems ARE REQUIRED to transmit their EVV data to HHA.

Providers currently use their EVV applications to do a number of important tasks necessary to be operational such as billing and payroll exports to their payroll vendors or clearinghouses. Since we are being told the no cost version of HHA will not gi

This was covered in the EVV Townhall webinar presentation on 6/18/24.  See slide 5. Please note that the State is not requiring EVV in-scope providers to use the free HHA option.  Provider agencies may maintain their current EVV systems as long as those systems are capable of capturing all six elements required under the 21st Century Cure's Act (refer to slide 41 of presentation for these elements).  Providers electing to maintain third-party EVV systems ARE REQUIRED to transmit their EVV data to HHA.

Will provider agencies be reimbursed for any cost related to the EVV vendor services?

If a provider utilizes the Department’s EVV vendor, HHAeXchange, there will be no cost to the provider. If a provider opts to use an alternate EVV provider of their choosing, the cost of that service will be the responsibility of the provider. In this case, EVV data captured by the provider will be required to be transmitted to HHAeXchange, as the 

State’s aggregator. HHAeXchange will work with the provider agency and their EVV vendor to ensure the data is transferred correctly. 

Which EVV aggregator will serve the state of Illinois?

HHAeXchange was selected as the EVV vendor and aggregator.

Many providers have lost revenue due to the system issues related to ebilling within HHAeXchange. Has HHAeXchange worked to resolve these issues?

As communicated in the June 18, 2024, EVV Townhall, in-scope EVV providers should maintain current billing practices.  The free HHAeXchange solution in Illinois does not utilize ebilling.

When do providers begin submitting their billings through this system?

This was covered in the June 18 EVV Townhall presentation.  See slide 5.  In-Scope EVV providers should maintain current billing practices. The HHA system will not be used for billing at this time.

Is there a way to see what percentage the provider agency has in terms of EVV compliance?

Please see slide number 36 of the July 3, 2024, EVV Townhall webinar presentation.

If you pay for HHAeXchange Enterprise, can you ebill?

Yes, ebilling is in scope with the Enterprise software.

Where in the HHAeXchange portal can the provider agency find the MCOs credentialed or contracted with? How will those be loaded in the agency portal?

Agencies can see their contracts by navigating to Admin > Contract Setup > Search Contract.

Will HHAX be devleloping dashboards for EDI providers to assess their compliance and information similar to those who use the direct app?

Compliance access is standard in HHAeXchange for all state sponsored portal users (regardless of whether you use the system directly or through the EDI process)

What is being done to remove the idea of Optional, Situational specifications? We can generally work with the optional, but we havent found a full set of rules that apply to Situational requirements.

Please submit a ticket for this to the HHAeXchange Client Support portal at https://hhaxsupport.atlassian.net/servicedesk/customer/user/login?destination=portals. HHAeXchange Customer support staff require a specific example to review the specification for their team. 

Is there an update on the home health aide (HHA)visit submissions? We have still not been able to successfully submit any home health aide visits due to the issue where HHA was removed from the HHAX system.

Concerns regarding auto placement and adding all accepted services to member profiles is part of an auto-script process at HHAeXchange and this can be verified by any agency in the HHAeXchange member portal. The agency user can always log in to the HHAX system and make the necessary updates to their members profiles to allow the visits to import. Home Health Aide (HHA) services require EVV entry.  The code G0156 should be included in the EVV system and should  not reject. If you are experiencing errors using G0156 , please submit a ticket for this to the HHAeXchange Client Support portal at https://hhaxsupport.atlassian.net/servicedesk/customer/user/login?destination=portals. If you have waited more than three business days for resoution, please send the ticket #, your provider agency name, your Tax ID number, and a brief summary of the concern to HFS via HFS.EVV@illinois.gov. HFS will escalate the concern to HHAeXchange Project Management staff for investigation. 

What should providers do with MCO EVV contacts?

The MCO EVV contacts are available for your use as a provider to outreach if or when you experience an EVV issue specifically related to a customer's MCO, including status, authorization being present, etc.

We used Sandata in the past and our caregivers had challenges clocking in and out. For DHS clients, will we have to switch back to the Sandata system?

If you are Homemaker agency or Home Health Care agency billing DHS-DRS, then you may use an EVV system of your choice; it is just that DHS-DRS requires you to integrate your system with Sandata in order to transmit EVV data from your system to Sandata. Please refer to DHS.EVV@illinois.gov for questions regarding DHS-DRS EVV policy.

Willl there be compliance dates carved out for IDoA?

When IDoA "go live" with HHAeXchange occurs, all needed information about compliance, including the date from which the 6-month and annual milestones start, will be reported.

Are providers required to input historical Social Security numbers for workers who are no longer employed in Medicaid waiver programs?

For any worker required to submit EVV data after the "go-live date" for HHAeXchange use and aggregation, the SSN needs to be recorded.

For integrating third party EVV vendors to HHAexchange by end of September 2024, does that include IDoA providers as well if there is no go-live date?

No. This is specific to DDD PSW agencies and HHCS providers billing State Plan Medicaid (and MCOs), DDD, or DSCC.

Please explain the rationale for requiring the SSN for execution of EVV. NAHC has stated the EVV requirement does not include supplying the SSN. This was provided to me by our concerned employees and it is from the Social Security website: https://www.ssa

The State presented their rationale for requiring tracking of full caregiver SSNs and addressed privacy concerns during the August 20, 2024, Illinois EVV Townhall webinar. The recording and presentation slides are available at https://hfs.illinois.gov/medicalproviders/electronicvisitverification/evvtownhallmeetings.html. The deadline for tracking full caregiver SSNs is October 17, 2024, as relayed in a 07/23/2024 HFS Provider Notice. During the September 4, 2024, EVV Townhall, HHAeXchange will discuss programming updates to the caregiver search screen within HHAeXchange that will mask full SSN as well as caregiver DOB for all users, except for provider agency administrators. EDI Providers may work with third-party vendors to stop transmission of full caregiver SSNs after those SSNs are initially transmitted to HHAeXchange, or if the provider agency admin elects to manually save the SSNs within the HHAeXchange system. HHAeXchange will address options for EDI providers during next week’s townhall as well.

