The EVV workflows in AlayaCare allow organizations to go through a verification process to determine whether any visits funded by electronic billing payors are in violation of the EVV requirements configured for your organization. If any EVV exceptions are found during the verification process, you will need to review the visits in violation and, where required, select the correct reasons and resolutions before you can approve the visit to include in electronic billing claims and payroll.
- Setting criteria and running visit verification
- Reviewing visits in violation and resolving exceptions
- Approving visits for electronic billing and payroll
- EVV and visit locking
- Reviewing approved and rejected visits
Roles and permissions
The following ACLs are required for various processes described in this article:
- Accounting>Reset visit to not approved: this ACL is required to be able to set a visit back to not approved
- Accounting>Reject visit: this ACL is required to reject a visit.
- Accounting>Override bill quantity: this ACL is required to edit the bill quantity on a visit before it is approved.
- Accounting>Override pay quantity: this ACL is required to edit the pay quantity on a visit before it is approved.
- Accounting>Override bill quantity on locked visit: this ACL is required to edit the bill quantity on an approved visit.
- Accounting>Override pay quantity on locked visit: this ACL is required to edit the pay quantity on an approved visit.
Setting criteria and running visit verification
To verify and approve visits according to the EVV requirements in effect for your organization, go to Schedules>Workforce Management>EVV.
Under EVV, you will see three tabs: not approved, in violation, and approved & rejected.
The number in parentheses for not approved represents the number of visits funded by an electronic billing payor up to the current date and time that have an approval status of not approved. Vacant and on-hold visits will not be included in the count. Note that in multi-office environments, this number will be filtered by branch.
The number in parentheses for in violation represents the current number of visits funded by an electronic billing payor for which one or more exception to the EVV requirements has been found during the verification process. These visits will require further action before they can be approved for claim generation and payroll. Note that in multi-office environments, this number will be filtered by branch.
To begin the verification and approval process, use the fields provided to select the visits you wish to verify and approve.
Use the visit end date field to select the cut-off date and time for the verification process. The system will include all not approved visits up to this date and time. The field will default to today’s date and time. Note that you cannot select a time or date in the future as visits must be in the past before they can be verified and approved.
In the additional fields, select one or more payors, service departments, employee departments, employee groups, client groups, or branches (multi-office environments only) by which you wish to filter the not approved visits. You can also choose to filter visits by a single employee or client.
Note that in multi-office environments, you will be able to select payors, departments, groups, employees, and clients that belong to the current branch, parent branch, or child branch but not sibling branches.
When you have selected the criteria you wish to apply, select verify and approve.
Clicking the action button will launch a background job to verify the not approved visits that meet the selected criteria. The number of visits found with exceptions displayed in the in violation tab will update once the verification process is run on new visits.
Any visits for which no exceptions were found will be automatically approved for the bill and pay quantities determined by the rounding rules set on the bill and pay code in effect for the service. You can review approved visits and, if necessary, override the bill and pay quantities for the visit by going to the approved and rejected visits tab.
Reviewing visits in violation and resolving exceptions
Select the in violation tab to review the exceptions found during the verification process. Each visit will be listed with its visit ID, client (or facility), employee, visit start date, associated payors, number of remaining exceptions, and corresponding branch (multi-office environments only).
You can filter the list of exceptions by client/facility, employee, client groups, employee groups, payors, service departments, or branches (multi-office environments only). Turn on the only resolved visits toggle on to filter to visits that still require time approval but for which all exceptions have been resolved.
Select resolve for the visit you wish to review.
In this screen, you will be able to review visit information, resolve exceptions, and approve bill and pay quantities so you can proceed to generate claims and run payroll.
Basic information about the visit will be displayed at the top of the screen. The client, employee, facility (if applicable), visit ID, service, and address will be displayed under visit information. Under scheduled visit details, you will see the scheduled start date, scheduled start time, scheduled end time, the duration of any scheduled breaks, and the total scheduled duration.
To review the next visit in the in violation list, click next.
