Electronic Visit Verification (EVV) Newsletter

Hello and welcome to the Electronic Visit Verification (EVV) Newsletter - a newsletter with timely content on important updates, best practices, and resources to support your EVV experience.

EVV Newsletter Highlights

• EVV and Community First Choice (CFC)
• EVV and CFC Frequently Asked Questions
• Revised EVV Exemption Process
• Live-in Caregiver Panel Updates
• EVV Listening Sessions Moving to Zoom!
• IHSS Relative Personal Care Billing Issue Resolved
• Exception Acknowledgement Notice
• Reminders

What is EVV?

Electronic Visit Verification (EVV) is a technology used to verify that home or community-based service visits occur. EVV aims to ensure that services are delivered to people needing those services and that providers only bill for services rendered.

Did you Know?

Sending unencrypted emails with Protected Health Information (PHI) or Personal Identifiable Information (PII) is compliant with the Health Insurance Portability and Accountability Act (HIPAA).

A. True

B. False

Correct Answer: B) False, emails containing PHI and/or PII should be encrypted because encryption scrambles the content of an email, making it unreadable without the decryption key, thus protecting PHI and PII. If you are unsure how to encrypt an email, ask your supervisor or other staff at your agency.

What's New with EVV?

EVV and Community First Choice

Community First Choice (CFC), also known as 1915(k), is an optional Medicaid program that allows states to offer select home and community based attendant services and supports to eligible members on the State Plan, expanding these long-term care services to more Health First Colorado (Colorado's Medicaid Program) members. With the authority from Senate Bill 23-289, Colorado implemented CFC on July 1, 2025. 

Billing providers (Provider Agencies and FMS Vendors) who provide Personal Care, Homemaker, and Health Maintenance Activities services in the home and community through an HCBS waiver will begin providing those services under CFC at the time their member transitions to CFC at their Continued Stay Review. Providers and FMS Vendors who provide CFC services will still be expected to collect EVV for EVV-required services. 

New procedure codes are being introduced for CFC services starting July 2025. This does not change EVV data collection requirements. However, providers using a Provider Choice System must ensure their system is updated to recognize the new procedure codes and continue mapping to the correct EVV service group codes (which remain unchanged).

An up-to-date list of services and procedure/revenue codes can be found in the Crosswalk of Codes – July 2025 and the EVV Program Manual for guidance.  

A full list of CFC services and other relevant information can be found on the CFC webpage.

EVV and CFC Frequently Asked Questions

Q: How will EVV work with CFC services?

A: Billing providers (Provider Agencies and FMS Vendors) who provide Personal Care, Homemaker, and Health Maintenance Activities services in the home and community through an HCBS waiver will begin providing those services under CFC at the time their member transitions to CFC at their Continued Stay Review. Providers and FMS Vendors who provide CFC services will still be expected to collect EVV for EVV-required services.

Caregivers will need to call in for any EVV-required services they provide and call out when that service ends, or a new EVV-required service begins. So, that may require a caregiver to call in and out multiple times during a visit if different services are provided during a visit. If a provider doesn’t collect EVV for both service types (for example, Personal Care and Homemaker), they will experience claim denials and potentially use up the PCP authorization early. Additionally, caregivers capturing a single EVV when multiple services were provided may result in administrators creating manual visits or modifying EVV records, which may impact a provider’s unmodified EVV compliance.

Q: Will there be any changes to EVV service group codes?

A: EVV service group codes are not changing related to CFC. An up-to-date list of services and procedure/revenue codes can be found in the Crosswalk of Codes – July 2025 and the EVV Program Manual for guidance.

Q: Previously, Homemaker services completed during Personal Care services were allowed to be billed together under Personal Care. Now that this has changed under CFC, how are Case Managers, agencies, and caregivers expected to differentiate these tasks/services? Are tasks/services to be split within the timesheets?

A: The Case Manager is responsible for determining the hours needed for Homemaker and Personal Care. The provider agency will work with the Case Manager and member to develop the Care Plan. Then, the provider agency and caregiver will use the Care Plan to guide service provision and the caregivers time sheet. The agency will bill for service hours in accordance to Prior Authorization Request, the care plan, and services provided.

Q: Are providers allowed to combine units in the PPA for Personal Care and Homemaker?



A: The rule revisions for CFC (MSB 24-07-11-A) have been adopted by the Medical Services Board (MSB) and will be effective 7/1/25. Through this rule revision, 8.7538.F.1.d has been revised to eliminate the ability to bill these services together. Under CFC, the existing differences in services between waivers had to be eliminated which is where this revision came from. Units for Personal Care and Homemaker Services should not be combined. They should remain separated in the DCSC, and should be billed separately.

Live-in Caregiver Panel - Began March 6, 2025

The Department of Health Care Policy and Financing (HCPF) has made updates to the live-in caregiver (LIC) exemption process using the Gainwell Provider Web Portal.

HCPF is implementing a tiered approach to help billing providers transition to the new EVV exemption request process using the Gainwell Provider Web Portal. This phased strategy begins with the release of the revised EVV Exemption Form, soon followed by a “soft-launch" phase of the revised EVV Exemption Process. This will eventually lead to the activation of the EVV exemption prepayment claim edit. Once activated, when claims are billed with an EVV live-in caregiver or ADA exemption without an active EVV exemption on file in the Gainwell Provider Web Portal will be denied. This phased approach is designed to reduce the administrative burden and financial impact.

