Netsmart EVV is a comprehensive electronic visit verification solution designed for states, Managed Care Organizations (MCOs), and home/community-based healthcare providers to ensure compliance with the 21st Century Cures Act for Medicaid personal care services (PCS) and home health services (HHCS).
The solution operates as an EVV data aggregator and clearinghouse, enabling states and health plans to gather and manage EVV data across all providers, including those utilizing alternate EVV vendors. It supports an open vendor model and is integrated with over 87 EHR platforms.
Key Features and Capabilities
- EVV Compliance: Electronically verifies service delivery details, including the date, time, location, type of service, and the individuals providing and receiving the service, meeting the requirements of the 21st Century Cures Act.
- Data Aggregation & Clearinghouse: Provides an aggregated view of all EVV data from a provider network, which is critical for MCOs and states to monitor compliance and utilization.
- Mobile Caregiver+ App: The provider-facing component offers an intuitive mobile application for caregivers to document visits and tasks at the point of care, supporting offline documentation that automatically syncs when connectivity is restored.
- Claims Pre-adjudication: Includes a business rules engine that handles pre-adjudication of claims, marking them as matched or unmatched prior to payment and returning unmatched claims to providers for updates.
- Real-time Visibility: Administrators and health plans gain powerful dashboards for real-time tracking of missed visits, provider adoption, claims status, and other key utilization management insights.
- Flexible Scheduling: Supports flexible scheduling and tracking of both billable and non-billable activities.
Benefits and Use Cases
Netsmart EVV moves beyond basic compliance to serve as a tool for productivity and efficiency. Key benefits include reducing fraud, waste, and abuse (FWA), increasing quality scores, improving utilization management, and enhancing care coordination by facilitating data collection and communication among care teams.
