Provider Billing Support Change
There has been a change with who to contact at Inclusa when authorization and billing/claim support is needed.
This change will be effective immediately for the following service types:
- Adult Day Care
- Daily Living Skills Training
- Day Services
- Prevocational Services
- Vocational Planning/Support
- Supported Employment
Moving forward, the new contact will be:
Email: ACS-SHC-SDS-HomeHealth@inclusa.org
Phone: 1-888-544-9353, ext. 7
Home Health and Nurse Supervisory EVV Soft Launch Information for January 1, 2024
On January 1, 2024, the Wisconsin Department of Health Services (DHS) will implement the soft launch requirements for Electronic Visit Verification (EVV) for home health care services (HHCS) and nurse supervisory visits using the following service codes:
- Personal Care Nurse Supervisory Visit (T1019 and T1020)
- Service Code 99509 – Home visit for assistance with activities of daily living and personal care
- Private Duty Nursing (Independent Nurses and Agency Nurses)
- Service Code 99504 – Home visit for mechanical ventilation care
- Service Code S9123 – Non-vent private duty nursing care in home, by Registered Nurse (RN)
- Service Code S9124 – Non-vent private duty nursing care in home, by Licensed practical nurse (LPN)
- Non-Private Duty Nursing (Independent Nurses and Agency Nurses)
- Service Code 99600 – Unlisted home visit service or procedure
- Service Code T1001 – Nursing assessment/evaluation
- Service Code T1502 – Administration of oral, intramuscular, and/or subcutaneous medication
- Service Code T1021 – Home health aide or Certified Nursing Assistant (CNA)
- Therapy
- Service Code 92507 – Treatment of speech, language, voice, communication, and/or auditory processing disorder
- Service Code 97139 – Unlisted therapeutic procedure – Occupational Therapy
- Service Code 97799 – Unlisted physical medicine/rehab service or procedure – Physical Therapy
For a full listing of all service codes identified for EVV, visit: https://www.dhs.wisconsin.gov/evv/service-codes.htm
Soft launch is the time to learn and use the EVV system without affecting payments! Below are a few resources and supports to assist providers in preparing for EVV.
Resources
- ForwardHealth Update 2023-40: an announcement from DHS providing extensive details related to EVV and Home Health services.
- ForwardHealth Update 2021-41: an announcement from DHS providing extensive details related to EVV and Nurse Supervisory Visit Service Code 99509.
- New to EVV Flyer: a great introduction to the required system, outlining steps to get started.
- What is EVV Flyer: a brief overview of the system and where to learn more.
- Wisconsin Electronic Visit Verification: a brief video focusing on the basics of EVV.
- EVV Fundamentals: a 30-minute training video about EVV and where to find resources.
- DHS EVV Training Page: a resource page on how to train workers and agency administrators.
- DHS EVV Website: a singular location to access these and all EVV related resources.
Supports
Inclusa is here to support providers with any contract or authorization specific questions as it relates to your contracted services.
- Contact Provider Relations at 877-622-6700 (select option 2, then option 3) or ProviderRelations@inclusa.org to discuss contract or service-related information.
- Contact Inclusa’s Home Health Authorizations & Claims Support Team at ACS-SHC-SDS-HomeHealth@inclusa.org or 888-544-9353 (select option 7) to discuss authorization or billing related information.
Wisconsin EVV Customer Care is available to provide support throughout the soft launch transition as it relates to the EVV vendor system. Customer Care is accessible by email at vdxc.contactevv@wisconsin.gov or by phone (in English, Hmong, and Spanish, among other languages) at 833-931-2035 Monday–Friday, 7 a.m.–6 p.m. CT.
Sign up for the DHS email list to receive updates and notifications on training opportunities, policy information, and other important details regarding EVV in Wisconsin.
EVV Hard Launch Information
On May 1, 2023 the Wisconsin Department of Health Services (DHS) implemented the hard launch of the Electronic Visit Verification (EVV) system for hands-on cares for the following Service codes:
- T1019 and T1020 – Personal Care services; per 15 minutes and per diem
- S5125 and S5126 – Attendant Care services; per 15 minutes and per diem
Claims will be denied for dates of service on May 1, 2023 and thereafter, if EVV requirements are not followed. Below are a few resources, reminders, and supports to assist impacted providers.
Resources
- New to EVV Flyer: a great introduction to the required system, outlining steps to get started.
- What is EVV Flyer: a brief overview of the system and where to learn more.
- Wisconsin Electronic Visit Verification: a brief video focusing on the basics of EVV.
- EVV Fundamentals: a 30-minute training video about EVV and where to find resources.
- DHS EVV Training Page: a resource page on how to train workers and agency administrators.
- DHS EVV Website: a singular location to access these and all EVV related resources.
- EVV Provider Billing Facts: a resource from Wisconsin Physicians Service (WPS), Inclusa’s Third Party Administrator (TPA) (claims processor), providing guidance to support the claims and billing process.
Important Reminders
EVV Visit Key Needed: Workers are required to check in/out using an EVV system at the start and the end of each visit. Claims without an EVV Visit Key will be denied. The EVV Flyers above provide further details regarding the EVV Visit Key.
