PSS / CLS / Claims Implementation Archive (2018 – 2021)

PSS / CLS Overview Archive

PSS / CLS What's New Archive

Posted 1/19/2022 - As of 1:01am EST on Thursday 1/20/22 providers will be able to submit claims with an open Tier 2 ticket or claims from a member with a cost share/patient liability directly to GAMMIS. As of 1:01am EST on Thursday 1/20/22 these claims will not deny for the 1072 Mandatory EVV edit. 

Previous communications outlined the need for claims submission via EVV for a Tier 2 ticket or cost share / patient liability before submitting claims directly to GAMMIS. That is no longer applicable. 

Please ensure there is an open Tier 2 ticket or the member has a cost share/patient liability. DCH has instituted reporting on all claims submitted to GAMMIS and outside of the EVV system. Providers submitting claims directly to GAMMIS without an open Tier 2 ticket will be subject to recoupment and corrective action.

If you have questions or concerns, please reach out to the EVV mailbox at [email protected].  

DCH is working with EVV to immediately correct the patient liability/cost share issue. It is currently the top priority for modification and we expect the issue to be corrected shortly.

Thank you for your continued participation in the Medicaid program and working with DCH to implement the federal mandated EVV program.

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Posted 11/4/2021 – The NOW and COMP waivers that have temporary rate adjustments in accordance with Appendix K related to Community Living Services have been adjusted in the EVV system.  If you have an applicable “unmatched” visit, you can manually “re-match” to receive an immediate update. If you have an applicable “matched” visit, the rate adjustment will only occur after you re-match the claim.  All new visits should reflect the adjusted rate. If you notice any errors with rates, please report them to the Georgia EVV call center at https://www.gaevv.com/.

Posted 10/27/2021 – As a reminder to providers who are not regularly using EVV for the required PSS and CLS services yet, starting November 1, 2021, all EVV-applicable claims must include the required EVV visit information and be submitted through the State EVV solution, Netsmart, with three (3) exceptions

Providers that have claims that fall within one or more of the following exceptions should submit those claims directly to GAMMIS until upgrades to the Netsmart solution are completed. The claim exceptions are as follows:

  1. A claim pertaining to a member with a Patient Liability (cost share), 
  2. A claim pertaining to Shared Service Code, or
  3. A claim type tied to an open “Tier 2” ticket with Netsmart.

Again, only providers submitting claims that meet any of the above exception criteria may submit those claim types directly to GAMMIS. All other EVV-applicable claims (those without an exception listed above) with a date of service on or after November 1, 2021, should be submitted through the State EVV solution, Netsmart.

If you have questions or concerns about whether these exceptions apply to one of your claims, please reach out to [email protected].

Posted 9/21/2021 – DCH will be extending the EVV deadlines for fiscal intermediary (FIs) and participant-directed/self-directed members to November 1, 2021. This extension is to allow participant-directed/self-directed members who are currently supported by the State’s FIs additional time to be onboarded.

Your FI may require different implementation deadlines or benchmarks to support testing and ensure compliance by the mandated deadline.

IMPORTANT EVV UPDATE:

The Georgia Department of Community Health (DCH) has decided to delay mandatory claims submission for EVV from July 1, 2021, to November 1, 2021. Fiscal Intermediaries and traditional providers may continue to bill through the Netsmart solution or GAMMIS until November 1, 2021. 

EVV itself is not postponed or delayed. EVV is up and fully functional for use now. All providers are encouraged to utilize and get on board with EVV as soon as possible and not delay. There will be no delay to the claims edit post November 1, 2021. And the sooner, you as a provider, start utilizing the system now the less concerns there will be when the mandatory claims edit goes into place November 1, 2021.

New deadlines related to EVV activities have been established. If you, as a Provider, have not completed the below activities by the expressed date, your agency will be subject to pre-payment review.

As a reminder, EVV is a federal mandate and will be required in Georgia. The mandatory claims delay to November 1, 2021, should be used as an opportunity to ensure you see no disruptions to your claims payments.

  • July 23, 2021All providers are required to be registered with the State EVV solution, Netsmart. Even Providers using a third-party EVV vendor are required to register with the State EVV solution. 
  • August 31, 2021 All providers are required to have employees added as users into your chosen EVV solution and successfully submit at least one EVV-related claim for each applicable Medicaid ID. To successfully submit a claim, aides and caregivers will have to use and capture visit data using EVV.
  • November 1, 2021 (Updated date; previously October 1) All EVV-related claims will be required to include EVV information and be submitted via the State EVV solution. The mandatory claims edit for EVV-required services will be turned on. The only exception to continue to submit claims through GAMMIS will be for those with an outstanding support ticket related to the State EVV solution.

Good Faith Exemption (GFE) Approval - DCH submitted a GFE Request Form on behalf of the State of Georgia on November 8, 2019. CMS granted an approval of the request on Monday December 3, 2019. Georgia’s new deadline for implementing EVV for Personal Care Services (PCS) is now January 1, 2021 and Home Health Care Services (HHCS) by January 1, 2023. While Georgia will miss this January 1, 2021 implementation deadline and incur incremental Federal Medical Assistance Percentage (FMAP) penalties, DCH is committed to working with Members, Providers, and vendors to meet training needs and implement a quality solution as quickly as possible. For more information about the GFE request, click Download this pdf file. HERE

Posted 3/29/2021 - The Georgia Department of Community Health (DCH) is happy to announce that registration for the Georgia Electronic Visit Verification (EVV) solution is open! Providers can register today by going to https://4tellus.com/ga-dch/ and/or using the DCH-provided guide, “ Download this pdf file. How to Register a Provider Agency to Use Netsmart EVV .”

Posted 03/18/2021 - EVV training is available! Training for Georgia’s EVV solution began on March 16th, 2021 and runs throughout the year. Training will be provided by Georgia’s EVV solution vendor, Netsmart, via their training website and will include live webinar and pre-recorded options. Visit the DCH EVV Schedule of Events page to register for EVV training!

Posted 01/14/2021 - Have questions about EVV? We want to help answer them! DCH has recently updated Download this pdf file. Member frequently asked questions (FAQs) and has created Download this pdf file. Provider and Download this pdf file. Self-Directed Member and Families FAQs. While the FAQs cover a variety of topics and questions, they might not address your specific issue. Don’t see what you need? Email the DCH EVV project team at [email protected] to have your specific question answered.

Posted 11/10/2020 - Netsmart, Georgia’s EVV Solution Vendor, already has existing relationships and integrations with many third-party EVV Vendors in Georgia, but not all! Netsmart will need to connect with all third-party EVV Vendors to provide information regarding next steps and the aggregation process. If you are a provider working with a third-party EVV Vendor, please have your EVV Vendor contact Netsmart at [email protected] for information. If you are an EVV Vendor working with a Georgia Medicaid provider and have not been in contact with Netsmart, please contact Netsmart at [email protected] for information.

Posted 10/02/2020 - GOOD NEWS!!! Georgia DCH is finally resuming EVV implementation activities. We have streamlined an implementation approach and selected Conduent in partnership with Netsmart as our EVV vendor.  Download this pdf file. Click here to read the full announcement.