Electronic visit verification (EVV) uses technology to make sure that members and participants receive the services they need. Workers check in at the beginning and check out at the end of each visit, using a smart phone or tablet, small digital device, or landline telephone. The EVV system captures six key pieces of information:
- Who receives the service
- Who provides the service
- What service is provided
- Where the service is provided
- The date of service
- The time the service begins and ends
The Wisconsin Department of Health Services (DHS) offers the Sandata EVV system for use with all DHS programs and providers, HMOs, managed care organizations (MCOs), Family Care fiscal employer agencies (FEAs), and IRIS (Include, Respect, I Self-Direct) FEAs who are required to use an EVV system. Providers can choose to use the DHS-provided Sandata EVV system or an alternate EVV system. All alternate EVV systems are required to integrate with the Sandata aggregator to get EVV information from the alternate EVV vendor to DHS.
Program payers play an important role in EVV in Wisconsin by acting as the bridge between providers and DHS. They are responsible for ensuring their network of providers use EVV systems efficiently and in compliance with DHS EVV policy. This ensures that members and participants receive the care they need, and providers’ claims are paid promptly.
Payers connect providers to DHS, making sure EVV information is sent and received accurately.
- Payers are responsible for making sure providers use an EVV system for services that require EVV. For more information on the DHS-provided Sandata EVV system, HMOs, MCOs, and IRIS FEAs may view the provider training to understand the system. Viewing the training is not required.
- HMOs and MCOs are required to send accurate and timely service authorization information to DHS for services that require EVV. DHS receives IRIS service authorization information from the state case management system.
- Sending timely authorization information allows EVV visits to flow through with minimal manual corrections.
- Payers should review the technical specifications for sending authorization information. IRIS FEAs are excluded from this authorization process (see above). The technical specifications are:
- EVV Authorization File Specification (PDF): File structure specifications for EVV data to be sent by program payers to DHS
- EVV Authorization Response File Specification (PDF): Record layout and data file error descriptions for the EVV authorization response file
- Payers are responsible for receiving EVV visit information and comparing it to records to ensure providers and caregivers are compliant with DHS EVV Policy, P-03053. Payers are required to:
- Review Program Payer Visit File Specification (PDF) that includes specifications for EVV data to be sent to program payers.
- Take Sandata’s aggregator training (see below).
The Sandata aggregator collects all EVV information and ensures the validity of the information before it is sent to the assigned payer. Payers can use the aggregator as a tool to supplement payer records, balance files, or view information applicable to their EVV processes. This can include reviewing authorizations and visit information for their contracted providers. The Sandata aggregator is view only.
Sandata’s self-paced aggregator training is available for payers and their staff. Payers can login at www.sandatalearn.com using one of these shared training accounts:
|Password (case sensitive)
- Click My Courses
- Click Aggregator Self-Paced to open the list of training modules
- Launch each module’s video by clicking Complete
Sandata's aggregator training videos and manual cover the basics of logging in, assigning roles and passwords for new users, filtering data, and running reports for export.
Note: Because the Sandata aggregator is built to function across different states, the self-paced aggregator training from Sandata refers to some features that do not apply in Wisconsin. These include:
- Geofence references
- Employee performance/supervisor/pay information
- Employee Social Security numbers
- EVV required services
EVV required services
EVV visit data is required for the following list of personal care services and home health care services codes in Wisconsin.