YH19-0025 – Electronic Visit Verification (EVV) Bidders’ Library

As a courtesy, AHCCCS is providing a draft Electronic Visit Verification (EVV) policy, AHCCCS Medical Policy Manual (AMPM) 540. This policy is not final and subject to change.

540, Electronic Visit Verification

The following are links to other pertinent AHCCCS policies.

• AHCCCS Contractor’s Operations Manual
  • ACOM 413 – Gap in Critical Services
• AHCCCS Medical Policy Manual

AHCCCS and Med-QUEST are providing the supplemental data located below. This supplemental data contains various utilization, cost, and demographic information.

• Section A – AHCCCS EVV utilization data

  The data provided in this report relays the AHCCCS membership utilization of services and service providers that are subject to EVV including a breakdown of claims versus encounter utilization data.

  • ALTCS_Acute tab = displays the difference in member population between ALTCS programs and acute care programs
  • Age tab = membership utilization by age: Under 18 for children, and 18 and Over for adults
  • County tab = membership utilization by County
  • Procedure tab = membership utilization by each service code and provider type subject to EVV
  • Provider Types by POS tab = membership utilization by each service code and provider type subject to EVV and the location in which these services take place.
  • Provider Count tab = The count of each provider type who has billed for services subject to EVV

  AZ EW Data

• Section B – Med-QUEST EVV utilization data

  The data provided in this report relays the Med-QUEST membership utilization of services and service providers that are subject to EVV including a breakdown of claims versus encounter utilization data.

  • Age tab = membership utilization by age: Under 18 for children, and 18 and Over for adults
  • County tab = membership utilization by County
  • Procedure tab = membership utilization by each service code and provider type subject to EVV
  • Provider Type by POS tab = membership utilization by each service code and provider type subject to EVV and the location in which these services take place.
  • Self Directed tab = The utilization of services subject to EVV by Hawaii’s self-directed population

  HI EW Data

• Section C – AHCCCS geographic utilization data
  • Member Count by County = a map of the members in each county that utilize services subject to EVV
  • Claim Count by County = a map of the claims/encounters for services subject to EVV

  AHCCCS Member Count by County

  AHCCCS Claim Count by County

• Section D – Med-QUEST geographic utilization data
  • Member Count by County = a map of the members in each county that utilize services subject to EVV
  • Claim Count by County = a map of the claims/encounters for services subject to EVV

  Med-QUEST Member Count by County

  Med-QUEST Claim Count by County

Below is a draft of the workforce retention tracking standards and metrics that AHCCCS/Med-QUEST will be requiring the Contractor (EVV Vendor) to track and report as outlined in the RFP.

Workforce Retention Metrics