Med-QUEST Division (MQD) is implementing electronic visit verification (EVV) for Home Health Agency, Personal Care Attendant, and Private Duty Nursing services in response to federal requirements set forth in the 21st Century Cures Act (Cures Act). In accordance with the Cures Act, the system implemented by MQD must record the: type of service, date of the service, time the service started and ended, individual receiving the service, person providing the service, and the location of the service. Both agencies and non-agency providers are impacted by EVV.
MQD has contracted with Sandata Technologies to provide an EVV system at no cost to providers or individuals receiving services.
- Non-agency providers must use the Sandata system.
- Agency providers can choose to use the Sandata system or a certified alternative EVV system. Alternative EVV systems must comply with all technical specifications and business rules and complete a certification process with Sandata before going into production. Neither MQD nor Sandata are responsible for any costs related to the development, certification, or use of an alternate EVV system.
More information on use of the Sandata system or a certified alternative EVV system, as well as updates and announcements from MQD about EVV can be found at medquest.hawaii.gov/en/plans-providers/electronic-visit-verification.
Home Health Agency, Personal Care Attendant, and Private Duty Nursing service providers must enroll with MQD and complete a separate enrollment for each provider type and island/region of service (as applicable) that they do business.
MQD Provider Types (PT) for each service are listed below:
- Provider Type 23 = Home Health Agency
- Provider Type 24 = Personal Care Attendant
- Provider Type 46 = Nurse-Private (RN/LPN)
PT-23 (Home Health Agency) providers must have a separate DOH/OHCA Home Health Agency license, active Medicaid Provider ID, and unique NPI per island, except for Hawaii Island, where providers must have a separate DOH/OHCA Home Health Agency license, active Medicaid Provider ID, and unique NPI for East Hawaii (i.e., Hilo) and West Hawaii (i.e., Kona).
PT-24 (Personal Care Attendant) providers must have a separate DOH/OHCA Home Care Agency license, active Medicaid Provider ID, and unique NPI per island, except for Hawaii Island, where providers must have a separate DOH/OHCA Home Care Agency license, active Medicaid Provider ID, and unique NPI for East Hawaii (i.e., Hilo) and West Hawaii (i.e., Kona).
PT-46 (Nurse-Private RN/LPN) providers must have a unique active Medicaid Provider ID and NPI that covers all PT-46 services statewide.
Providers cannot share NPIs across their Medicaid Provider IDs.
More information on enrolling with MQD and obtaining the necessary Medicaid Provider IDs can be found at https://medquest.hawaii.gov/en/plans-providers/Provider-Management-System-Upgrade.html
Once you are an active Medicaid provider in MQD’s HOKU web-based provider enrollment system, you will be required to update, change, and revalidate your agency information including licenses directly on-line in the HOKU system.
Please send Provider Enrollment inquiries to HCSBInquiries@dhs.hawaii.gov or call MQD’s Provider Hotline at 808-692-8099 should you have any questions.
Effective for dates of service (DOS) on or after Oct. 1, 2020, HMSA Medicaid providers of Home Health Agency, Personal Care Attendant, and Private Duty Nursing services are required to use the standard list of EVV service codes and modifiers for claims submission. The standard list of EVV service codes and modifiers can be found in MQD memo QI-2125 EVV Service Codes and Modifier table at: medquest.hawaii.gov/en/plans-providers/electronic-visit-verification.
- For DOS prior to 10/1/20 only:
- Providers that are contracted with HMSA for both Personal Assistance and Private Duty Nursing services must bill both types of services under their current NPI for Private Duty Nursing (PT-46) services.
- Home Health Agency, Personal Assistance and Private Duty Nursing services must be billed using the billing codes and units that were in effect prior to 10/1/20.
- DOS on or after 10/1/20 cannot be billed on the same claim.
- For DOS on or after 10/1/20:
- Providers must bill for authorized services rendered using the NPI that is actively enrolled with MQD for that provider type and island/region of service, as applicable.
- Home Health Agency services must be billed under the provider’s current island/region-specific NPI for Home Health Agency (PT-23) services.
- Personal Assistance services must be billed under the provider’s current island/region-specific NPI for Personal Assistance (PT-24) services
- Private Duty Nursing services must be billed under the provider’s current NPI for Private Duty Nursing (PT-46) services.
