How to choose EVV software for IDD providers.

01 · EVV and visits

Start with your state's EVV model.

Federal law requires states to verify certain visits electronically, but each state chooses how. Some provide one state system every agency must use. Others let agencies use their own EVV system if it sends visit data to the state's or managed care plan's aggregator. Some do both.

Before you look at any product, find out which model your state and each managed care plan you bill use, whether third-party systems are allowed, and what testing or approval a system needs before you can send live data.

• Is there a mandatory state system, an open vendor model or both?
• Which aggregator receives visit data for each payer?
• What approval or testing does a third-party system need?
• Which of your services are EVV services in your state?

03 · EVV and visits

Check that it connects to your aggregator and payers.

A system that records visits but cannot deliver them to the aggregator your payers use leaves you re-entering data or risking denied claims. Ask for the exact connection: which aggregator, which file or interface, how rejections come back and who fixes them.

Ask whether the vendor has completed testing with that aggregator for your state, and get the answer in writing.

05 · EVV and visits

Make sure staff can actually use it.

EVV only works if direct support professionals clock in and out at every visit. Test the caregiver experience on the phones your staff carry.

Ask what happens with no cell signal, whether there is a telephone (IVR) option from the person's home, whether the app works in the languages your staff speak, and how long training takes. Federal guidance also says the person receiving services should not have to supply a phone or internet connection.

07 · EVV and visits

Ask about data, security and cost.

Ask how health information is protected, whether the vendor will sign a business associate agreement, who owns the visit data, how you get it back if you leave and how long it is kept.

Get the full price in writing: per person, per staff member or per visit, setup and training fees, aggregator connection fees and contract length.

09 · EVV and visits

What does EVV software cost?

EVV software cost depends on the pricing model and on the work it leaves your staff, so compare the total cost, not the headline rate. Where your state provides a system at no charge to agencies, your costs are mostly staff time, devices and training. A system you buy yourself adds a subscription on top.

Common pricing models charge per person served, per staff member or user, per visit, or a flat monthly fee by agency size. Some add one-time fees for setup, data migration or connecting to an aggregator. Ask which model rises fastest as you grow, and model it with your own numbers for this year and next.

Compare options on the same assumptions, and ask what support is included: phone hours, response times and who handles aggregator rejections. Support you pay for separately, or do yourself because the vendor will not, is part of the real cost.

• Subscription model and what counts as a billable person, user or visit.
• Setup, migration, training and aggregator connection fees.
• Price changes at renewal and how much notice you get.
• Contract length, auto-renewal and the cost to leave.
• Fees to export your own data.
• Office time spent fixing exceptions and rejected visits.

11 · EVV and visits

What reports should EVV software provide?

EVV software should give you reports that help you fix problems before billing, not just a list of visits. Ask to see each one with realistic data during the demo, and ask whether you can filter by person, staff member, service, payer and date.

Then use the reports on a routine. A daily look at open exceptions and rejected visits keeps problems small. A weekly comparison of authorized and delivered units shows who is falling behind before the authorization period ends. A monthly review of manual corrections by staff member shows where coaching is needed.

• Open exceptions by type, age and who is assigned.
• Visits not yet accepted by the aggregator, with the reason.
• Scheduled visits with no clock-in, and visits with no schedule.
• Authorized units compared with units delivered.
• Manual corrections, with who made them and why.
• Clock-in method used, such as app or telephone.
• Visits per staff member, for coaching and follow-up.

13 · EVV and visits

What red flags should you watch for in an EVV vendor?

The biggest red flag is a vendor that cannot clearly explain how it connects to your state's aggregator. Treat vague answers on testing, data or pricing as a reason to slow down.

Also watch how the vendor treats your questions. A vendor that rushes you to sign before a trial, will not put its promises in the contract or blames the state for every problem is likely to behave the same way after you sign.

• No completed testing with your state's aggregator, or no written proof.
• A demo that only uses polished sample data and avoids exceptions.
• Editing that changes visit times without keeping the original record.
• Unwillingness to sign a business associate agreement.
• No clear way to export your data if you leave.
• Long contracts with auto-renewal and unclear price increases.
• No references from agencies that bill the same payers.
• Claims that the software makes you compliant on its own.

Sources

Check the official source.

Requirements change and differ by state. Confirm current rules with your state agencies and payers.

• Medicaid.gov: Electronic Visit Verification
• CMS: EVV frequently asked questions (May 2018)
• CMS: Informational bulletin on EVV (August 2019)