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Live-in Caregiver Panel Timeline
By Spring 2026, all claims billed with a live-in caregiver or ADA exemption will require an active EVV live-in caregiver or ADA exemption on file in the Gainwell Provider Web Portal to avoid denial. The following phases outline the implementation plan for this new process:
February 2025 – EVV Exemption Form Release
The revised EVV Exemption Form will be made available to help billing providers familiarize themselves with the updated requirements, instructions, and expectations. Billing providers can begin updating their EVV exemption documentation and completing the EVV Exemption Form (see Attachments section) to indicate their understanding of these changes.
Feb. 26, 2025 – Gainwell Provider Web Portal Soft Launch EVV Exemption Documentation Requirements Begins
The Gainwell Provider Web Portal EVV Exemption Documentation requirements will begin, enabling billing providers to submit EVV exemption documentation using the new EVV Exemption Form through the Gainwell Provider Web Portal.
During the soft-launch phase, the Gainwell Provider Web Portal EVV Exemption panel will have a maximum capacity of 200 active and inactive live-in caregiver exemptions on file. This capacity is temporary and HCPF will increase to the volume necessary for all billing providers in the near future. HCPF will be communicating directly to billing providers who currently exceed the capacity with additional information.
Billing providers are reminded that the total maximum file size for attachments allowed per maintenance application is 5 megabytes and only one (1) maintenance application can be submitted at a time. Any additional requests within the maintenance application besides EVV exemptions may result in denial of the application and delayed approvals. Additionally, if a maintenance application is submitted for both an EVV exemption and license update, if one of those requests is denied, the entire request is denied, so providers should avoid combining multiple requests within the maintenance application that could disrupt approvals.
During this "soft-launch" period, Remittance Advice (RA) feedback will inform billing providers when claims lack an active EVV exemption on file using the Explanation of Benefits (EOB) 3056 “EVV Exemption Required - Not Found”. However, claims that lack an active EVV exemption will not be denied during this phase.
During this time, HCPF will focus on supporting providers as they get familiar with the revised form and process. Billing Providers should focus on understanding the new process, getting new forms completed, submitting documentation, and working with HCPF.
Prepayment Claim Edit Activation
The prepayment claim edit is expected to be activated once one or more of the below metrics are achieved:
- 80% or more of EVV exempt claims are successfully billed for 2 months in a row
- After 12 months of the soft-launch period have expired
After the activation of the EVV exemption prepayment claim edit, RA feedback will inform billing providers when claims lack an active EVV exemption on file using the EOB 3056 “EVV Exemption Required - Not Found”. Claims billed with an EVV live-in caregiver or ADA exemption without an active EVV exemption on file in the Gainwell Provider Web Portal will be denied.
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