EVV Reason Codes

Please click here to see the updated reason codes in PDF format.

The Texas Department of Aging and Disability Services (DADS) has developed a presentation that provides an overview of how the use of the electronic visit verification (EVV) system and reason codes impact provider compliance under the Compliance Plan.

Each time a change is made within the Electronic Visit Verification (EVV) system, a reason code must be entered to provide the Texas Department of Aging and Disability Services (DADS) with information regarding the reason a change was made to the electronic record.

The following reason codes must be used when making updates or corrections in Visit Maintenance and when manually verifying visits. There is also the ability to add free text in the Comments section to provide additional information. However, a reason code(s) must first be selected before adding supporting comments. Providers and Consumer Directed Services (CDS) Employers must associate appropriate reason code(s) with each update made in Visit Maintenance.

Reason codes fall into one of two categories: Preferred Reason Codes and Non-Preferred Reason Codes.  A preferred reason code is a code that documents visit maintenance necessitated by a situation in which the provider staff are delivering and documenting services in accordance with DADS expectations. A non-preferred reason code is a code that documents visit maintenance that is necessitated by a situation in which the provider staff is not delivering and documenting services in accordance with DADS expectations.

When noting the actual time the service delivery occurred, Providers and CDS Employers must use the Comments field to clearly document the actual start and end times worked by the employee. Additionally, Providers and CDS Employers must use the Comments field when there are not calls to verify this information. The table below outlines all specific reason codes as well as examples of use.

