EVV Attestation Form Instructions

1 Department of Health COVID-19 Provisional Temporary PROVIDER ENROLLMENT ENROLL NOW welcome to ~ .. ~ MEDICAID MANAGED Office of Health Insurance Programs '="1 Login ePACES Login exchange Login PTAR Provider Portal ~~};'K I Department ~ATE of Health 1 EVV Attestation Form Instructions As a requirement of the New York State Electronic Visit Verification (EVV) Program, all provider agencies and fiscal intermediaries (FI) must submit an annual EVV Attestation to the EVV Program through the eMedNY portal. The EVV Attestation presents provider and FI responsibilities and helps ensure explicit provider and FI understanding of and compliance with New York State s EVV requirements and policies. If a provider or FI fails to submit a complete and accurate EVV Attestation by their specified deadline, the provider or FI will be referred to the Office of the Medicaid Inspector General (OMIG) for review.

2 This document provides two sets of Instructions . The first describes how to sign up for an eMedNY account, if necessary, and how to complete and submit an EVV Attestation . The second describes tasks that can be performed after submission: checking an Attestation s status or updating its information. step -by- step Attestation Instructions Begin Provider Enrollment (PE) Portal Account Creation 1. Go to 2. Click on Electronic Visit Verification (EVV) on the right-hand side of the main page. email: Electronic Visit Verification (EVV) Section 12006(a) of the 21st Centurv. Cures Act mandates that states implement EW for all Medicaid personal care services (PCS) and home health services (HHCS) that require an in-home visit by a provider. This applies to PCS provided under sections 1905(a)(24), 1915(c), 1915(i), 19150), 1915(k), and Section 1115; and HHCS provided under 1905(a)(7) of the Social Security Act or a waiver.

3 EW is a system that may include multiple point-of-care verification technologies, such as telephonic, mobile, and web- based verification inputs. The system electronically verifies the occurrence of home-or community-based service visits, identifying the time that service provision begins and ends to ensure accurate claims disbursement and safeguarding that beneficiaries who are authorized to receive services get the expected care. EW is used to: Verify visits on a real-time basis, Including date, location, type of service, individual(s) providing and receiving services, and duration of service(s) Validate hours of work for home health employees Eliminate billing data entry mistakes Reduce costs related to paper billing and payroll Help combat fraud, waste, and abuse ~MedNV ID Sign in with your username and password Username Username Password Password Forgot your password? Sign in Need an account~ n tii:1).

4 EVV Technical User Guide e' Li' Email for Attestation Provider Enrollment Provider Portal Attestation Form Interface Control document Published Rate Codes and Procedure Codes fil!l)j~ Technical Assistance Information ~~};'K I Department ~ATE of Health 2 3. Click on Attestation Form on the right-hand side of the page (under Useful Links). Sign Up for the PE Portal 1. Click on Sign up at the bottom of the PE Portal window. 2. The following stipulations are required: A valid email address is required. Your phone number must start with +1. Your password must contain a lower-case letter. Your password must contain an upper-case letter. Your password must contain a special character. Your password must contain a number. Your password must contain at least 16 characters. Note: For any questions regarding the PE Portal, please call the eMedNY Call Center at 1-800-343-9000.

5 Email: ~MedNY~ID we nave sent a code by email to n @g _com. Enter II below to confirm your account. Verification Code LI---------~ Confinn Account Didn't receive a cooe? Resend it A Welcome to your Provider Dashboard G W Manage your current applications and keep an eye on your progress as well as starting a new submission when it is convenient for you. 0 In order to begin submitting EW information you must submit an Attestation . Click here to begin the process. Let's get that enrollment going .. So far, you don't have anything submitted int o our system. Just follow the simple steps listed below and we will get you moving along as soon as possible . e > > e 7. Begi n 2. Enro ll 3. Upload Click begin to enroll step through the forms Upload required documents Begin a New Subm1ss1on + > 4 . Submit That's it. You're done. ~~};'K I Department ~ATE of Health 3 Confirm Your PIN 1.

6 You will be told a PIN was sent to the email address you used to create your account. 2. Go to your email to retrieve the PIN and enter it in the Verification Code box. 3. Click Confirm Account. Begin the EVV Attestation Process 1. Enter the Provider Dashboard on the PE Portal. 2. Click on Click here to begin the process near the top of the page. email: I EVV Attestation x We'll guide you through the EVV Attestation process To get started, please provide the organization's MMIS Provider ID or NPI number. Organization's PIO or NPI Enter PIO or Cancel :@w EVV Attestation x This is the information we found Please verify that everything looks correct, and select 'Next' to continue. Provider Name: Name Provider ID: ,1111111111 NPI: NM=IM Cancel Ni@Mi I EVV Attestation x Your user account is not currently linked to this provider To link your account to this prov ider, please select "Send PIN".

