Sandata Alternative in Wisconsin: Third-Party EVV Vendors
Compare a third-party EVV vendor with Wisconsin's state-sponsored Sandata system for personal care and supportive home care: certification and claims.
Resources
State-Sponsored Sandata or an Alternate EVV System?
Sagar Kumar, COO and Co-Founder, Verveware
Looking for a Sandata alternative in Wisconsin? Homecare agencies can use a third-party EVV vendor, which the Wisconsin Department of Health Services (DHS) calls an "alternate EVV system." The other option is the state-sponsored Sandata system that DHS provides. Either way, visits flow through the Sandata aggregator. Verveware's alternate EVV system is certified for use in Wisconsin. The state system focuses on EVV. These aren't listed among its features in the DHS sources we reviewed:
Billing
Payroll hours export
Care notes
Private-pay clients
Training tracking
Verveware adds billing for state/Medicaid, MCO and private-pay clients alongside EVV.
Which Wisconsin Services Need EVV
DHS requires EVV for personal care services (PCS) under these programs:
ForwardHealth Medicaid and BadgerCare Plus fee-for-service
BadgerCare Plus and Medicaid SSI HMOs
Family Care
Family Care Partnership
IRIS
The codes that need EVV are S5125, S5126, T1019 and T1020, which cover personal care and supportive home care. New to EVV? See what an EVV system is.
Personal care and supportive home care: soft launch November 2, 2020; hard launch May 1, 2023.
How Wisconsin Matches Claims to EVV Visits
DHS sources don't set a compliance percentage. Instead, claims are matched against verified EVV visits one by one. For fee-for-service claims with no matching verified EVV visit, the claim is suspended for 2 business days and then denied (EOB 1047). The EVV units also have to cover the billed units (EOB 1048). HMOs and MCOs set their own EVV payment policies and may deny claims. At hard launch, the consequences DHS listed were claim denial, exclusion from capitation rate setting and possible IRIS disenrollment.
What the State-Sponsored Sandata System Covers
The DHS-provided Sandata system captures visits through:
A mobile app
A phone (telephonic visit verification)
A fixed device in the home
An alternate EVV vendor uses its own caregiver mobile app instead. The Sandata system also includes a provider portal and the aggregator. Only verified visits go to payers, and they're sent daily. For help, Wisconsin EVV Customer Care is at 833-931-2035 or vdxc.contactevv@dhs.wisconsin.gov, Monday to Friday, 7 a.m. to 6 p.m. CT.
What You Still Do by Hand
None of these are listed among the state system's features. Here's the manual work they leave.
Billing. By hand: you build claims for ForwardHealth fee-for-service and each HMO or MCO, then work denials when a claim doesn't match a verified visit or the units don't line up.
Private-pay clients. By hand: they need their own scheduling, records and invoicing outside the state system.
Payroll hours. By hand: every pay period, you pull visit hours, check them, and re-key them into your payroll system.
Care notes and documents. By hand: notes and files live in shared drives, on paper or in another app.
Training records. By hand: you track when each worker took a training, when the next one is due, and where the certificate is.
None of this is a criticism of Sandata. The state system is built for EVV and aggregation. The question is who handles the rest.
How Alternate EVV Certification Works in Wisconsin
DHS's Alternate EVV Certification Process Checklist (P-02663A) lays out the steps:
Contact Sandata to start certification.
Sign the attestation (F-02659).
Add workers in the ForwardHealth Portal and give their EmployeeIdentifiers to your vendor.
Complete the Sandata aggregator training. DHS requires this for administrators.
DHS says to allow up to three months. The process is shorter if your vendor is already certified in Wisconsin. You can keep using Sandata until your alternate system is ready, and DHS may require a demo or recertification. DHS isn't responsible for alternate-system costs, including interfacing with the Sandata aggregator.
Verveware's alternate EVV system is already certified for use in Wisconsin. Your agency still completes its own steps, such as the attestation, adding workers in the ForwardHealth Portal and aggregator training.
To see how this works in another state, read how this works in Illinois. If you're thinking about switching, see how implementation works.
What a Third-Party EVV Vendor Adds
Ask yourself:
How many hours go into claims, denials and payroll prep?
Can you find care notes and training records quickly?
Do you serve private-pay clients?
Verveware's EVV software includes:
Real-time EVV compliance tracking, so you can see where your visits stand.
Scheduling and case notes in one place.
Document storage.
Billing for state/Medicaid, MCO and private-pay clients, including MCO billing and private-pay billing.
Payroll hours export to ADP, Paylocity and QuickBooks. Verveware exports the hours; your payroll provider runs payroll.
Billing is not listed among the state system's features; with Verveware, EVV and billing run in one system. These tools support your records. They don't replace documentation required by DHS or your HMO or MCO.
FAQ
Do I Have to Use Sandata for EVV in Wisconsin?
No. Wisconsin DHS lets agencies use either the state-sponsored Sandata system or an alternate EVV system. An alternate system must be certified and integrate with the Sandata aggregator, which sends only verified visits to payers each day. You can keep using Sandata until your alternate system is ready.
Is the Sandata EVV System State-Sponsored in Wisconsin?
Yes. DHS provides the Sandata EVV system to provider agencies as the state-sponsored option. If you choose an alternate EVV system instead, DHS isn't responsible for its costs, including the cost of interfacing with the Sandata aggregator. Check DHS's EVV pages for current requirements.
Which Services Need EVV in Wisconsin?
Personal care and supportive home care services billed under S5125, S5126, T1019 and T1020 need EVV across ForwardHealth fee-for-service, BadgerCare Plus and Medicaid SSI HMOs, Family Care, Family Care Partnership and IRIS. Check DHS's service-code list for the current scope.
How Long Does Alternate EVV Certification Take?
DHS says to allow up to three months. You contact Sandata to start, sign attestation F-02659, add workers in the ForwardHealth Portal, and complete aggregator training. The process is shorter if your vendor is already certified in Wisconsin, and DHS may require a demo or recertification.
Is There an EVV Compliance Percentage in Wisconsin?
DHS sources don't set a compliance percentage. Instead, Wisconsin matches claims to verified EVV visits. For fee-for-service, a claim with no matching verified visit is suspended for 2 business days and then denied, and EVV units must cover the billed units. HMOs and MCOs set their own EVV payment policies.
See Verveware With Your Wisconsin Workflow
Verveware's alternate EVV system is certified for use in Wisconsin. Request a Verveware demo to see EVV, scheduling, case notes, billing and payroll hours export together for your agency. Book a demo.
