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EVV matching is what turns a verified visit into a billable claim line, and the audit trail that shows how.

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EVV Bill Codes

Texas Medicaid EVV Service Bill Code Configuration (Version 12.1) with HCPCS codes, modifiers, unit types, and temporal claim denial rules. Columns: Payer · Program · Service · HCPCS · Mod 1 · Mod 2 · Mod 3 · Mod 4 · Unit Type · Units Matched · EVV · Effective Begin · Effective End · Denial Begin

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What each field controls

Denial Begin is a temporal rule. Claims for service dates on or after that date are denied without a matching EVV transaction, while earlier dates may still pay. A configuration that worked last year can start producing denials once this date passes.

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Modifier combinations matter

The same HCPCS code with different modifiers can represent different services at different rates. The modifier set is part of what the payer matches on, so an incomplete modifier combination produces a denial even when the base code is right.

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EVV Match Results

Audit trail of EVV claims matching outcomes showing which bill code rule was applied and any unit discrepancies. Columns: Claim · Service Date · HCPCS · Modifiers · Result · Billed Units · Visit Units · Variance · Evaluated This is where you find out why a claim line looks the way it does.
A non-zero Variance is the fastest explanation for “the claim does not match the visit”. Check it before investigating the visit or the schedule.

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Diagnosing a claim that will not generate

1

Confirm the visit verified

The visit must be COMPLETED with no outstanding exception. See Time & Attendance.
2

Find the bill code rule

Filter EVV Bill Codes by payer, program, and service. If no rule exists, no claim line can generate.
3

Check the effective window

The service date must fall between Effective Begin and Effective End.
4

Check the match result

EVV Match Results shows whether matching ran and what it concluded.
5

Compare units

A large Variance points at the visit’s clock times or the unit type configuration.

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Troubleshooting

The bill code configuration follows Texas Medicaid EVV Service Bill Code Configuration Version 12.1. When the state publishes a new version, the configuration needs updating to match.

Claim lines

What matching produces.

Time & Attendance

The visits being matched.