7 A 6 digit Pl N number will be sent to the correspondence email address w e have on file for this provider. Cancel 1 @1 ~~};'K I Department ~ATE of Health 4 Enter Provider Information 1. Enter the PID or NPI of the provider or FI you are submitting the Attestation for. Note: The PID is the provider ID (also known as an MMIS ID). 2. Click Next. 3. The information for the provider or FI you entered will be displayed. If this is correct, click Next. Link Your Provider or FI to Your PE Portal Account email: 15( OAt\ftUl tlQ,n EVV Attestation x Please enter your 6-digit PIN number below We have sent the PIN number to the correspondence email address we have on file for the provider. Select 'Submit' to finish linking this provider to your account and continue t o the Attestation form. PIN Number Enter 6 -digit PIN number.)

8 Cancel if f Electronic Visit Verification (EW) Attestation Instructions An EIKU orwc V'Klt VenfteatJOn (EW) Aueuauon m~t ha !.ubm1tt@d on ,1n annual ~-to the W through the Etvoflment and Ma, PofU,I Please continue to the next section to perform your Attestation . ~~};'K I Department ~ATE of Health 5 1. Click Send PIN. Note: A PIN will be sent to the email address that eMedNY has on file as the correspondence address attached to the provider ID. The PIN is not sent to the email address you used to create an account for the PE Portal. a. Your correspondence email address can be verified by contacting the eMedNY Call Center at 1-800-343-9000. b. If you need to change your correspondence email address, click on Change Email for Attestation under Useful Links on the right-hand side of the eMedNY EVV page. Confirm Your PIN 1. After the PIN has been sent to the correspondence email address, it can be retrieved and entered in the PIN Number box.

9 2. Click Submit. Note: For assistance with any part of this process, please contact the eMedNY Call Center at 1-800-343-9000. Begin Entering Information on the Attestation Form 1. You can start the Attestation form after you have successfully submitted the PIN. 2. The electronic Attestation form has three sections: Introduction, Attestation , and Submitters. 3. Read the Introduction and click Next. email: I PMedNY Provider Enrollment "''"-'"'""' ~ "' ss MySectlons I .,, Attestation ~ m-.~.~~C:0~ 0 ll"IHOdUC11on Q Subm,ttefS ---New York Electronic V isit verif ication (EW) Prov ider Attestation New York St t chown to 1mplem 1t illn EW S)'U m llowir19 Provdtor~rw: l lnte,rmtod ;ar-to Sfi t n EW s;, of lh r ctioec th t tlw requirements of lh 21~ Century curn Act. :11 . 1 /l> ~i.: t~fSCilll 1n:.,-m J1 )'/ 1,,;nchr5-t nd th ill I illffi r~'C- ble n'il th ~nU of th 21~ C-,,t\lryCurft Act~ !

10 1-pnwd 2016. lid Vofk S-t t SfMC hc: r,tq,1,1 ,.l"l'lff"llS O\.lt .~ ,n t~ ,., Yo,k .. Ei r,o,,,c v,s,r W,rdf('i11(1on (; (Hlrnn #nd ~l,IU~U docum., <II Qn th NVS EW ,,t 1 ht>re-bj ~rH thilll t ill l'l "'tl hH bMn pror,,lded to " 1.,q, , uMrs illnd ..,.,11 ~ p,OV>dl'd to future vwr,. {P,IOf to UHi of the UTlt)lemfflted Elotetronic Vtl+t (tvv) t,em nd thillt training w1'l b4> ptO\IICMd on illl"I Ol'"iiJOl!\O bt$1$ 1 htorflll'/ grHth t a,11 c,a,1~..,..1,who m"t tlw ~f1n1t10n ~vv1,..,..,,, ur4-9~ exemption statusO\olV nf'd., ,v ~ su,reEl rr~ v,s,r \!Wlf~ r,on PYOfJr m cu,(hlmn nd!Q".,qv,ftlfflt'ltUdoc:um.,,t NW Cutf nt ~ffllt'lfflt r~n,eyKUibl!Sh~ ~ tMCOf'IIUmff-lnd CM~iv-r onf ,., I Mr~-0'" to iw.,p "-Kh le,;ot'dS M 1 ~wiry to dt>mon'5-tr t I~ .u 21'" Ce-ntu,y Act p, 1 ,11t ~nts l'ld N4'W Voll,; SWl N to ,u,n.,Sh thow lO th<t ,..wYOrk St t De,panmentofMe-alth loot-!))))}