Mercy Care is now submitting all prior authorization and service confirmation records for services requiring EVV to the AHCCCS contracted EVV vendor (Sandata). We are also sending claims for EVV services having a Date of Service Start Date of January 1, 2021 to Sandata for claims validation. This means we can now begin to evaluate EVV in action and share information to ensure compliance with these requirements. We are sharing a few preliminary findings and request your immediate attention.
Mercy Care has received only a fraction of the service confirmation records we would expect based on utilization history
Without an authorization or service confirmation record, providers are not able to enter scheduling detail or tie EVV to a service in the Sandata system. If providing a service requiring EVV that does not require prior authorization, the providers must submit a service confirmation through the AHCCCS Service Confirmation Portal.
To find out which Mercy Care services require prior authorization versus a notification on the AHCCCS Service Confirmation Portal, please review our grid which can be found here: EVV Prior Authorization and Notification Grid.
A large percentage of records sent to Sandata for claim validation are being returned as FALSE with a "detailsreason "value of “No visit found”
Providers are not entering schedule detail and documenting the EVV in/with Sandata. These must be completed. Without these actions, the plan will not be able to confirm EVV. We are currently operating under a “grace period”, but claims having Dates of Service April 1, 2021 and later will be denied if EVV has not been documented.
As always, don't hesitate to contact your Mercy Care Network Management Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website. We appreciate your participation in our network and your dedication to the health and welfare of our members and your patients.
Thanks for all you do!
