EVV vs eClaims

In this article we want to clear up some of the confusion between two similar terms EVV and eClaims. First each of these are abbreviations of terminology used in the Personal Care industry. EVV is the abbreviation for Electronic Visit Verification, while eClaims stands for Electronic Claims. With the new mandates that have come out due to the 21st Century Cures Act, regarding EVV it’s easy to get the two terms confused. 

Let’s start by providing you some information on EVV. EVV is an electronic system that verifies a client’s shift and its appropriate care are completed as authorized by a specific caregiver at a certain time and location. In many states this completed shift information is accumulated, checked, and stored by a third party auditor, also known as an “aggregator”. (Of note: each state chooses its own aggregator.) EVV is mandated by the Federal (United States) government, to verify that a client received legitimate care during the visit. The way they verify the visit electronically is either done through GPS on the caregiver’s smartphone or through a hard line on Telephony, using the client’s landline. EVV is also specific to Medicaid.

eClaims on the other hand deals with the monetary aspect of providing care. eClaims involves filing electronic claims, to the Payer, in order to be paid/reimbursed for providing care. Some states now require that you use eClaims (837i and 837p) in order to be paid. That said other states will allow your agency to continue filing paper claims (UB-04 and CMS-1500). Another thing to note is that some aggregators are also clearinghouses. A clearinghouse collects the transactions and claims and then forwards them over to the correct Payer.

If you are interested in finding out more about EVV or eClaims and whether your organization needs to make appropriate changes in your EVV or eClaims processes, please reach out to us for a free consultation, our site is seniorcarebusinessadvisors.com. Our team looks forward to working with your office, and changing the way you care! Thank you again for reading today’s article.

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