Under Social Services Law, certain certified home health agencies, long term home health agencies or personal care providers exceeding $15 million in Medicaid fee-for-service and/or Medicaid managed care reimbursements are required to utilize a verification organization (VO) to perform a pre-claim review. Participating providers are required to contract with a VO vendor that uses electronic means of verification, including but not limited to contemporaneous telephone verification or contemporaneous verified electronic data to ascertain whether a service or item was provided to an eligible Medicaid recipient.
The VO must verify the home health service(s) within the claim or encounter, collected from the electronic visit verification (EVV), prior to submission of the claim or encounter to the Department of Health (DOH) or to a managed care provider.
Many providers in New York State, especially in New York City (NYC), are familiar with EVV technology. NYC Human Resources Administration (HRA) has for many years stipulated the use of this technology for Medicaid Personal Care Level 2 providers and recently also stipulated the use of a VO vendor. HRA's VO requirements are not the same as those required by OMIG.
To assist the Medicaid provider community, OMIG will periodically develop a list of the participating providers who are required by the OMIG to contract with a VO and will notify them by certified letter. Only providers who receive notification from OMIG are required to have their services verified by a VO.
Providers must select their VO from the joint OMIG/DOH list of approved VOs, which appears below. Please note that the VO selected does not have to be the same vendor utilized for EVV services.
Providers who have questions regarding their status and/or VO requirements may contact OMIG at [email protected].
More information about NYS Medicaid Requirements for Home Health Providers and VOs is available here:
NYS Medicaid Requirements for Home Health Providers and Verification Organizations