Navigating the Claims Validation Process in Missouri

Missouri’s claims validation process ensures that submitted claims align with visit data in the Electronic Visit Verification (EVV) Aggregator Solution (EAS) records for all services that require EVV.  

Discrepancies in this data will prevent claims from being paid. This guide explains Missouri’s claims validation process and what provider agencies need to know to ensure claims are successfully processed and paid.

There will be no change in the way providers submit claims. Claims will continue to move through the adjudication process with an additional check for matching visits in the EAS.  

What is the Claims Validation process?

The claims validation process compares claims data to visit data in EAS. The following data elements on the claim must match to the visit(s) in EAS:

• Provider Medicaid ID
• Department Client Number (DCN)
• Date(s) of Service
• Procedure Code/Modifier(s)
• Units (must be less than or equal to units in EAS)

Steps to Navigate the Claims Validation Process

Follow these steps for successful claims validation: 

1. Log into EAS  
   Log into the EAS at least once a week to verify accuracy of visit data and ensure visits are in a verified status.  Visits not in a verified status will not be considered for claims validation. 
2. Visits should be marked as Verified or Processed. If not, investigate and correct any issues.

Do not submit duplicate visits—duplicate visits will be marked omitted in EAS. 

Visits are considered duplicates if they share all of the same seven (7) data elements, which include:

• Provider ID
• Account Number
• Client ID
• Employee ID 
• Type of service
• Begin Time
• End Time 
   
• Create Accrued Minutes Visits (AMV)

If you are submitting a claim for accrued minutes, there must be a matching visit in EAS to account for these accrued units.  The process for creating and submitting this visit to the EAS is as follows: 

• Create the AMV in your EVV system.  This can be created manually or systematically by your EVV vendor. AMVs, whether created manually or systematically, must meet all Missouri requirements.  
• AMV must include all data elements required for a verified visit:
  • DCN
  • Provider Medicaid ID
  • Employee FCSR (can be any caregiver involved in that participant’s care during the accrual period)
  • Service type: Procedure code and modifier submitted with the original visits
    • For visits that require tasks, a new task 0280 (Accrued Minutes Visit) may be selected. This task should be utilized only for accrued minutes visits.
    • For visits requiring a memo, providers may use a default memo “This is an accrued minutes visit”
    • Visit date used must match date of service submitted on the claim. 
• Start and end time: Any time period may be used as long as it is divisible by 15 (e.g., 30 minutes, 45 minutes).  It is recommended that AMV visits do not overlap with an existing visit for the same service.
• Reason code 280 must be used to identify this as an AMV (this code should not be used for any other visit).
• All AMV must be recorded as a “Manual” call type. 
• These visits will be excluded from all auto vs manual reporting statistics.
• It is recommended to utilize the Memo field to document the service dates for when the minutes were accrued.

Understanding Claim Responses

In addition to your existing Remittance Advice process, you can also review denial information using the new Claims Validation Rejection report available in EAS. 

Here are common EVV claim denial errors and what they mean:

EVV Claim Denial Errors	Scenario
Provider ID does not match Participant ID does not match Verified visit(s) not found for the procedure code and date range	No visit found: Provider, patient or procedure/modifier do not match.
Unmatched units	No visit found: Everything matches except units in claim exceed units in visit(s).
Duplication of visit(s)	Multiple visits found: Two or more identical visits were found. Visits have the same provider, client, service, units, employee, start date and end date with both visits in a “Verified” or “Processed” state.