Can you confirm that the MCOs (aetna, molina, humana, etc.) have a go live date of 9.1.24? The only one delayed is the IDOA program?

Home Health Care Service (HHCS) providers billing MCOs were required to begin using EVV by 12/31/2023.

Our caregivers currently use Telephonic Visit Verification (TVV) and not GPS. Does HHAexchange software allow for both telphonic and GPS?

HHAeXchange offers telephony and GPS options for EVV.  If you are utilizing an EDI vendor, the EVV captured times will send to HHAX after they are verified by your vendor and loaded into our system with the visit data.

Are provider agencies billing DHS required to integrate third party EVV systems with HHAeXchange by 09/30/2024?

Only DHS-DDD at this time. Providers billing DHS-DRS will continue using Sandata, or sending EVV data to Sandata from their third party systems. DRS has current policy in place for agency providers. Please reach out to DHS.EVV@illinois.gov to request current DHS-DRS policy.

Are there any portions of home health care claims that would not be paid by the Medicare part of MMAI and forwarded to Medicaid for payment?

Yes.  All home health providers, regardless of the payor, should be using EVV when a Medicaid customer is receiving the service.  In addition and regardless of the specific payor, when utilizing the EVV, the Medicaid Home Health service codes (https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hhfeeschedule.html) should be used to denote the type of service provided.  This is considered appropriate for MMAI MCO customers since the service code used for EVV is not necessarily relevant to the billing code that may be used to submit the service to Medicare for reimbursement.  Using the Medicaid service code will help ensure EVV for the service is present when/if all or a portion of a MMAI claim needs paid by Medicaid due to Medicare not covering all/part of the service expense.

Home Health is a dually eligible service between both federal CMS and HFS.   For MMAI customers specifically, the Medicare component typically serves as primary payor and pays the claim.   And while Medicare pays as primary, Medicaid can at times serve as a secondary payor source.    With MMAI MCOs, the MCOs process the claim with through Medicare software, then MCOs send the claim it to their through Medicaid software to determine if there is any cost sharing to be picked up under Medicaid.  If it can be covered by Medicaid, Medicaid will cover part of a claim and all Medicaid claims require EVV to be utilized. 

Will IDoA providers with third-party vendors need to re-test integration with HHA ahead of the revised EVV implementation date? We would anticipate tech specs, etc., would necessitate this.

This is dependent on vendor requirements. However it is typically a good idea to validate any new data transmission, but it should be brief and non disruptive.

Can the need for full clinician Social Security Number (SSN) be explained? My Agency clinical staff are asking why this data is needed to pay services for a member when it was not needed prior to EVV. Seems like a lot of clinician personal data (date of b

HFS is allowing provider agencies subject to EVV requirements until October 17, 2024 (https://hfs.illinois.gov/medicalproviders/notices/notice.prn240726a.html), to transition to tracking caregivers by full Social Security Numbers (SSN) in consideration of the burden a change in caregiver tracking requirements could impose on provider agencies. The decision to track caregivers by full SSN was made after consultation with the HFS Office of Inspector General (OIG) and Administration of the Division of Medical Programs at HFS. This is a requirement employed by other State Medicaid agencies for EVV tracking and investigating fraud, waste, and abuse, and it aligns with the overall intent of the Federal 21st Century Cure’s Act. HFS, as the State Medicaid agency, has a vested interest in ensuring adequacy of service provision by Medicaid-funded provider agencies and their caregivers. Tracking workers by the full SSN will allow HFS to ensure our ability to compare clock in/out data against all paid claims associated with an individual worker, regardless of whether they worked/are working for different agencies or as an Individual Provider. Full SSNs are unique to the individual, do not change, and follow an individual/provider across different EVV systems and nationally.  When HFS’ Office of Inspector General (OIG) identifies fraud, waste, and abuse for Medicaid-funded caregivers, caregivers and their SSNs are tracked within both HFS and U.S. Department of Health and Human Services (HHS) databases, preventing the caregiver from future Medicaid billing.  

To become a vendor with HFS, HHAeXchange underwent an extensive security review, including validation of HIPAA and HITRUST compliance.  This review is completed by HFS’ Chief Security Officer, involves two separate Service Organization Controls (SOC) reports, and is completed on an annual basis. HFS and Federal CMS require monthly and quarterly Security reports from the State’s elected EVV aggregator, HHAeXchange. During both the State’s and HHAeXchange’s Operational Readiness and Certification reviews with Federal CMS, CMS conducts in-depth security reviews.

When will EVV be enforced by claims denials and will the date be different for PCS and HHCS?

As previously communicated in the July 16, 2024, EVV Townhall webinar, the State does not anticipate implementing hard claims penalties at this time.  Please refer to your respective payer for EVV policy inquiries.  HFS will release an EVV compliance policy for State Plan HHCS agencies upon HFS leadership approval of the policy.  

How can we add MCOs as payers with HHAeXchange as our third party EVV vendor is working with HHAeXchange on IDoA integration?

IDoA EVV integration within HHAX has not yet begun. Updates about when IDoA go-live will occur will be communicated by IDoA and HFS when go-live roll out approaches, as well as posted on the HFS EVV website.

Are live-in caregivers exempt from EVV requirements?