No Date Span Billing: Claims for the related services must be submitted separately for each date of service. Claims submitted using date span billing will be denied. The WPS EVV Provider Billing Facts link above provides further details and helpful tips regarding claims and billing.
Date Span Example: A member received services on 14 dates in the month of May. Date span billing is when a date span of 5/1/2023–5/31/2023 is submitted for total units (days) and total charges. Instead, submit each day separately with units and charges on 14 individual claim lines.
Supports
Wisconsin EVV Customer Care is available to provide support throughout the process. Customer Care is accessible by email at vdxc.contactevv@wisconsin.gov or phone at 833-931-2035 Monday–Friday, 7 a.m.–6 p.m. CT.
Inclusa Authorization and Claims Support Team is available to provide support with authorization and claims:
- Supportive Home Care/Personal Care – contact ACS-SHC-SDS-HomeHealth@inclusa.org or 1-888-544-9353, option 7.
- Community Supported Living – contact ACS-Residential-CSL-NH@inclusa.org or 888-544-9353, Option 6.
Inclusa Provider Relations Team is available to provide support with contracting questions. Please contact your local Program Manager, ProviderRelations@inclusa.org, or 877-622-6700, option 2, then option 3.
Humana to Expand Medicaid Services in Wisconsin with Acquisition of Inclusa, Inc
We are excited to announce that Humana has agreed to purchase substantially all of Inclusa’s assets. This acquisition will allow us to create a model of care that provides industry-leading support for members across the health care continuum.
“Since our founding in 2000, the mission of Inclusa has been to maximize health outcomes for our members by proactively partnering with others to build vibrant and inclusive communities in Wisconsin that offer people dignity, choice, and connections,” said Mark Hilliker, Inclusa chief executive officer. “I am proud of the success we have achieved and look forward to the greater impact our team can have as part of Humana.”
This partnership upholds the continuity of Inclusa’s culture and locally-rooted legacy, while expanding its contribution within Humana’s national Medicaid platform. Thank you for joining us in this exciting opportunity.
Press Release: Humana Inc. – Humana to Expand Medicaid Services in Wisconsin with Acquisition of Inclusa, Inc.
We will share more information as it becomes available.
2021 State Directed HCBS Rate Increase – Impacted Service Codes
Family Care HCBS Inclusion Logic
SPCs Covered
102.00 | Adult Day Care |
110.00 | Daily Living Skills Training |
706.00 | Day Habilitation Services |
202.11 | AFH 1-2 bed (care&supervision) |
202.22 | AFH 3-4 bed (care&supervision) |
506.71 | CBRF- 5-8 bed (care&supervision) |
506.76 | CBRF- greater than 8 beds (care&supervision) |
711.02 | RCAC- (care&supervision) daily |
103.99 | Respite Care |
104.00 | Supportive Homecare – Daily |
104.20 | Supportive Homecare |
104.30 | Supportive Homecare |
Procedure Codes Not Covered
S5120 | Chore Services, per 15 min |
S5121 | Chore Services, per day |
Covered Supported Employment Codes
108.10 | Prevocational Services |
114.00 | Vocational Futures Planning & Support |
615.00 | Supported Employment |
615.10 | Supported Employment- Integrated |
Procedure Codes:
H2025 | Supported employment, ongoing coaching |
T2014 | Community based prevocational services |
T2015 | Community based prevocational services |
T2018 | Integrated: 1-2 Members |
T2019 | Integrated: 1-2 Members |
T2038 HJ | Voc Futures Planning |
Family Care Partnership HCBS Inclusion Logic
Procedure Codes Not Covered: A0000 through R9999
Revenue Codes Not Covered: 0550 through 0559
Procedure Codes Covered
99509 | RN Supervisory visit for personal care |
99600 | Skilled Nursing services |
H2014 | Daily Living Skills Training |
S5100 | Day care services, adult; per 15 minutes |
S5101 | Day care services, adult; per half day |
S5102 | Day care services, adult; per diem |
S5105 | Adult day care: SERVICE NOT INCLUDED IN PROGRAM FEE, per diem |
S5125 | Attendant Care, per 15 mins |
S5126 | Attendant Care, per day |
S5130 | SHC-Routine Health Care Service |
S5136 | Supportive Home Care – per day: Community Supported Living |
S9125 | Respite care-institutional setting, per diem |
T1005 | Respite care in the home, per 15 minutes |
T2012 | Daily Living Skills; per day |
T2013 | Daily Living Skills per hour |
T2021 | Day Services; per 15 minutes |
S5135 | Companion Care; per 15 min |
T2020 | Community-Based Day Services, per day |
Revenue Codes Covered
0220 | AFH bedhold ancillary residential care services only; per day |
0229 | CBRF bedhold ancillary residential care services only, day |
0240 | AFH- 1-2 bed C/S |
0241 | AFH- 3-4 Bed C/S |
0242 | CBRF < 8 bed C/S |
0243 | CBRF > 8 bed C/S |
0670 | RCAC- C/S |
0672 | SHC- C/S |
Supported Employment Codes Covered
H2025 | Supp Employ Coaching, hour |
T2014 | Prevocational services; per diem |
T2015 | Prevocational services; per hour |
T2018 | Supported Employment |
T2019 | Supported Employment |
T2038 HJ | Voc Futures Planning |