Code Reason Code DADS Examples of Use Preferred?
01 Wrong Phone Number — Verified Services Were Delivered Reason Code 01 is used when calls for a visit are received from a number that is not recognized by the EVV system. This is a NON-preferred reason code. No
02 Invalid Attendant or Individual ID Entered — Attendant Verified Reason Code 02 is selected when an attendant does not accurately enter the entirety of his/her employee ID and/or the individual’s Client ID into the EVV system. This is a preferred reason code. Yes
03 Phone Unavailable — Verified Services Were Delivered Reason Code 03 is selected when the attendant cannot use the phone to call-in and/or call-out because the phone is in use when the service provision begins or ends (e.g., the individual is on the line with his/her doctor when the attendant begins the shift). If this becomes a routine issue, a Fixed Visit Verification device should be ordered. This is a preferred reason code. Yes
05 Multiple Calls For One Visit Reason Code 05 is used when an attendant makes multiple calls for a single scheduled visit. Code 05 is not used if technical issues with the phone prevent the attendant from calling in. Code 18 should be used for technical problems with the phone. This is a NON-preferred reason code. No
06 Attendant Failed to Call In and Out — Verified Services Were Delivered Reason Code 06 is used when an attendant fails to use the EVV system to call in and call out (e.g., the attendant fails to call in and call out on the individual’s landline, or the attendant fails to enter the Fixed Visit Verification device values in the system). Free text is required in the Comment field; the provider must record the actual time service delivery begins and ends in the Comment field. This is a non-preferred reason code. No
08 Fill-in for Regular Attendant Reason Code 08 is selected when someone other than the scheduled attendant provides services. This is a preferred reason code. Yes
10 Individual Does Not Have Home Phone — Verified Services Were Delivered Reason Code 10 is selected when an individual qualifies for and requires the use of a Fixed Visit Verification device, but one has not yet been requested by the provider. Because Fixed Visit Verification devices should be ordered promptly, use of RC 10 for the same individual over a period greater than 14 calendar days may constitute misuse of this preferred reason code. This is a preferred reason code. Yes
11 Companion Case Reason Code 11 is selected when the attendant delivers services to two or more individuals in the same household and only uses the individuals’ landline to call in once and call out once for the entirety of the visit. This is a preferred reason code. Yes
12 Service Suspension Reason Code 12 is selected when the provider has suspended the individual's services per program policy (e.g., the individual is in the hospital or temporarily in a nursing facility). All situations that require documentation must be documented according to program policy. This is a preferred reason code. Yes
13 Individual Refused Attendant Use of Phone — Verified Services Were Delivered Reason Code 13 is selected when an attendant cannot use the phone to call in or call out of the system because the individual refuses to allow the attendant to use the phone in this particular instance (e.g., the individual does not trust the fill-in attendant and chooses not to allow the fill-in attendant access to the phone). If this becomes a routine issue, a Fixed Visit Verification device should be ordered. This is a preferred reason code. Yes
14 Consumer Directed Services (CDS) Employer Time Correction Reason Code 14 is ONLY used by individuals self-directing their services using the CDS option who need to correct an EVV entry. This code should only be used by CDS employers or Financial Management Services Agencies (FMSAs). This is a preferred reason code. Yes
15 Services Provided Outside the Home — Supported By Service Plan or Verified with Individual Receiving Services Reason Code 15 is selected when the attendant cannot call in and/or call out because some or all of the scheduled services were provided outside of the home in accordance with program policy. This is a preferred reason code. Yes
16 Fixed Visit Verification Device Has Been Ordered — (Initial or Replacement Order) Reason Code 16 is selected when a Fixed Visit Verification device has been ordered, but the provider has not yet received the device. This is a preferred reason code. Yes
17 Individual Does Not Qualify for Fixed Visit Verification Device — Verified Services Were Delivered Reason Code 17 is only used to document service delivery to individuals who do not have a home phone available for EVV and are authorized or scheduled to receive services less than once a week. These individuals do not qualify for a Fixed Visit Verification device. This is a preferred reason. Yes
18 Phone Lines Not Working —Attendant Not Able to Call — Verified Services Were Delivered Reason Code 18 is used to document service delivery when call in or call out is not available due to technical problems (e.g., phone lines down, individual’s phone is not working, etc.) This is a preferred reason code. yes
20 Attendant Failed to Call In — Verified Services Were Delivered Reason Code 20 is used when an attendant fails to use the EVV system to call in. Free text is required in the comment field to document the actual “call in” time. This is a non-preferred reason code. No
21 Attendant Failed to Call Out — Verified Services Were Delivered Reason Code 21 is used when an attendant fails to use the EVV system to call out. Free text is required in the comment field to document the actual “call out” time. This is a non-preferred reason code. No
22 Individual Agreed or Requested Attendant Not Work Schedule Reason Code 22 is selected when the attendant does not work and the individual was contacted and agreed to the change in schedule, or the individual contacted the agency and requested attendant not work. All situations that require documentation must be documented according to program policy. This is a preferred reason code. Yes
24 Downward Adjustment to Billed Hours Reason Code 24 is used when the time billed is adjusted downward to offset rounding. (e.g., 7:55 a.m. for a shift starting at 8:00 am and 11:05 am for a shift ending at 11:00 am). Free text is not required. This is a preferred reason code. Yes
25 Respite Hours Reason Code 25 is selected when in-home respite hours are provided. This is a preferred reason code. Yes
26 Medicaid Reinstatement: Service Hours Worked Reason Code 26 is selected when visits that were documented on paper time sheets during the time period when the individual's Medicaid eligibility was suspended, and the provider chooses to deliver services, are entered into the EVV system through visit maintenance after the individual's Medicaid eligibility has been reinstated. This is a preferred reason code. Yes
27 Schedule Variation Reason Code 27 is used when the attendant provides more or fewer hours of service to the individual than scheduled. All situations that require documentation must be documented according to program policy. This is a preferred reason code. Yes
28 Malfunctioning Fixed Visit Verification Device and/or Invalid Fixed Visit Verification Device Value — Verified Services Were Delivered Reason Code 28 is selected when a Fixed Visit Verification device malfunctions and/or provides invalid values. Free text is required in the comment field; the provider must document the actual time service delivery begins and ends in the comment field. If RC 28 is used for the same individual over a period greater than 14 calendar days, a replacement Fixed Visit Verification device should be ordered. This is a preferred reason code. Yes
29 Fixed Visit Verification Device Pending Placement Reason Code 29 is selected when a Fixed Visit Verification device has been received by the provider, but the provider has not yet placed the device in the individual’s home. Because Fixed Visit Verification devices should be placed promptly, use of RC 29 for the same individual over a period greater than 14 calendar days may constitute misuse of this preferred reason code. This is a preferred reason code. Yes
99 Other This code is selected when a provider must address a system exception that cannot be addressed using one of the pre-existing reason codes. This code must always be accompanied by a free text explanation entered in the Comment field denoting why use of this code was required. This is a NON-preferred reason code. No

 

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Updated: December 9, 2014