DDD is the only payer/Home and Community-Based Services (HCBS) Waiver Program that offers paid caregivers who reside in the same home as customers an opportunity to apply for an exemption from EVV requirements.  Live-in caregivers must apply for and be approved for an exemption initially and annually thereafter.  If a live-in caregiver does not have an approved exemption, then s/he must use EVV until an exemption is submitted and approval is received.  

I thought the aide requirement was set for 1/1/2024 and nursing would be some time in the future, but I’m not seeing that differentiation on the site. Can you please advise?

EVV for personal care services provided by aides is currently required but has not been implemented. This issues will be addressed during upcoming EVV trainings. EVV for nursing visits was required as of January 1, 2023. As stated above, the State has requested an extension for implementaion until January 1, 2024.

What is the allowed radius IL will be using for GPS verification, as well as the allowed variance for visit start times, if applicable?

This issue will be addressed during upcoming EVV trainings.

What reason codes will IL be using?

This issue will be addressed during upcoming EVV trainings.

Can you please provide some clarification on the EVV system by confirming what the plans are for MCOs to use EVV?

Managed Care Organizations (MCOs) are required to ensure that any provider of personal care services or home health services is utilizing an EVV system and that all data are being transmitted to HHAeXchange. Implementation timeframes and other information regarding this question will be addressed during the upcoming EVV trainings.

Illinois Department of Healthcare and Family Services (HFS) submitted a Good Faith Effort to Federal Centers for Medicare and Medicaid requesting an extension of the Home Health services deadline date for EVV to January 1, 2024. Can you confirm Illinois i

If approved by CMS, the Department plans to delay the implementation of EVV for home health services until January 1, 2024.

Will Managed Care Organization (MCO) authorizations Illinois Department on Aging (IDoA) and Illinois Department of Human Service’s Division or Rehabilitation Services (DRS) be present within the HHAeXchange (HHA) system, effective 11/1/24?

Yes.  The State and HHA are working with the MCOs to have both IDoA and Division of Rehabilitation Services (DRS) authorization data within the HHA system by 11/1/24.

Does EVV apply to skilled nursing services with the MFTD waiver? This falls under Home Nursing and not Home Health. If so when is the deadline?

Yes, EVV applies to skilled nursing services for all Medicaid customers. The State has requested an extension that would extend the deadline for this implementation to January 1, 2024. 

What is the “hard date” that all agencies must comply?

The Department will release information regarding implementation dates for all programs once determined.

Is the EVV requirement just for straight Medicaid, or is it also required for any Managed Care Organizations?

EVV is required for all Medicaid customers receiving personal care services and home health services, regardless of if they are straight Medicaid or enrolled in a MCO.

With the implementation of EVV, will there be any exceptions for individuals who have Personal Support Workers (PSWs) or Individual Providers living in the same household, such as parents and guardians?

All providers of personal care services will be required to use EVV, with the exception of PSWs providing HCBS to customers within the Division of Developmental Disabilities and completing the process to receive an annual formal live-in caregiver exemption.

Can you provide a timeline of when each agency's records should reflect EVV documentation?

This was covered in the June 18th EVV Townhall presentation.  See slides 8-9.  Personal Care Service (PCS) and Home Health Care Service (HHCS) providers serving IDoA’s Elderly waiver or DRS waivers (Persons with Disabilities, Brain Injury, HIV/AIDS) should already be using EVV.  IDoA and (NOTE: Per an HFS Provider Notice dated 7/12/2024, EVV implementation with HHA for IDoA has been postponed until future notice) DRS EVV data will be shared within the HHA system by 11/01/2024.  All DDD PCS Provider agencies, and HHCS agencies billing DDD, State Plan Medicaid, HCI MCOs, MMAI MCOs, and DSCC should currently be using EVV, whether via the free HHA solution or through a third-party EVV system.

Can you direct me to the process for agencies to get signed up, so that I may share that information once the agency inquires of us?

The information on how to sign up for EVV is not available at this time. The Department will release this information once determined.

Is the assumption that Nov 1 is a deadline and those vendors and agencies who can deliver data early, can do so when ready?

That is correct. However, if you do send data early, just note that it may reject if the members and authorizations are not loaded yet. The members and authorizations are expected to be loaded around 10/1/24 in advance of the 11/1/24 go-live.

HHA Exchange is not actively loading IDOA contract with provider portal.

Correct. See slide 21 of the June 18th EVV Townhall presentation. In September, (NOTE: Per an HFS Provider Notice dated 7/12/2024, EVV implementation with HHA for IDoA has been postponed until future notice) the portals should start being linked with access going out.

Why are MCOs not sending over information timely to HHAeXchange?

This was covered in the June 18th EVV Townhall presentation.  See slide 34.  MCO HHCS authorization data is expected to be present within the HHA system by 07/01/24.  MCO IDoA and (NOTE: Per an HFS Provider Notice dated 7/12/2024, EVV implementation with HHA for IDoA has been postponed until future notice) DRS authorization data will be present within the HHA system by 11/1/24.

Has Illinois been granted a one-year extension on EVV for Medicaid home health customers, or is January 1, 2023, the effective date?

Illinois submitted a Good Faith Effort Exemption request in November 2022, which will allow the date for EVV for home healthcare services to be delayed until January 1, 2024. We are awaiting a response from CMS.

Do nurses who provide services to children on the Medically Fragile Technology Dependent (MFTD) waiver fall under personal care or home health services?

Yes, nurses who care for individuals on the MFTD waiver fall under the home health services category.

Do provider agencies continue to use their existing systems or must they move to the new state EVV aggregator’s system?

Provider agencies can elect to continue to use their current EVV system; however, the EVV provider will need to ensure all data is submitted to the EVV state aggregator. Provider agencies have the option of using the EVV state aggregator directly. HFS provides 100% funding for the EVV state aggregator.

Our provider agency has employees who are still using paper documentation.