Billing providers will still be responsible for ensuring accurate and complete documentation for each EVV exemption. The following highlights key components of the new EVV Exemption process:

• A new EVV Exemption Form will replace the old “EVV Live-in Caregiver Attestation Form”. The new EVV Exemption Form, which includes instructions and supporting documentation requirements, is available on the EVV Newsletters and Resources webpage. 
• Once an EVV Exemption Form is completed, the new formalized process requires billing providers to submit EVV exemption requests through the Provider Web Portal within 30 days of the member’s attestation date. 
• The transition to utilizing the Provider Web Portal does not change the billing provider's responsibilities.
• Providers will receive notifications 60 and 30 days before expiration, on the day of expiration, and 30 days after. 

Additional information, including implementation timeline, can be found in Operational Memo 25-008 - Revised EVV Exemption.

See the January 2025, October 2024, and July 2024 EVV General Stakeholder Meeting Presentations or recordings for previous information.

Live-in Caregiver Panel Updates

Based on stakeholder feedback, HCPF has implemented and continues to work on updating the LIC Panel to make it easier to use and improve providers’ experience. The most recent update includes:

Starting July 10, 2025, the window of time between the EVV Exemption Form Effective Date and submission date will increase from 30 days to 90 days. This is meant to enable more flexibility in completing and submitting exemption requests through the Gainwell Provider Portal.

Other improvements that HCPF is evaluating:

• Updating the exemption review process to improve the approval rate and increase turnaround time for decisions for EVV Exemption applications.
• Increasing the volume of exemptions that can be submitted at one time.

EVV Listening Sessions Moving to Zoom

EVV Listening Sessions will transition from Google Meet to Zoom Meetings. The listening session will be held:

Thursday, August 7, 2025

10 to 11 a.m.

Register via Zoom

EVV Listening Sessions are informal opportunities for stakeholders to bring questions to HCPF about EVV implementation. No new policy or technical processes will be announced in these Listening Sessions. New information will be discussed in the Quarterly EVV Stakeholder meeting and published on this page: https://hcpf.colorado.gov/electronic-visit-verification-stakeholder-workgroup

In-Home Support Services (IHSS) Relative Personal Care Billing Issue Resolved

A known issue has been identified and posted to the Known Issues and Updates webpage, for Professional claims for HCBS services, specifically In-Home Support Services - Relative Personal Care Services, and may be denied incorrectly for no Electronic Visit Verification (EVV). 

We are working to resolve this issue and will provide updates as soon as possible. This particular issue would produce EOB (Explanation of Benefits) 3054 when trying to bill for IHSS Relative Personal Care using the following procedure codes:

• T1019 U1 SC TF - In-Home Support Services (IHSS) - Relative Personal Care (Complementary and Integrative Health Waiver), Outside of Denver
• T1019 U1 SC TF HX - In-Home Support Services (IHSS) - Relative Personal Care (Complementary and Integrative Health Waiver), Denver County

Updates are being made to claims processing for these services and once completed providers should no longer expect the denial of claims when all billing requirements are met.

Billing providers should continue collecting EVV and billing for those claims as outlined in the respective Billing Manual and EVV Program Manual.

Exception Acknowledgement Notice

Visits with exceptions requiring acknowledgment must submit the exception with all required visit data. If an exception is considered "fixable" in the Colorado HCPF Provider Choice EVV - Companion Guide (Addendum) to Alternate EVV System Specification - February 2025 and does not allow acknowledgment, the visit will be rejected and must be corrected before resubmission. 

Please ensure submissions comply with these requirements to avoid rejected visits. Contact the Sandata Electronic Visit Verification (EVV) Help Desk support team at 1-855-871-8780, or COCustomerCare@sandata.com or Submit a Ticket for assistance.

Refer back to the EVV Newsletters and Resources web page under the Provider Choice Resources section for the Colorado HCPF Provider Choice EVV - Companion Guide (Addendum) to Alternate EVV System Specification - February 2025.

Reminders

Recently Released Resources

• Operational Memo 25-008 - Revised EVV Exemption Process - January 2025: This memo details revised billing provider responsibilities when declaring an EVV exemption and includes revised operational processes and methods for applying and billing for services with EVV exemptions. The updated operational methods include the utilization of the Gainwell Provider Web Portal and the revised EVV Attestation of Exemption Form (EVV Exemption Form).
• Tips to Improve Collecting EVV in Real-Time Document: HCPF has put together a list of some effective methods to help caregivers collect EVV at the time of service.
• EVV Caregiver Checklist: This customizable checklist can be used by caregivers to build better habits for collecting EVV at the time of service.

Need to Make an Accommodation Request for any of our EVV-related Meetings?

Reasonable accommodations for the meetings will be provided upon request for persons with disabilities. Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request.

Please contact John Barry at john.r.barry@state.co.us or HCPFs 504/ADA Coordinator at hcpf504ada@state.co.us at least one week prior to the scheduled meeting to make arrangements.