EVV for Behavior Analysis to be Suspended

The Florida Medicaid program has announced that Electronic Visit Verification for Behavior Analysis Services (EVV) will be suspended effective February 5. This announcement comes following a Nov. 10, 2021 provider alert announcing that the Agency for Healthcare Administration will transition to the American Medical Association (AMA) Behavior Analysis Current Procedural Terminology (CPT) code structure effective July 1.

Effective January 10, providers may bill through Netsmart or the Florida Medicaid Secure Web Portal during the transition period. Effective Feb. 5, behavior analysis providers no longer will use the Netsmart EVV system to verify Medicaid BA services and must begin billing via direct data entry in the Florida Medicaid Secure Web Portal.

If you have visits scheduled or unmatched visits, in the EVV system, then you may bill for those visits directly in the Florida Medicaid Secure Web Portal.

If you have denied claims in the Florida Medicaid system, you should correct the edits based on your remittance advice and bill Florida Medicaid directly via the Florida Medicaid Secure Web Portal.

In 2019, the AMA adopted CPT codes for behavior analysis services. Behavior analysis CPT codes will align Florida Medicaid behavior analysis service and billing codes with national standards and improve transparency into the types of interventions delivered to Florida Medicaid recipients to promote service quality.

The EVV system has proved controversial. Last June, Health News Florida reported that Positive Behavior Support, the state’s largest provider of autism services, filed an administrative complaint against the Medicaid program, alleging the EVV system system was a roadblock to reimbursement and an overstep by the Agency for Health Care Administration.

The lawsuit alleges that alleges that the EVV system, or someone with access to it, was changing behavior-analysis claims after submission and making them invalid.

The EVV system was rolled out in 2019 by the State’s Agency for Healthcare Administration as part of an effort to crack down on Medicaid Fraud.

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The Health Law Offices of Anthony C. Vitale

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