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    OpenPayerPolicy UpdatesAdministrative/Operational PolicyNevada Medicaid EVV Policy Update | OpenPayer
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    ModifiedNevada Health AuthorityPolicy N/A

    Medicaid Services Manual Changes Addendum B

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    Establishes Electronic Visit Verification requirements for Nevada Medicaid providers delivering covered personal care, home health, and specified home- and community-based services, including documentation, verification, and claim-support requirements.

    Policy Summary
    PayerNevada Health Authority
    PolicyMedicaid Services Manual Changes Addendum B
    Policy CodePolicy N/A
    Change TypeAdministrative consolidation and revision
    Effective DateJanuary 1, 2024
    Next Review DateN/A
    Key ActionVerify the EVV record and any visit maintenance before submitting an associated claim.
    SourceLink
    POLICY UPDATE CHANGES

    Adds Addendum B to consolidate existing EVV policies.

    Adds EVV documentation requirements for specified home health, personal care, and HCBS visits.

    Requires EVV records to support claims before submission.

    Clarifies how service-delivery location is captured.

    Standardizes terminology and reorganizes the EVV policy.

    90%Required EVV utilization
    10%Manual-entry allowance

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    7 yearsRecord retention period
    6EVV data elements per visit
    4Electronic documentation methods
    4Manual chapters consolidated

    EVV Coverage and Claim Requirements

    EVV Documentation and Claim Support

    Services subject to EVV must be electronically documented and supported by an EVV record.

    ALL of the following

    • Covered service category

      • Personal Care Services (PCS) provided under a Medicaid State Plan or waiver program.
      • Home Health Care Services (HHCS) provided under a Medicaid State Plan or waiver program.
      • Home- and Community-Based Services specific to the Frail Elderly and Physically Disabled.
    • The provider uses the State-procured EVV system or an alternate EVV system that meets the 21st Century Cures Act requirements.
    • Service information is recorded electronically through an agency or caregiver smartphone or tablet, or through the recipient's landline or cellular telephone for Interactive Voice Response (IVR) purposes only.

    • The EVV record captures

      • The type of service performed.
      • The individual receiving the service.
      • The date of service.
      • The location of service delivery.
      • The individual providing the service.
      • The time the service begins and ends.
    • The provider agency verifies the EVV record, including any visit maintenance, before submitting an associated claim.
    • The claim is supported by an EVV entry made before claim submission.

    Denial, Rejection, and Recoupment Risks

    Claims for EVV-required services may be rejected, denied, or recouped when delivery, provider eligibility, authorization, or EVV compliance cannot be verified.

    Any of the following may result in rejection, denial, or recoupment

    • Delivery of an EVV-required service is not verified by EVV, regardless of how the claim is submitted, including claims submitted using a third-party EVV vendor.
    • An equivalent service provided through a self-direction program under the State Plan or an HCBS waiver is not verified by EVV.
    • The caregiver included in EVV data has not satisfied applicable training, TB-testing, or background-check requirements.

      Including a caregiver in EVV data attests that all applicable requirements have been satisfied.

    • The caregiver who performed the service is excluded or debarred from Medicaid participation.

    EVV Coding and Thresholds

    Applicable procedure codes and modifiersmixed
    No codes listed
    Minimum EVV utilization
    Required utilizationProviders of in-home services must meet a 90% EVV utilization threshold.
    EVV record standardAn EVV record includes both an EVV check-in and an EVV check-out.
    Applicable servicesThe threshold applies to in-home services subject to the EVV requirements.
    Manual-entry allowance
    AllowanceQualifying nonstandard or manually entered records are subject to a 10% allowance threshold.
    Counts against allowanceManual entries without a valid documented reason, partial EVV records, and specified edited records count against the allowance.

    Provider EVV Responsibilities

    Documentation Required

    Use EVV for mandated services

    Use an EVV system to electronically document all covered home health care and personal care service visits subject to the EVV mandate.

    Documentation Required

    Capture required visit information

    Record the required visit information in the EVV system for each service visit.