All EVV in-scope provider agencies are required to ensure their caregivers utilize EVV.

What is the allowed variance, in minute, that visit durations can differ from the scheduled duration?

This issue will be addressed during upcoming EVV trainings.

How long has IL been using EVV for home and community-based services (HCBS)?

Illinois originally launched EVV for personal care services (PCS) about 10 years ago. More specifically, the Illinois Department on Aging (IDoA) and the Department of Human Services, Division of Rehabilitation Services (DHS-DRS) implemented EVV for their respective waiver programs around 2014. The Department of Human Services, Division of Developmental Disabilities (DHS-DDD) started EVV for PCS within their waiver programs in September of 2023.

Is SanData still the state-selected EVV aggregator for DHS-DRS customers?

Yes. All questions regarding SanData should be referred to DHS-DRS. For questions regarding EVV, please call the DHS EVV Help Line at 1-888-713-5139 (1-888-575-0531 TTY) or email dhs.evv@illinois.gov .

Can you describe the process that will compare the EVV Data in HHAX to bill/claim files to DHS? When will that process be implemented?

DHS sends HHAeXchange a Paid Claim file, which is then compared against the supplied EVV data from agencies. The match is based on provider, member, date of service and units. This match is already happening for DHS audit purposes and required reporting to CMS, but it is not impacting claims payment for agencies.

Is there a way to select receipt of HFS Provider Notices that are only EVV related?

At this time, there is no option or "EVV" specific category for HFS Provider Notices (https://hfs.illinois.gov/medicalproviders/notices/provideremailsubscribe.html).  Currently, EVV related updates are relayed to individuals subscribed to "Waiver" and "Home Health" categories.  HFS is looking into creating an "EVV" specific category with our tech department.

What is the start date of capturing EVV data?

The Department will release information regarding implementation dates for all programs once determined.

Will this integration replace Sandata so that HHAeXchange will be EVV aggregator for all payers and all Illinois Medicaid Departments?

Please note that Illinois Department of Healthcare and Family Services (HFS), as the State Medicaid agency, has contracted with HHAeXchange to aggregate EVV data for all Medicaid-funded providers throughout the State.  Illinois Department of Human Services' Division of Rehabilitiation Services (DRS) is the only HCBS Waiver Program with its own EVV aggregation system.  DRS individual providers (Personal Assistants, no-agency CNAs, non-agency LPNs, and non-agency RNs) use Sandata.  DRS requires that Home Health Care Service (HHCS) and Homemaker agencies with under ten staff secure their own third-party EVV vendors and transmit EVV data to Sandata.  In order for HFS and Federal CMS to have insight into DRS provider EVV data, HHAeXchange will work with DRS and Sandata to integrate their EVV data to the HHAeXchange system.

It was previously stated that the hard EVV go-live date for Home Health Care Service (HHCS) provider agencies was 7/1. There were difficulties with MCO payers and we were under the impression that the go-live date had been extended to 11/1. Is this true,

HFS has consistently communicated that the go-live for HHCS agencies billing State Plan Medicaid, DSCC, DDD, and the MCOs was 12/31/2023.  The only reference to 7/1/24 made by the State or HHAeXchange was MCOs beginning to transmit authorization data to the HHAeXchange system, thus avoiding continued rejection errors related to service provision to individuals enrolled with an MCO.  While the IDoA go-live date was expected to occur by 11/01/2024, the State has delayed it until further notice, effective 07/10/2024.

What happened in the past few years to change EVV in IL?

The 21st Century Cures Act (Federal Register 21st Century Cures Act) was passed into law by the United States Congress on December 13, 2016.  Among other things, the 21st Century Cures Act mandated Electronic Visit Verification (EVV) for certain Personal Care Services (PCS) and Home Health Care Services (HHCS) provided to Medicaid Home and Community-Based Services (HCBS) customers.  The Act required EVV for PCS to occur by January 1, 2020, and EVV for HHCS to occur by January 1, 2023.  The Act also required each State to have an EVV state-wide aggregator so all EVV information was housed in and reportable via a central entity.  

Could you please specify what type of services are covered under the Personal Care Services?

Personal care services are in-home visits by a provider that include activities of daily living (ADL), such as bathing, grooming, dressing, meal preparation, household tasks, etc. Each HCBS waiver offers different services, with some waivers offering personal care services. To learn more about Illinois’ HCBS waivers and those that include personal care services, visit: 

Home and Community Based Services Waiver Programs | HFS (illinois.gov).

Should visits for DRS waiver customers continue to be submitted directly to Sandata? Will those transition to HHAX at some point?

HFS and DRS will communicate with providers regarding any EVV related updates in the coming months. However, providers should continue to submit to Sandata. The idea is that Sandata will be sending all EVV data to HHAX, and therefore the provider process shouldn't change much. However, more to come, including the ETA for this process to start, which has not been decided yet.

Do visits paid by private insurance need to be exported to HHA Exchange when the patient has both DSCC and private insurance coverage?

No. Only Medicaid-funded services are subject to EVV requirements. EVV data must be transmitted from a Home Health Care Service (HHCS) agency to HHAeXchange for any service outlined in HFS' Home Health fee schedule (https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hhfeeschedule.html). This topic was addressed during the August 7, 2024, EVV Townhall webinar. Materials from the August 7, 2024, EVV Townhall webinar may be accessed at https://hfs.illinois.gov/medicalproviders/electronicvisitverification/evvtownhallmeetings.html. 

Can we consider EVV data integration of IDoA and MCOs in-home caregiver services on hold because the IDoA payer portal is not active yet?

If you are referencing IDoA Community Care Program (CCP) customers enrolled with an MCO for management of Elderly waiver services, then yes. 

Are visits subject to EVV if Medicaid is a secondary payer (and Medicare is the primary, for example)?

