Electronic Visit Verification Provider Survey

Welcome to the Electronic Visit Verification Provider Survey

Dear Provider,

Beginning in 2020, AHCCCS will require Medicaid providers of personal care and home health services to use Electronic Visit Verification (EVV) pursuant to Section 1903 of the Social Security Act (42 U.S.C. 1396b). EVV is an electronic based system that verifies when caregiver visits occur and documents the precise time services begin and end. It ensures that members receive their medically necessary services. AHCCCS has selected Sandata Technologies LLC to deliver the statewide EVV system that will be made available to all service providers required to use EVV. Service providers may choose to use an alternate EVV system vendor (at their own cost) and must interface with the statewide system as a data aggregator. More information on AHCCCS' plans for EVV is outlined on the AHCCCS website.

AHCCCS is requesting service providers, subject to EVV, complete the survey to inform readiness activities to support successful implementation of the EVV system.

For assistance in completing the survey, please email EVV@azahcccs.gov prior to the 10/31/19 deadline submission date.

A provider is subject to EVV if they are registered with AHCCCS as one of the following providers types, provide at least one of the service codes and provide those services in the Place of Service (POS).

Question Title

*Note:

EVV is required for DDD Individually Designed Living Arrangement settings that do not utilize a service matrix to establish total support hours needed for members living in a shared apartment or home and the provider bills hourly Habilitation (HAI).

EVV is not required for DDD Individually Designed Living Arrangement settings that do utilize a service matrix which establishes total support hours needed for members living in a shared apartment or home and the provider bills a daily rate for Habilitation (HID).

1. The survey must be completed and submitted by the service provider’s Chief Executive or Authorized Representative no later than 10/31/19. It is important to note, the survey responses may require additional research in order to complete all responses.

Question Title

* 1a. Contact Information for the Chief Executive/Authorized Representative, the person completing the survey:

*If the organization has multiple AHCCCS Provider Registration IDs that may be subject to EVV, please include all relevant Provider IDs.

If you have more provider ID’s than the survey allows, please email a separate list of all your provider ID’s to EVV@azahcccs.gov.

Please be advised, group billers should not respond on behalf of the rendering provider. AHCCCS needs the individual providers to respond to the survey.

Name

Title

Provider Agency Name

DBA Name

Address line 1

Address line 2

City

State

Zip Code

Primary Phone

Office Phone

Mobile Phone

Fax

Email address

AHCCCS Provider ID*

Question Title

* 1b. Please verify the name and contact information for the administrative representative within your organization who will be responsible for primary interaction with the EVV system.

The EVV contact for the organization is the same as the Chief Executive/Authorized Representative that completed this survey:

Yes