| (a) A program provider and an FMSA must:
(1) ensure that an EVV visit transaction contains the
data elements required by the EVV system, including:
(A) the first and last name of the member who received
the service;
(B) the type of service provided;
(C) the date the service was provided;
(D) the time the service began and the time the service
ended;
(E) the first and last name of the service provider
who provided the service;
(F) the location, including the address or geolocation,
where the service was provided; and
(G) other information HHSC determines necessary to
ensure the accurate payment of a claim for services, as described
in the EVV Policy Handbook; and
(2) ensure the data elements required by paragraph
(1) of this subsection are accurate.
(b) A CDS employer who elects to complete visit maintenance
on the HHSC Employer's Selection for Electronic Visit Verification
Responsibilities form must:
(1) ensure that an EVV visit transaction contains the
data elements required by the EVV system, including those listed in
subsection (a)(1) of this section; and
(2) ensure the data elements required by paragraph
(1) of this subsection are accurate.
(c) A program provider and an FMSA must:
(1) before submitting an EVV claim:
(A) ensure that the EVV visit transaction is transmitted
to and accepted by the EVV Portal; and
(B) ensure that the data elements on the EVV claim
match the data elements in the accepted EVV visit transaction; and
(2) submit the EVV claim in accordance with HHSC or
MCO billing requirements and the EVV Policy Handbook.
(d) HHSC or an MCO denies an EVV claim or recoups a
payment made to a program provider or an FMSA if the EVV claim does
not meet requirements described in the EVV Policy Handbook, including
if:
(1) the EVV claim does not match the accepted EVV visit
transaction; or
(2) there is no accepted EVV visit transaction that
supports the EVV claim.
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