- A list of services that relate to each provider type can be found in MQD memo QI-2119 (Appendix A), at medquest.hawaii.gov/en/plans-providers/electronic-visit-verification.
- Personal Assistance services and Private Duty Nursing services cannot be billed on the same claim.
- All EVV services must be prior authorized.
- HMSA EVV authorization inquiries can be sent to MMEVVAUTHinq@hmsa.com
- HMSA billing and claim inquiries should contact us at 808-948-6330
- MQD EVV inquiries can be sent to EVV-MQD@dhs.hawaii.gov
- Providers must bill for authorized services rendered using the NPI that is actively enrolled with MQD for that provider type and island/region of service, as applicable.
HMSA and all QUEST Integration (QI) health plans are required to use the Sandata system to validate claims billed with EVV service codes and modifiers prior to payment.
Effective for DOS on or after October 1, 2021, QI health plans must deny claims for EVV services that don’t match the data in the Sandata system.
- For DOS prior to 10/1/21 only:
- HMSA will provide a ‘soft edit’ notification on claims for EVV services that don’t match the EVV system data, using message code 245 on our Report to Provider. The goal of this notification is to help providers identify and resolve errors during the soft edit period to ensure payment isn’t interrupted when hard claim denials are enforced.
- For DOS on or after 10/1/21:
- HMSA will deny claims for EVV services that don’t match the data in the Sandata system, using the following denial codes on our Report to Provider:
- Q014: No payment can be made due to a discrepancy between the units in the EVV system and the units billed.
- Q015: No visit found in the EVV system.
- HMSA will deny claims for EVV services that don’t match the data in the Sandata system, using the following denial codes on our Report to Provider:
Providers receiving either of these denial codes should review what was captured in the EVV system and submit a corrected claim or resubmit the claim, if appropriate.
Billing for authorized Private Duty Nursing services with the U6 modifier (eff. DOS 12/1/2021):
- 1 unit = 1 visit.
- Our claims system will only accept and reimburse one visit per claim line when the U6 modifier is billed, regardless of the number of units on the claim line.
- Additional visits for the same service on the same day may be billed on additional claim lines.
- If multiple claim lines are billed, the same HCPCS/U6 modifier combination must be billed on every claim line. Other HCPCS/modifier combinations must be billed on separate claims.
- If any of the above instructions are not followed, the claim may deny.
Billing for authorized Private Duty Nursing services with the UA modifier (this methodology will be end-dated eff. DOS 11/30/2021)
- 1 unit = 15 minutes
- Our claims system will only accept one visit per claim line when the UA modifier is billed.
- The number of units billed on the claim line should reflect the number of 15-minute units rendered during the visit. This will support appropriate validation of units in the Sandata system for EVV claim validation.
- Our claims system is set up to reimburse the 2-hour minimum adjusted rate when the UA modifier is billed, regardless of the number of units on the claim line.
- Additional visits for the same service on the same day may be billed on additional claim lines.
- If multiple claim lines are billed, the same HCPCS/UA modifier combination must be billed on every claim line. Other HCPCS/modifier combinations must be billed on separate claims.
- If any of the above instructions are not followed, the claim may deny.
Only visits in “Verified” status in the Sandata system will validate a claim for payment. It is recommended that provider agencies log on to the Sandata system to see if any visits are “Incomplete” before submitting claims. Providers using alternative EVV vendors should update visits in their EVV system, send them to Sandata, confirm the visit is in “Verified” status in the Sandata system, then submit a corrected claim or resubmit the claim, if appropriate. Visits in “Processed” status in the Sandata system means that the visit was previously in “Verified” status and a claim successfully processed against it.
Sandata cannot validate claims line items with more than 31 days of service. When submitting EVV claims lines, please bill for 31 days or less on a claims line to ensure it can be validated with Sandata. The overall claim can span more than 31 days.
What to do when an authorization is missing or incorrect in Sandata:
- If an authorization is missing or incorrect in Sandata, please notify HMSA by emailing MMEVVAUTHinq@hmsa.com. Include the authorization number in the email. If any other member information is included, then it must be sent via a secure/encrypted email.
