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A state healthcare agency was required by the 21st Century Cures Act – which was signed into law in 2016 – to implement an electronic visit verification (EVV) system for personal care services and home health care services covered by Medicaid. This agency managed a $25.2 billion Medicaid program that serves well over 4 million patients each year. The agency also handles the licensing of the state's 48,500 healthcare facilities, many of which provide home health services. 


Due to the multitude of moving parts involved with the project, our personnel approached the development of the EVV with a focus on program management. This began with defining a clear technology roadmap that identified dependencies and sequenced our tasks in detail. Once the roadmap was defined, the team worked closely with the state agency in defining short- and long-term business objectives as they related to the EVV.  Based on the needs of the state agency and the sensitivity of the data they handled, a secure, cloud-based solution hosted on Amazon Web Services was developed.


The EVV system provided the state agency with a comprehensive point-of-care solution that combines care plan compliance and claims verification. It identified the delivery of the service, validated tasks, approved visits, processed claims data, and deterred aberrant billing practices. The system also provided an electronic billing interface and allowed for electronic submission of claims for home health services that are verified by prior authorization, and produced reports for services not delivered as authorized. 


In addition to helping the state agency remain compliant, the EVV system could save the state tens of millions of dollars in erroneous and fraudulent claims, which cost the state $23 million and $22 million, respectively, in the 2020 fiscal year.

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