Yes, any PCS or HHCS billed to Medicaid is required to have the accompanying EVV data elements. 

Do Physical Therapy Assistants and Occupational Therapy Assistants need to use EVV?

Yes, Physical Therapy Assistant (PTA) and Occupational Therapy Assistant (OTA) need to use EVV when providing Medicaid billable Home Health Care Services (HHCS).  System related updates are being made within HHAeXchange to accept either Physical Therapy (PT) or PTA for service codes G0151 and G0151:U2 and Occupation Therapy (OT) or OTA for service codes G0152 and G0152:U2 as appropriate for the purposes of EVV.  Once updates are completed, impacted providers will receive outreach from HHAeXchange to confirm both PTA and OTA visits will now be accepted into the system. Slides 15 and 24 of the August 7, 2024, EVV Townhall cover this topic. The August 7, 2024, EVV Townhall webinar presentation and recording can be accessed at https://hfs.illinois.gov/medicalproviders/electronicvisitverification/evvtownhallmeetings.html.

We are providing therapy services to Medicaid patients for skilled care services through contracted companies and getting visits documents via fax or eDocs. So how can we verify the EVV for those therapists PT/OT/ST?

These Medicaid HHCS providers should be using a system to record the required 6 elements for EVV.  These elements are recorded point in time when the provider calls in at the start of the visit and calls in at the end of the visit.   If one or both call ins do not occur, then the provider would submit a request to approve a manual entry.  The provider agency would need to approve the manual entry, including any vetting needed to verify the provider was present with the customer to provide a Medicaid HHCS.

When a person does not clock in but clocks out, when manually entering in the system for HCA, does our agency need a signed document by HCA and client verifying the services?

The State certainly believes the process you suggested to be best practice, but is not currently planning to require it by way of policy. We do expect that when the provider agency admin goes in to manually edit the visit, the admin is verifying the visit actually took place.

Are clinicians providing skilled care nursing PT OT considered caregivers? I wasnt sure if caregiver was referring to nonskilled care.

Home Health Care Service (HHCS) providers, who may also be called "clinicians," include Nurse, Physical Therapist, Occupational Therapist, and Speech Therapist.

Why do PSWs have to send our live-in caregiver exemption applications to ACES$?

At this time, DDD requires that ACES$ or the PSW agency receive the exemption forms so that they can be logged in the respective Independent Service Coordination's (ISC) electronic system. This ensures all exemptions are in one place at the time of audit and/or payment. ACES$, as the financial intermediary agency paying DDD PSWs, needs to know who is allowed to submit paper timesheets and who is required to use EVV (the app or telephony) for time keeping purposes when submitting their timesheets so that there are no payment issues. If there are further questions or needed clarifications, they can be sent to the DDD EVV email address which is DHS.DDDEVV@Illinois.gov. 

Will there be an exception for IDoA provider agencies to send retro active visits back to a certain date into 2024, when a new implementation date is finally established?

IDoA providers are currently using EVV; although, the EVV data is not yet being aggregated within HHA, as the state-wide EVV aggregator.  A specific decision relative to how much/how far back EVV will need to go for being housed within HHA will be determined as go-live for IDoA HHA aggregation nears/occurs. The answer is yet to be determined and will be based on guidance from federal CMS.

How do you correct a missing clock out data where the clock in data is present, but the clock out data is not? Our agency has been having to delete the clock in data, then re-entering the clock in data in addition to the clock out data.

Missed clock in / clock out can be manually added to confirmed visits in HHAX. This workflow is outlined in the HHAX knowledge base - specific page linked here https://knowledge.hhaexchange.com/provider/Content/Documentation/Visit/Visit-C-Manually-Confirm-Visits-S.htm?Highlight=manual%20confirmation  There should be no need to alter the visit in any way besides adding the missed clock in or out and adding the visit edit reason and action taken.  Please submit a ticket to HHAX support if you'd like further assistance on this workflow.

How can provider agencies edit missed punches?

Missed clock in / clock out can be manually added to confirmed visits in HHAX.  This workflow is outlined in the HHAX knowledge base - specific page linked here.

For visit edit action taken, what does "other-flag to require note" mean?

The expectation with this selection is that the provider team assesses all the ‘action taken’ options and decides instead to enter a note which explains what the action taken was.  Additionally, the provider should be clear why that was not accurately represented in the pre-entered codes and why the extra note was needed. Using the “other” selection would only be appropriate if none of the pre-determined options apply.  HHA and the State encourage use of the preset options below as they ensure effective reporting and compliance monitoring.

• Supervisor approved change

• Unverified visit; this service cannot be billed

• Change in schedule

• Mutual Case/ or Cluster Case/ or Live-in Case

• Timesheet received and signed by supervisor

• Changed verification collection method and documented

• Updated customer's phone number and documented

• Updated customer's address and documented

• Service(s) cancelled or suspended until further notice

• Visit rescheduled

• New worker assigned to customer

• Confirmed visit with outside entity and documented

• Confirmed visit with the customer or the customer's family customer/representative and documented

Is it permissible to add a missed visit two days later?

Yes, that is fine, but it will still count as a manual entry/edit.

Can you walk us through the things a supervisor/manager needs to do in HHAeXchange? Examples: approving manually entered times, unscheduled visits, basically any exceptions a manager should be verifying to ensure compliance.

At a high-level, a supervisor in HHAeXchange should be managing the Call Dashboard, confirming/editing visits manually as needed, and ensuring the Pre-billing module is clean of errors related to Incomplete Confirmations.  

If the scheduled clock in time is 1 pm, how much time on either side is acceptable without needing manual adjustment?

Acceptable departure from scheduled time/actual time difference can be set by a provider within the office set-up options of the portal. Providers are never required to update visit time to match scheduled time. Providers have the choice to set their own preferences for flagging visit time discrepancies.