- If using Sandata for EVV visit capture:
- Include your agency’s HMSA provider ID, 5-digit Sandata account number 85xxx, and 6-digit Medicaid Provider ID for the authorization you are inquiring about in the email.
- Continue services by instructing the caregiver to “Start Unknown Visit” to log unscheduled visits. See #4 below for instructions and screenshots on logging unscheduled visits.
- An exception for the authorization will post to the visit.
- Once the authorization is loaded or corrected in Sandata, then you can fix the exception and link the authorization to the visit. The name of the client will be available in the memo tab of the visit in Visit Maintenance.
- For technical questions, review the training material found here EVV Training (wistia.net)
- For technical issues open a ticket by emailing HICustomerCare@sandata.com
- If using an Alternate EVV Vendor for visit capture:
- Contact your Alt EVV vendor for instructions on how to update the authorization in their system.
What to do when services will exceed the current authorization:
- When you see an authorization is about to expire/run out of available units, contact the member’s HMSA Health Coordinator directly, or send an email to MMEVVAUTHinq@hmsa.com to request additional authorizations. Include the authorization number in the email. If any other member information is included, then it must be sent via a secure/encrypted email.
- If using Sandata for EVV visit capture:
- If you have requested and are expecting an updated authorization, continue with the services by instructing the caregiver to “Start Unknown Visit” to log unscheduled visits. See #4 below for instructions and screenshots on logging unscheduled visits.
- An exception for the authorization will post to the visit.
- Once the new or extended authorization is loaded to Sandata, then you can fix the exception and link the authorization to the visit. The name of the client will be available in the memo tab of the visit in Visit Maintenance.
- If you are not expecting an updated authorization, you can adjust the visit by updating the Adjusted Call-In or Adjusted Call-Out time to reduce the units down to the authorized amount.
- If you adjust a visit to accommodate the expired authorization and later want to ask for additional authorization, you can correct the visit by either changing the Call-In/Call-Out again or by entering a new visit to account for the additional time.
- For technical questions, review the training material found here EVV Training (wistia.net)
- For technical issues open a ticket by emailing HICustomerCare@sandata.com
- If you have requested and are expecting an updated authorization, continue with the services by instructing the caregiver to “Start Unknown Visit” to log unscheduled visits. See #4 below for instructions and screenshots on logging unscheduled visits.
- If using an Alternate EVV Vendor for visit capture:
- Contact your Alt EVV vendor for instructions on how to capture visits and update them according to the authorization.
What to do when an EVV claim line denies:
- The following denial codes will appear on our Report to Provider:
- Q014: No payment can be made due to a discrepancy between the units in the EVV system and the units billed.
- Q015: No visit found in the EVV system.
- If using Sandata for EVV visit capture:
- Be sure the Visit Exceptions are acknowledged for all of the member’s visits related to the claim line.
- Be sure the visit status is Verified/Approved and the units add up in Sandata to be equal to or greater than what is on the claim.
- Wait until the next business day, then submit a corrected claim, or resubmit the claim, if appropriate.
- If using an Alternate EVV vendor for visit capture:
- Contact your Alt EVV vendor for instructions on how to update visits.
- Be sure the visit status is Verified/Approved and the units add up in Sandata to be equal to or greater than what is on the claim.
- Wait until the next business day, then submit a corrected claim, or resubmit the claim, if appropriate.
How to start an Unknown Visit using Sandata Mobile Connect (SMC) when there is no authorization:
- A short 1.5 minute video with instructions on how to Start an Unknown Visit using Sandata Mobile Connect (SMC) can be found here: Starting an Unknown Visit – Hawaii Provider Agency Training (wistia.net).
- After signing in to Sandata Mobile Connect, click on the menu icon
If you have questions about using the Sandata system, please contact Sandata Support at 1-855-928-1141 or HICustomerCare@sandata.com and support is available 24 hours per day.
All EVV services must be prior authorized.
HMSA EVV authorization inquiries can be sent to MMEVVAUTHinq@hmsa.com.
HMSA billing and claim inquiries should contact us at 808-948-6330.
MQD EVV inquiries can be sent to EVV-MQD@dhs.hawaii.gov.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |