> ## Documentation Index
> Fetch the complete documentation index at: https://docs.officeridge.com/llms.txt
> Use this file to discover all available pages before exploring further.

# EVV matching

> Texas Medicaid EVV bill code configuration and the audit trail of matching outcomes.

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

## 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

### What each field controls

| Field                     | What it controls                                                       |
| ------------------------- | ---------------------------------------------------------------------- |
| **Payer / Program**       | Which payer and program the rule applies to                            |
| **Service**               | The service the rule covers                                            |
| **HCPCS**                 | The procedure code submitted on the claim                              |
| **Mod 1–4**               | Modifiers that qualify the procedure code                              |
| **Unit Type**             | How units are counted for this service                                 |
| **Units Matched**         | How units are reconciled against the EVV visit                         |
| **EVV**                   | Whether the service requires a matching EVV transaction                |
| **Effective Begin / End** | The window the rule applies in                                         |
| **Denial Begin**          | When the payer began denying claims lacking a matching EVV transaction |

<Warning>
  **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.
</Warning>

### 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.

## 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.

| Column           | What it tells you            |
| ---------------- | ---------------------------- |
| **Result**       | The outcome of matching      |
| **Billed Units** | Units placed on the claim    |
| **Visit Units**  | Units the EVV visit recorded |
| **Variance**     | The difference between them  |
| **Evaluated**    | When matching ran            |

<Tip>
  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.
</Tip>

## Diagnosing a claim that will not generate

<Steps>
  <Step title="Confirm the visit verified">
    The visit must be `COMPLETED` with no outstanding exception. See
    [Time & Attendance](/attendance).
  </Step>

  <Step title="Find the bill code rule">
    Filter **EVV Bill Codes** by payer, program, and service. If no rule exists, no claim line can
    generate.
  </Step>

  <Step title="Check the effective window">
    The service date must fall between **Effective Begin** and **Effective End**.
  </Step>

  <Step title="Check the match result">
    **EVV Match Results** shows whether matching ran and what it concluded.
  </Step>

  <Step title="Compare units">
    A large **Variance** points at the visit's clock times or the unit type configuration.
  </Step>
</Steps>

## Troubleshooting

| Problem                                        | What to check                                                                     |
| ---------------------------------------------- | --------------------------------------------------------------------------------- |
| No claim line for a verified visit             | No bill code rule matched the payer, program, and service combination.            |
| Claims deny for missing EVV                    | The service date is on or after **Denial Begin** and no matching visit was found. |
| Billed units differ from visit units           | Check **Variance** and the **Unit Type** on the bill code rule.                   |
| A rule stopped applying                        | **Effective End** has passed. Configure the successor rule.                       |
| Denials started without any change on our side | A **Denial Begin** date passed, or the payer published a new bill code version.   |

<Note>
  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.
</Note>

## Related

<CardGroup cols={2}>
  <Card title="Claim lines" icon="list" href="/billing/claim-lines">
    What matching produces.
  </Card>

  <Card title="Time & Attendance" icon="clock" href="/attendance">
    The visits being matched.
  </Card>
</CardGroup>