Could you explain the exceptions that will occur when there are missing clock outs and when we manually enter a clock out and how that will affect our percentage?

If a manual clock in and out is entered, it will be considered an exception and count against the EVV Compliance % for the agency. It is expected that there will always be cases where manual entry is needed (e.g., caregiver's mobile dies, member is on the home phone when caregiver arrives, etc.), but these cases should be much less frequent than the use of EVV tools.

Why should #7 on slide 34 of the July 3, 2024, EVV Townhall presentation be a required edit when schedule is not required?

Scheduled visit times can be different than visit confirmed times. There is no need to change the scheduled time. Visit confirmation time only needs to be changed if the caregiver makes an error in entering clock-in/clock-out times compared to the actual time the caregiver was there.

If I understand correctly, the MCOs will directly send their authorizations to HHA directly, and if we login we will see the client info and auth there?

This is correct for services that require an authorization and are paid for by MCOs. Please see slide 8 of the August 7, 2024, EVV Townhall presentation for reference.  

There is a delay in authorizations being uploaded to HHA from the MCOs. We have been entering our auth manually into HHA. What kind of an issue is this going to cause if there is an overlap on the auth screen?

For MCO provided services - all visits should be applied to the MCO supplied authorization.  This can easily be updated on the visit screen once the visit is created / confirmed

Is our agency responsible to manually add patients into our HHA portal?

For DDD, HFS, and DSCC, members should be added and linked to the appropriate payer. The MCOs in IL will send member and authorization information through HHAX.

How do Home Health Care provider agencies add multiple service codes per discipline?

This question was addressed during the August 20, 2024, EVV Townhall webinar. Please visit this site to access the recording and slides 26 through 28 of the August 20, 2024 EVV Townhall webinar presentation.

Contract placement in HHAeXchange for an MCO payer fails, stating "matching payer patient not found." I have reached out to HHA in the past regarding this issue and was advised to reach out to the MCO. I have reached out to the payer - verified patient de

In instances where providers have submitted a ticket to the HHA Client Support portal without resolution, please send your agency name, ticket #, TIN, and a summary of your concern to HFS.EVV@illinois.gov.  HFS will work to escalate your concern to HHA Project Management staff in Illinois for investigation and/or the respective MCO.

Can authorizations be done for the full calendar year or should they be monthly as shown in HHAs authorization presentation during the August 7, 2024, EVV Townhall webinar?

HHAX system will support varying types of authorizations.  That said, it is recommended that authorizations should be entered in the HHAX system to represent the authorizations your agency was issued from the associated payer.

How to upload referrals and staff assignments?

Please reference slide 24 of the EVV Townhall webinar presentation on 6/18/24.

What if provider staff express concern about putting in the last 4 digits of their social security number (SSN) in the EVV system because of all the hacking going on, how do we address this concern? Can we put in a dummy number? How do we assure them it

Please note that at this time, HFS as the State Medicaid agency is still determining whether to require tracking of caregivers by SSN within the EVV system. Once a final decision is made, it will be relayed to providers via HFS Provider Notice.  When signing up for HFS Provider Notices, selecting the "Home Health Agency" and "waiver"categories will ensure receipt of EVV related notices.  

Would you be able to provide some additional information on Authorizations? It seems like there is some confusion among provider organizations about whether those would be submitted by the payors or by the providers.

It varies by service and program. Please refer to the info center under the overview tab for more details on how to approach those: https://www.hhaexchange.com/info-hub/illinois. This is also covered in the 06/18/2024 EVV Townhall presentation materials (https://hfs.illinois.gov/medicalproviders/electronicvisitverification/evvtownhallmeetings.html).

Who will upload the referrals on/to HHAeXchange portal of the provider?

This was covered in the June 18th EVV Townhall Presentation.  See slides 23-24.

Will the member ID stay the same? In other states, we have seen HHA use an HHA number for the Member ID. Just validating.

For services that have been live, those will stay the same, including the values from the MCOs. For IDOA and (NOTE: Per an HFS Provider Notice dated 7/12/2024, EVV implementation with HHA for IDoA has been postponed until future notice) DRS, HHA will have more information and confirmation on those prior to technical go-live, approximately a mid-September timeframe. It will be communicated to providers. The intent is to have a singular and consistent member ID.

Do we need to enter management employees SSNs in the third party EVV vendor software during data integration, or is this requirement only for caregivers?

Provider agencies only need to track SSNs for staff providing services (caregivers). The SSN requirement is for providers billing for those Medicaid services requiring the EVV elements.

If our provider agency has been using the HHAeXchange application would we have to reenter the SSNs, or is the set up to use the app sufficient?

If your provider agency has entered genuine full SSNs and you are referencing the same provider portal, you shouldn't need to re-enter. Please spot check several caregiver profiles to confirm this.

Our EVV vendor is not able to only send new caregivers. Is there a way that we can just not send the SSN column and not have it overwrite what was manually entered since we wouldn't even send that coiumn?

Yes, if you want to manually update each in HHAeXchange that is fine. The file shouldn't reject, but if there are issues you can send blank values as well. HHAeXchange's EDI support team can help you figure out the specifics on that. For now, the easiest approach would be to not send that column and just update all provider SSNs manually within the HHAeXchange portal.

For provider agencies with third party EVV vendors, can a caregiver's SSN be entered in the portal directly instead of sending them in the extract?

Yes, HHAeXchange presented on this topic during the September 4, 2024, Illinois EVV Townhall Webinar (https://hfs.illinois.gov/medicalproviders/electronicvisitverification/evvtownhallmeetings.html). Please see slides 30-34. Please submit an EDI ticket for any specific further quetions on this topic (https://hhaxsupport.atlassian.net/servicedesk/customer/portals).