    • Type of service performed
    • Individual receiving the service
    • Date of service
    • Location of service delivery
    • Individual providing the service
    • Service start and end times

    EVV Definitions

    Alternate Electronic Visit Verification (EVV) System
    DefinitionAn EVV system chosen by a provider as an alternative to the DHCFP-selected EVV vendor.
    SelectionThe provider selects the alternative system.
    Relationship to DHCFP systemThe system is used instead of the DHCFP-selected EVV vendor.
    Caregiver
    DefinitionA paid individual who provides assistance with basic daily activities, chores, errands, and complete medical duties with a doctor’s approval or order.
    ExamplesCommon types include family caregivers and personal care assistants.
    Compensation
    Policy Summary
    PayerNevada Health Authority
    PolicyMedicaid Services Manual Changes Addendum B
    Policy CodePolicy N/A
    Change TypeAdministrative consolidation and revision
    Effective DateJanuary 1, 2024
    Next Review DateN/A
    Key ActionVerify the EVV record and any visit maintenance before submitting an associated claim.
    SourceLink
    On This Page
    EVV Coverage and Claim RequirementsEVV Coding and ThresholdsProvider EVV ResponsibilitiesEVV Definitions
    The provider submits a manual entry without a valid documented reason.
  1. The EVV record is partial and contains only a clock-in or only a clock-out.
  2. The EVV record was edited to add time to the beginning or end of a shift.
  3. The EVV record's begin date was edited.
  4. The worker providing the service was edited in the EVV record.
  5. The provider uses a third-party EVV system that DHCFP determines does not meet requirements through its design or proper use.

    The provider will no longer be allowed to use that system to meet State EVV reporting requirements and must use the State's EVV system.

    6. Prior authorization exceptionServices provided to an at-risk recipient before prior authorization is available in the EVV system are not counted as part of the 10% allowance.
    Record retention period
    Retention periodManual and edited EVV records must be retained for seven (7) years.
    Records coveredThe retention requirement applies to supporting documentation for manual corrections, edits, and entries.
    Audit purposeSupporting documentation must be maintained for auditing purposes.
    Billing Rule

    Use an approved EVV system

    Use the DHCFP-provided EVV system or an alternate EVV system that meets the 21st Century Cures Act requirements and interfaces with the applicable state EVV infrastructure.

    • The system must electronically capture the required service and visit information.
    • Alternate systems must timely collect and submit all data required for EVV claim verification.
    • Alternate systems must report encounter or claim data to the data aggregator.
    Billing Rule

    Verify EVV records before billing

    Verify the EVV record, including any visit maintenance, before submitting a claim associated with that record.

    Billing Rule

    Support claims with prior EVV entries

    Ensure that every submitted claim is supported by an EVV entry created before claim submission.

    Documentation Required

    Maintain a personal-device backup plan

    If caregivers use personal devices for EVV, maintain a backup plan for EVV when a caregiver’s device becomes inoperable.

    Denial Risk

    Prepare for EVV monitoring

    DHCFP will monitor services entered or submitted through the State’s EVV system to ensure proper use of EVV. Suspected fraud or other policy violations may be referred to Program Integrity.

    Documentation Required

    Document and verify covered in-home services

    Use an EVV system to electronically document and verify all Medicaid personal care services, home health care services, and certain waiver services requiring an in-home visit that results in a Medicaid reimbursement claim.

    • Require employed or contracted caregivers to use EVV.
    • Complete the documentation and verification before submitting associated claims.
    Billing Rule

    Verify EVV records before billing

    Verify the EVV record, including any visit maintenance, before submitting a claim associated with the record.

    Documentation Required

    Register alternate EVV systems

    Providers using an alternate EVV system must register with the State’s EVV system vendor and complete all necessary requirements. The alternate system must collect and submit the required data for EVV verification.

    • Transmit procedure codes and modifiers, when applicable, and specific caregiver tasks.
    • Transmit recipient, service-date, service-location, agency, caregiver, and caregiver NPI information.
    • Transmit the EVV capture method and corresponding validation data.
    • Report encounter or claim data to the data aggregator.
    Denial Risk

    Validate caregiver eligibility

    By including a caregiver in EVV data submitted to the DHCFP EVV Vendor, attest that applicable training, TB testing, and background-check requirements have been satisfied. Claims involving caregivers who have not met these requirements, or who are excluded or debarred from Medicaid, may be denied, rejected, or recouped.

    Documentation Required

    Meet EVV utilization threshold

    Maintain at least 90% EVV utilization for in-home services. Manual and edited records must be supported and handled under the applicable allowance rules.

    • An EVV record includes both an EVV check-in and an EVV check-out.
    • The 10% allowance applies to qualifying records, including manual entries and specified edits.
    • Manual entries without a valid documented reason, partial records, and specified time, date, or worker edits count against the 10% allowance.
    Documentation Required

    Support and retain manual entries

    Maintain supporting hard-copy or electronic documentation for all manually corrected or edited entries, including the required signatures, service details, and the specific reason for the manual entry or edit.

    • Include the participant’s printed name and signature.
    • Include the worker’s printed name, signature, and date.
    • Include the supervisor or timekeeper’s signature and date.
    • Record the recipient, service type, service date, location, service start and end times, and servicing individual.
    • Retain the records for seven years.
    Documentation Required

    Maintain EVV controls and staff training

    Develop and maintain written EVV procedures, train staff on those procedures, and maintain signed attestations that workers have read and understand the EVV requirements.

    • Address clock-in and clock-out, password and credential security, editing, outage reporting, and manual or edited record documentation.
    • Maintain access attestations and procedures for terminating access when employment ends.
    • Include EVV compliance monitoring and periodic training.
    • Train staff on the mobile application, IVR, claims, EVV data, and applicable prior authorization or plan-of-care information.
    Documentation Required

    Maintain caregiver identifiers and records

    Ensure that each caregiver has a unique National Provider Identifier (NPI) for EVV purposes and allow DHCFP to review or obtain EVV documentation at no charge.

    The individual is paid for providing the assistance.
    Electronic Visit Verification (EVV)
    DefinitionTechnology used to verify that home or community-based service visits occur.
    Mobile verificationEVV may verify visit information through a mobile application on a smartphone or tablet.
    Other methodsEVV may also use a landline or telephone number, or a web-based portal.
    Electronic Visit Verification (EVV) System
    DefinitionA computer-based system that electronically verifies the occurrence of authorized service visits.
    Visit detailsThe system documents the precise time a visit begins and ends, the individuals receiving and providing the service, and the type of service performed.
    Approved systemsThe system may be DHCFP-procured or a DHCFP-approved alternate EVV system.
    EVV Aggregator
    DefinitionA platform that receives and stores data from third-party systems and the DHCFP EVV system.
    Data environmentThe data is collected into a single uniform platform.
    PurposeThe platform facilitates payment of claims and allows providers to use a third-party, or alternate, EVV system.
    Manual Edit
    DefinitionAny change to the original visit data.
    Audit requirementEvery edit must include an appropriate audit trail.
    Affected dataThe change may involve information originally recorded for the visit.
    Manual Entry
    DefinitionAn EVV record for which all verification data points are entered manually through the web-based portal.
    Entry methodThe verification points are entered through the web-based portal.
    Record statusThe entry contains manually entered verification data for the EVV record.
    Electronic visit verification (EVV)
    DefinitionAn electronic system that records service delivery information.
    Information capturedThe information includes service type, recipient, service date, service location, caregiver, and the beginning and ending time.
    Check-in and check-outThe service location is collected when the caregiver checks in and checks out; the system does not continuously track recipients or caregivers.
    Alternate EVV system
    DefinitionAn EVV system that is not provided by DHCFP and that a provider elects to use instead of the DHCFP-provided EVV system.
    Provider choiceProviders may choose either the DHCFP-provided EVV system or an alternate EVV system.
    Registration requirementProviders using an alternate system must register with the State’s EVV system vendor and complete necessary requirements.
    EVV record
    DefinitionAn EVV record containing both an EVV check-in and an EVV check-out.
    Check-inThe record includes electronically captured information showing when the service visit began.
    Check-outThe record includes electronically captured information showing when the service visit ended.
    EVV visit
    DefinitionA visit electronically verified through a mobile application on a smartphone or tablet or through an interactive voice response system.
    Telephone verificationInteractive voice response verification uses a landline or other telephone number.
    ExclusionA manual web-portal entry alone is not an EVV visit because it is not electronically verified.
    Manual entry
    DefinitionAn entry made in an EVV web portal rather than electronically verified through a mobile application or interactive voice response system.
    Web-portal methodThe information is entered manually through the EVV web portal.
    Not an EVV visitA manual entry is not considered an electronically verified EVV entry or visit.