Body
Revision 26-1; Effective Jan. 30, 2026
Program providers, FMSAs and CDS employers are required to use an EVV system and meet the minimum EVV Usage Score.
Payers will monitor the number of manually entered EVV visit transactions and the number of rejected EVV visit transactions to make sure the minimum EVV Usage Score is met for the state fiscal year quarter.
Refer to 11000 EVV Compliance Reviews for more information.
A manual EVV visit transaction is an EVV visit transaction directly entered in the EVV system when a service provider or CDS employee fails to use the EVV system to clock in when service delivery begins, clock out when service delivery ends, or both.
Refer to 7000 Clock In and Clock Out Methods for more information.
A rejected EVV visit transaction is an EVV visit transaction that is exported from an EVV system to the EVV Aggregator but is not accepted by the EVV Aggregator.
12010 EVV Usage Score
Revision 26-1, Effective Jan. 30, 2026
Program providers, including program providers approved as a Proprietary System Operator (PSO), FMSAs, including FMSAs approved as a PSO, and CDS employers must achieve and maintain a minimum EVV Usage Score of 80% rounded to the nearest whole percentage each state fiscal year quarter unless noted by HHSC.
Program providers, FMSAs, CDS employers and PSOs below the EVV Usage Score will be reviewed. Payers may choose to review all or a sample of program providers, FMSAs, CDS employers and PSOs that did not meet the minimum EVV Usage Score.
The data payers use to determine the EVV Usage Score is in the EVV Usage Report. Refer to 14010 EVV Portal Standard Reports.
Program Provider Score Calculations
The EVV Usage Score for a program provider and program provider approved as a PSO equals the Manual EVV Visit Transaction Score plus the Rejected EVV Visit Transaction Score.
The Manual EVV Visit Transaction Score equals the total number of electronic (nonmanual) visit transactions divided by the total number of visit transactions accepted by the EVV Aggregator and then multiplied by 60%.
The Rejected EVV Visit Transaction Score equals the number of non-rejected visit transactions divided by the total number of exported visit transactions sent to the EVV Aggregator and then multiplied by 40%.
Non-rejected visit transactions are the number of EVV visit transaction submission attempts that were not rejected.
FMSA Score Calculations
The EVV Usage Score for an FMSA and an FMSA approved as a PSO equals the Rejected EVV Visit Transaction Score.
The Rejected EVV Visit Transaction Score equals the non-rejected visit transactions divided by the total visit transactions exported to the EVV Aggregator.
Non-rejected visit transactions are the number of EVV visit transaction submission attempts that were not rejected.
CDS Employer Score Calculations
The EVV Usage Score for a CDS employer equals the Manual EVV Visit Transaction Score.
The Manual EVV Visit Transaction Score equals the total electronic visit transactions captured using the EVV system divided by the total visit transactions accepted by the EVV Aggregator.
12020 Manual EVV Visit Transaction Score
Revision 26-1, Effective Jan. 30, 2026
The Manual EVV Visit Transaction Score:
- Excludes manual EVV visit transactions with zero bill hours
- Includes manual EVV visit transactions accepted by the EVV Aggregator
- Includes EVV visit transactions with either a clock in or clock out manually entered into the EVV system
Refer to 7000 Clock In and Clock Out Methods for more information.
12030 Rejected EVV Visit Transaction Score
Revision 24-1; Effective Sept. 12, 2024
When an EVV visit transaction is sent to the EVV Aggregator and does not pass all EVV visit transaction validations, the EVV visit transaction is rejected and sent back to the EVV system. This tells the program provider, FMSA or CDS employer visit maintenance is required.
Each time an EVV visit transaction is rejected by the EVV Aggregator, it counts against the Rejected EVV Visit Transaction Score. This is true for EVV visits which are exported from an EVV system and rejected by the EVV Aggregator multiple times.
For example:
- On Monday, a program provider submits an EVV visit transaction to the EVV Aggregator and the EVV visit transaction is rejected.
- On Tuesday, the program provider completes visit maintenance and resubmits the EVV visit transaction to the EVV Aggregator. The EVV Aggregator rejects the EVV visit transaction again.
- On Wednesday, the program provider completes visit maintenance and resubmits the EVV visit transaction to the EVV Aggregator. The EVV Aggregator accepts the EVV visit transaction.
- In this scenario the Rejected EVV Visit Transaction Score will reflect:
- Two rejected EVV visit transactions
- One non-rejected EVV visit transaction
- Three total exported EVV visit transactions
A rejected EVV visit transaction only counts against the Rejected EVV Visit Transaction Score if the rejection is identified as a program provider or FMSA error.
Appendix M, EVV Visit Data Layout Edits Crosswalk, of the EVV Business Rules contains all the data elements, as applicable, and EVV visit transaction rejection reasons identified as program provider or FMSA errors that count as a rejected EVV visit transaction. Appendix M is on the TMHP Website.
12040 How EVV Usage Reviews are Conducted
Revision 24-1; Effective Sept. 12, 2024
Payers conduct EVV Usage Reviews by the following contract and agreement types:
- Program providers and FMSAs with LTC FFS contracts are monitored at the provider number level.
- Example: If a program provider or FMSA has five different LTC FFS contracts, each unique provider number will receive an EVV Usage Score.
- Program providers and FMSAs enrolled with TMHP for Acute Care FFS are monitored at the NPI or API/TIN combination level.
- Example: If a program provider or FMSA has three different NPIs or APIs with the same TIN or three different TINs, each NPI or API/TIN combination will receive an EVV Usage Score if the TIN is the same or different.
- Program providers and FMSAs with MCO contracts are monitored at the NPI or API/TIN combination level.
- Example: If a program provider or FMSA has three different NPIs or APIs with the same TIN or three different TINs, each NPI or API/TIN combination will receive an EVV Usage Score if the TIN is the same or different.
- CDS employers are monitored at the member level.
- Example: Each member who has selected the CDS option will be reviewed.