If a third party vendor sends a revised SSN and the provider has not updated it in HHAX, will this be rejected?

No, the newest SSN data sent by the third party vendor would be applied within the HHAeXchange system.

Our (IDoA provider) agency's API integration has been done with a 3rd party EVV vendor, but we haven't received portal credentials yet.

Linking will not be completed until closer to IDoA implementation.  Effective 07/10/2024, the State has elected to postpone IDoA implementation until further notice.  While IDoA providers who have completed API integration technically may be able to send data, HHAeXchange will not built a payer portal to receive the data until closer to the point of IDoA implementation.

How do provider agencies update their time zone to Central Standard Time (CST)?

Please refer to slide 26 of the July 3, 2024, EVV Townhall presentation.

How can we have our log in and out time in CST? Enrollment of clients with Medicaid numbers is not going through.

Agencies can update the time zone of the office by submitting a ticket to the HHA Client Support Portal.  Please ensure the Medicaid ID follows the correct format. If you are still getting a "Patient Not Found" error, please make sure to double check eligibility.

Can you talk about required changes to schedules if we elect to send schedules; when would HHA need a schedule update to be sent ? E.g., schedule is 1-5 PM, but call in /out is 2-6 PM?

Updated schedule times are never required. The only time you would want to send an updated schedule time is if the schedule was truly moved in advance of the visit. If there is some variation from the schedule time to the visit times, that is expected.

Do we have to complete the survey again if we completed it previously for a go-live?

No, no need to submit the survey again.

How do you change a caregiver's email address in the mobile user management tab? I was able to change it in their profile, but not for the app.

If you've changed it in the HHAX app it should update on the mobile app. If not, this would be a great item to bring to the HHAX support team via submission of a a ticket to the HHAeXchange Client Support portal at https://hhaxsupport.atlassian.net/servicedesk/customer/user/login?destination=portals. 

Our caregivers are experiencing a message in the Mobile App about requiring RN signatures.

Please see slide number 27 of the July 3, 2024, EVV Townhall presentation.

Is there a video that shows how the caregiver can use the community option? It’s hard to explain to our workers over the phone and they don’t always understand what I mean.

Please see slide 28 of the July 3, 2024, EVV Townhall for reference.  There is not a video available for this specific functionality, but caregivers can access help within the application, which shows them how to use this function.

Is there help/ support for the mobile app?

Yes, it is handled through the same process as the HHAX Knowledgebase and support pages that have been shared. Feel free to create a ticket through that process.  The knowledge base has a lot of step by step instructions on the mobile application and should answer most questions that you may have. https://knowledge.hhaexchange.com/provider/Content/Home/Home-C.htm

Providers need an update on "Member not found" and Aide visit errors.

HHAeXchange can assist with specific rejections and help troubleshoot to resolve rejections.  Please submit a ticket to HHAX support for assistance resolving a rejection at  https://hhaexchange.com/supportrequest

Where do I find support for connecting the clinician to HHAeXchange via mobile phone app? We are getting error messages including "no user in the system- no email." The email field is grey and unable to change.

You can contact HHAeXchange support (https://hhaxsupport.atlassian.net/servicedesk/customer/portals)for assistance with these errors.  Support personnel usually want a screenshot and the user information so they can troubleshoot further.  

What is the ticket turnaround time roughly?

Roughly 24 Hours to let you know that the ticket is under review. When HHA requires additional information, communications will be sent to the provider through the HHA Client Support Portal. 

The name of our provider agency is not showing on an individual caregiver's home page.

Please send an example of this to the HHAeXchange Support Portal (https://www.hhaexchange.com/supportrequest), so we can advise on the specific issue you may be facing.

How do provider agencies address GPS location errors "Out of Window" and "No schedule on calendar" even when there are schedules?

Please refer to slide 30 of the July 3, 2024, EVV Townhall presentation.

How can provider agencies edit missed punches?

Missed clock in / clock out can be manually added to a visit and sent to HHAX from your primary EVV vendor.  This workflow is outlined in the HHAX knowledge base - specific page linked here. 

Do EDI providers need to submit authorization documents to HHA from third party vendor software, or just the authorization numbers including end dates?

EDI providers do not need to send authorization documents, just the data points from the EVV validations.

Are authorizations sent in via a separate API than the one that visits use?

There are 3 separate API processes, including caregiver, visit, authorization.  The caregiver and visit are required APIs and authorization is optional.  Any additional authorization-specific API questions can be directed to HHAX's EDI team.

There is documentation for manually adding authorizations, but is it expected that EDI providers would be able to automate sending authorizations via API interface as well?

Yes, EDI providers are able to use the HHAeXchange Authorization API to transmit authorizations from a third-party into the EVV system automatically.

For EDI providers entering Authorizations for Payors that require provider driven placement (e.g. HFS - State Plan), are those Authorizations able to utilize the existing visit API automated entry, or are they required to be added through a separate inter

They would utilize the separate authorization API

Does HHAX Support Auto placement requests like other states who use API method? If yes! Is there any User guide for the same?

Yes. Guidance can be obtained by accessing the EDI tab on HHA's Illinois Information page and reviewing the EDI specifications there. Additional questions may be submitted to HHA's Client Support portal.

As we are using two different EVV third party vendors to separate skilled and non-skilled agency services. Do we need to integrate both systems with HHA?

Both will need to be integrated as an EDI vendor if any of the services are listed as in scope for EVV.

How can providers confirm their third-party vendors are able to integrate with HHAeXchange?

All provider agencies intending to keep third-party EVV vendors must ensure their vendors are compliant with 21st Century Cure's Act requirements and capable of transmitting EVV data to HHAeXchange.  Please reference the process outlined on the HHAeXchange IL info hub.  You'll need to submit a survey for a portal, and then if you want to integrate your current EVV vendor, follow the steps on the "EDI Process" tab at https://www.hhaexchange.com/info-hub/illinois

How long does the process take for a third-party vendor to integrate with HHAeXchange?

