Agencies that will submit claims for EVV Visits must first enter their Medicaid ID (for HCBS claims) and optionally their LTC Medicaid ID (for long-term care claims if applicable).

Claims may not be filed until required information related to the claim is entered into SpokeChoice. In addition, visits may not be sent to Sandata until the following are entered.

1. Each client must have a Contingency Plan and the agency must attest that the plan has been reviewed within the last 12 months and a copy is on file. See People Manager>People Client Fields.
2. Each client must have a valid Medicare ID which is entered in Home Care>Client Payers> DDD policy.
3. Each employee must have a social security code which is entered in the People Manager>People Employee Fields. A claim may not be filed until this information is entered. The employee must also have a proper full address.

Authorizations - Before a claim may be submitted to WellSky for payment, a WellSky authorization that covers the claim service date must be loaded into SpokeChoice in Home Care>Health Plans>Client Authorizations. SpokeChoice will not allow a visit that requires authorizations if no authorization is found or if the authorized hours are all used by previous claims.

Live-In Providers & Onsite Caregivers  - Live-In providers are not required to have schedules. To mark a provider as a Live-In, use People Manager>People>Provider Assignments. Edit the client assignment and check the Is Live-In / Onsite Caregiver.

Live In and Onsite providers are exempt from scheduling. The following schedule rules apply to all other providers.

The basic scheduling requirements are as follows:

1. In all cases when an appointment will not be met the day it is scheduled to occur or the provider will arrive more than 60 minutes after the start time, the agency is required to contact the member to determine how to handle the missed or late appointment. This conversation is required to occur within the contingency plan time frame.
2. An appointment is considered a no-show if the visit does not occur on the day it is scheduled to start. In this case, you should capture the reason code for the no-show in SpokeChoice for documentation purposes.
   If a no-show appointment is rescheduled, the new appointment should be marked as a reschedule of a no-show. SpokeChoice does this for you if you use the Resolve No-Show user interface.
   Example: Appointment on 5/4 at 11pm. Provider does not arrive until 5/5 at 1pm. The 5/4 appointment is considered a no-show and either needs to be rescheduled for 5/5 at 1pm or the provider may make an unscheduled visit. SpokeChoice will not allow clocking in on the 5/4 appointment on 5/5 due to Sandata limitations.
3. When the visit for an appointment starts more than 60 minutes after the appointment scheduled start time, the visit must note the ‘Late In Call’ exception (done automatically by  SpokeChoice) and capture the reason code during Clock-In.
   Example: Appointment on 5/4 at 2pm. Provider does not arrive by 3pm but agrees with member to arrive any time between 3:01pm and midnight and captures Late In Call exception and reason code for being more than 60 minutes late.

The SpokeChoice Schedule features supporting these and other minor rules:

1. To make it easier for you to manage EVV type appointments, SpokeChoice has a special EVV schedule type schedule used to enforce scheduling rules for EVV type appointments.
2. A schedule may be created up to the start of a visit but may not be created (and associated to a visit) after the visit is started. SpokeChoice provides a Quick Schedule feature to automatically handle creating schedules for previously unscheduled visits. Added in version 1.5.
3. The EVV System is prohibited from canceling/deleting/modifying a schedule after the visit was scheduled to start. Added in version 1.5.
4. The EVV System must denote when a scheduled visit is rescheduled. Added in version 1.5.
5. An unscheduled visit is allowed so you may mitigate access to care issues. These visits trigger an exception that must be cleared. The Quick Schedule feature should be used to prevent unscheduled visits.  Added in version 1.5.

1. GPS coordinates are required when using a mobile device to clock-in and clock-out of a visit.
2. A second modality is required. SpokeChoice allows for the use of FOBs which produce a unique number which can later be used to verify the date/time of a visit start & end.
3. Actual visit start/stop times must be verified by the one of EVV system's modalities. The Clock-In & Clock-Out or FOB feature captures the actual start/stop times.
4. Changes to EVV visits are allowed provided:
   • The visit start/stop times are within the actual clock-in & clock-out times. I.e. if the stop time is after the provider clocked-out, the visit may not be verified.
   • Guardians sign/approve the visit after changes are made.
5. Manual visits can be entered however the following exceptions must be cleared:
   • They do not contain GPS coordinates.
   • They do not have verified actual start/stop times.
   • They must have a referenced schedule (if applicable).
6. Starting a scheduled visit more than 60 minutes late triggers a Late or Missed visit exception that must be cleared. Communication with the client will determine if the visit should be done as soon as possible, rescheduled, or done with the next scheduled visit. Added in version 1.5.

Visit Maintenance refers to adding/changing: service date, service code, start/stop time.

1. Visits may be modified by a provider or system administrator. A change history is kept for each visit and may be viewed by an administrator.
2. Each manual entry/change requires a reason code and may optionally require a memo and/or resolution code. STILL IN DEVELOPMENT
3. Guardians must digitally sign/approve visits. The guardian is shown visit modifications and by signing/approving, they are attesting to the changes made. IE: You have communicated with them about the service change. SpokeChoice captures the electronic signature in a method approved by the state of Arizona.
4. Finally, each visit is approved by a system administrator. By approving a visit the administrator is attesting to the changes (if any) made by all involved allowing the exceptions to be cleared by Sandata and since it has been approved it is clear of exceptions and WILL BE PAID by the payer. Any exceptions means you are out of policy by AHCCCS but will be paid.

Note: If a provider is not able use the forgot clock in / out there could be several reasons. 1) The provider is trying to put in time where the time is greater than 2 days or 2) the period is closed or 3) The admin has removed the ability for the provider to use that feature (employee fields - settings allow manual edit). If that is unchecked then the provider can not use this feature.

1. A claim must be synced to Sandata 2 days prior to being submitted to WellSky for payment.
   This means you must wait at least two days after approving a claim before submitting creating an 837 file. I.e.: If you approve on Monday, you must wait until Wednesday to submit your claims. Claims that have not been synced to Sandata for 2 business days will not output in the 837 file.

This article should only be used as a quick reference. Agencies are responsible for implementing EVV requirements. More information may be found at:

https://www.azahcccs.gov/AHCCCS/Initiatives/EVV/

Also The AHCCCS Q&A is here