Electronic Visit Verification: Live-in Worker Update

The Wisconsin Department of Health Services has published ForwardHealth Update 2021-05, "Electronic Visit Verification Prior Authorization Procedure for Live-In Workers."

The following are highlights of the Update, based on whether or not providers are fee-for-service.

Fee-for-Service Providers

Effective February 1, 2021, new prior authorizations (PAs) must include an EVV Live-In Worker Identification form, F-02717, with supporting documentation when submitting fee-for-service PA requests for live-in workers who will not be required to use EVV.

Effective April 1, 2021, existing prior authorizations will require an amended PA to be on file with ForwardHealth for services provided by live-in workers who will not be using EVV. A completed EVV Live-In Worker Identification form, F-02717, and supporting documentation must accompany the PA amendment.

Providers That Are Not Fee-for-Service

HMOs, managed care organizations, and IRIS (Include, Respect, I Self-Direct) providers should follow policies and form submission requirements for those payers.

To coincide with the publication of the ForwardHealth Update 2021-05, changes were made to the EVV Live-In Worker Identification form, F-02717, and the EVV policy decision document, P-02614. These changes include the new EVV live-in worker definition.

Electronic Visit Verification Launched

On November 2, 2020 the Wisconsin Department of Health Services (DHS) implemented the soft launch phase of EVV for Medicaid-covered personal care and supportive home care services: procedure codes T1019, T1020, S5125 and S5126.*

DHS is committed to working with all stakeholders to integrate EVV while maintaining services and ensuring needed care is delivered. DHS will not deny claims or disregard submitted encounters without EVV data during the soft launch.

This soft launch phase will integrate EVV into the visit and claims process and prepare for the hard launch phase of EVV. The date for hard launch of the EVV program in Wisconsin has not been set.

Visit the EVV website for more information.

*Beginning January 1, 2021, EVV is required in the IRIS program for procedure codes S5125 and S5126.