It is dependent on the vendor the provider agency is using. Please contact your vendor to understand the time it generally takes your vendor to establish a new integration.

How often will EVV data be taken from 3rd party EVV vendors?

This varies per vendor. HHAeXchange will constantly "sweep" looking for the data. Please reach out to your vendor to see how often they send the data.

We use a third-party product for our EVV requirements. Is there a place where we can see the aggregation on information being sent to HHAeXchange?

Providers with EDI connections have access to an HHAeXchange portal as well. The portal contains reports where agencies are able to pull visit data which has loaded successfully into HHAeXchange. If you need assistance logging in, please submit a ticket to HHAeXchange Technical Customer Care via the Support Portal: https://www.hhaexchange.com/supportrequest

How should we get therapyBoss notes associated with EVV to the State? We upload the notes to our EMR, but we do not have access to the staffing company’s EVV information? What should we do? Right now, we do manual edits to submit their EVV information

All Medicaid-funded providers, including Physical, Occupational, and Speech Therapy providers are required to use Electronic Visit Verification (EVV) per the Federal 21st Century Cure's Act.  Slide 41 of the June 18, 2024, EVV Townhall presentation (https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/06182024illinoisevvtownhallconsolidatedslides.pdf)outlines the six elements that must be captured in order for a visit to be considered Cure's Act compliant.  If an EMR system like therapyBoss does not capture those six elements, then the provider agency should reach out to the vendor and supply them with the HHAX EDI integration specifications to get started. If the vendor is unable or unwilling to meet those specifications, then therapy providers should either utilize the free HHAeXchange solution or the agency should select an EVV vendor capable of capturing those six elements, then work with HHAeXchange to integrate the data.  

We are using Wellsky for home health, and we are part of their beta. We have started EVV, and data is being collected. Do we still need to open an account with HHAeXchange?

Yes, all providers must enroll with HHAeXchange, whether choosing to use HHAeXchange's EVV tools or a Third-party system (e.g., Wellsky). When enrolling, please select that you will be completing an integration, and follow all subsequent steps provided. This will ensure your visit data is aggregated to the State appropriately.

How do we send EVV data from a Third Party System, including the Electronic Data Interchange (EDI) process and issues? Questions regarding 300 ft (NOTE: HFS announced during the EVV Townhall presented on 7/16/2024 that 300 feet would be expanded to 500 f

The EDI Setup steps are covered in slides 30-32 of the EVV Townhall webinar presentation on 6/18/24. At this time, the State has chosen 300 ft (NOTE: HFS announced during the EVV Townhall presented on 7/16/2024 that 300 feet would be expanded to 500 feet within the IL HHA EVV system) as the acceptable GPS radius from the member's home. If you are able to set this same radius in your source system, it is recommended.

When will the integration between WellSky as a third-party EVV vendor and HHAeXchange be completed?

Please reach out to Wellsky to confirm their testing timeline or contact the HHAeXchange EDI Provider Support team through the Client Support Portal: https://www.hhaexchange.com/supportrequest.  

Is Paycom one of the timekeeping systems that HHAX is integrated with?

You can submit an EDI ticket for any specific vendor questions. There should also be a dropdown when completing HHA’s Provider Enrollment Survey that will allow you to check your vendor. HHA is integrated with almost all known EVV vendors in the market.

What does it mean when we receive the credentials for integration with a third party EVV vendor?

There are two sets of credentials you can receive as part of an EDI integration.  You will receive portal credentials for your HHAX portal, and you will also have credentials for an SFTP for transmitting files from your EVV system to HHAX.  If you have any questions on these two access points, please submit a ticket to HHAeXchange EDI support.

How do provider agencies set up their third-party systems to implement EVV?

Please ensure your agency has completed enrollment with HHAeXchange at https://www.cognitoforms.com/HHAeXchange1/IllinoisHHAeXchangeProviderEnrollmentForm. Please visit HHAeXchange's Illinois Information page at https://www.hhaexchange.com/info-hub/illinois and click on the "EDI Process" tab for guidance on the process for integrating third-party EVV systems with HHAeXchange.

Will HHAeXchange be sending completed visit data back to the systems provider agencies are using for billing, or will provider agencies who use HHAeXchange and a separate billing system now have to manually double document completion of visits?

HHAeXchange will not be sending data back to other systems automatically. However, many agencies have used the suite of reports available, which includes download capability, in order to upload visit data to other systems as needed.

As a third party EVV vendor, the EVV compliance metrics report in HHAeXchange does not match the compliance data within our system. How do we evaluate where the discrepancy is? We ve had several tickets opened with HHAeXchange and they are unable to prov

In instances when HHAeXchange customer support is unable to provide resolution or helpful guidance, please send the provider agency name, Tax Identification Number (TIN), latest ticket number, and a summary of the concern to HFS.EVV@illinois.gov. HFS staff will escalate the condern to HHAeXchange Project Management staff dedicated to Illinois EVV implementation for investigation. 

Is there somewhere where I can find out how to resolve some of the exception/ rejection details?

Yes, please see the EDI specifications on the EDI tab on the info center as well as presentation slides (slide 45-50) and the recording from the September 4, 2024, Illinois EVV Townhall webinar (https://hfs.illinois.gov/medicalproviders/electronicvisitverification/evvtownhallmeetings.html). Also, please submit an EDI ticket for any specific further quetions on this topic (https://hhaxsupport.atlassian.net/servicedesk/customer/portals).

Is there a vendor support portal? Will Vendors be given a Client support portal so we can track technical assistance?

The Client Support Portal is meant for agency use; however, agencies can have vendors included as participants on the tickets to get alerts when updates are being made.