If you have the required permissions, you can edit the status of the visit from in violation to not approved or rejected from the edit status dropdown. Note that once you reject a visit, you will not be able to verify it for exceptions again.
In the work session information section, you will see information about the total duration of the visit based on the clock-in and clock-out times as well as information about the location of the visit.
The total duration displays the actual duration of the visit based on the recorded clock-in and clock-out times. The coverage % represents the percentage of the scheduled time that the actual visit lasted (total duration/scheduled duration).
Under work sessions, you will see the times at which the employee clocked in and clocked out of the visit. An icon will indicate whether the clock-in and clock-out occurred via the web application, mobile application, or the interactive voice recognition (IVR) system. If there were multiple clock-ins and clock-outs, you may need to scroll down to see all the information>
Mobile application: IVR application:
If the clock-in or clock-out occurred from the mobile application, the distance from the client’s address that the clock-in or clock-out occurred will be displayed below the clock-in/clock-out time in the units configured by your organization in settings>system settings> locale>unit of distance.
If the clock-in and clock-out occurred via IVR, the phone number that the employee used to clock in or clock out will also be displayed. If the phone number matches the client’s phone number, it will be displayed in green. If the phone number they used does not match the phone number on the client’s profile, it will be displayed in red.
If the employee clocked in or out from the mobile application, the GPS coordinates of the location at which they clocked in (shown in green) and out (shown in red) will be displayed on the map as well as the location at which the visit was scheduled to occur (shown in blue).
If the employee clocked in and out via the web application or IVR, the clock-in and clock-out coordinates will not be captured, and only the service location will be displayed on the map.
If your organization uses visit notes, you can click to open the visit notes section to review any notes written by care providers during the visit before approving the visit and resolving the exceptions.
Note that you must be in a role with the view visit notes ACL to view this section.
The exception list section will display the exceptions to the EVV requirements that were identified for the visit. For details about the various exception types, please see the user guide for more information on the exception types.
For each exception, you must select from the dropdown in the reasons column to resolve the exception. If required, enter comments in the comment(s) field and click save. The status of the exceptions will change to resolved.
For each exception, you must select from the dropdown in the reasons column to resolve the exception. If you only need to acknowledge the exception to verify the visit, select acknowledge.
If you are required to select a reason and matching resolution, select a reason from the dropdown and then select the corresponding resolution. Note that only resolutions that have an association created in your branch with the reason you selected will be available to select.
If required, enter comments in the comment(s) field.
Click save to save your changes to the exception list.
The status of the exceptions will change to resolved.
If a comment was not entered for an exception or resolution that requires a comment, you will be prevented from saving and receive the following error:
Approving visits for electronic billing and payroll
Once all exceptions on the visit have been resolved, you can review the bill and pay quantities and approve the visit so it can be included on electronic billing claims and running payroll, if you have the required ACLs.
Adjust the bill and pay quantities for the visit if necessary. When you are ready, click approve.
Once you click approve, the visit’s status will be changed to approved.
EVV and visit locking
A visit gets locked when its status changes to approved or rejected. The visit will become unlocked again if its status is changed to not approved.
Note that this locking applies the reject all batch action on the vacant visits page, but only for visits where funder type is electronic billing payor.
Reviewing approved and rejected visits
To review visits that have already been approved or rejected, select the approved and rejected visits tab and select review to view the visit details.
You can manually change the status of an approved visit to rejected or not approved. You can also set a rejected visit back to not approved status.
In the exception list section for an approved visit, you can edit the selected reasons and resolutions for the exceptions. Click save to save your changes.
If you wish to override approved bill and pay quantities calculated during visit verification for an approved visit, adjust the values in the bill quantity or pay quantity field and then select override in the time approval section. Note that you must have the required permissions to override bill and pay quantities for an approved visit.
If you wish to override approved bill and pay quantities, adjust the values in the bill quantity or pay quantity field and then select override in the time approval section. Note that you must have the required permissions to override bill and pay quantities for an approved visit.
On a rejected visit, you will not be able to edit the exception list or time approval sections.