Electronic Visit Verification

What is EVV?

Section 12006 of the 21st Century Cures Act requires the North Carolina Department of Health and Human Services (NCDHHS) begin using an Electronic Visit Verification (EVV) system for Personal Care Services (PCS) by Jan. 1, 2021, and for Home Health Care Services (HHS) by January, 2023.

EVV uses technology to record the times, dates and specific services that are given. This helps make sure people who should receive services, in fact, receive them.

What's New?

See new Managed Care Home Health Electronic Visit Verification Escalation guidance below under Contact Information for a list of EVV vendor contacts who can assist with unresolved issues.

See new Home Health Crosswalk Guidance for Managed Care Service Codes, Description of Services and Prior Authorizations under the Provider Resources and Service Codes section.

See the new Reminder for Home Health Providers: Associations in the Sandata System bulletin posted Jan. 24, 2024. 

Electronic Visit Verification (EVV) for Medicaid-funded Personal Care Services (PCS) and Home Health Services (HHCS)

Section 12006(a) of the 21st Century Cures Act mandates that states implement Electronic Visit Verification (EVV) for all Medicaid-funded Personal Care Services (PCS) and Home Health Services (HHCS) that require an in-home visit by a provider.

See the Manual Entries and Sandata Mobile Connect 2.0 bulletin posted Jan. 29, 2024. 

Appropriate Use of EVV

The purpose of the Electronic Visit Verification is to track and monitor timely service delivery and help to assure access to care for Medicaid beneficiaries. EVV uses technology to record the following to ensure people who should receive services receive them:

  • Type of service performed
  • Person receiving the service
  • Date
  • Location
  • Person providing the services, and
  • Service begin and end times

There are several ways to electronically capture this information. Occasionally, manual edits are needed to update or correct a record. A manually entered visit is defined as one where there is no electronic check-in and check-out, and the visit information is typed in manually. While sometimes necessary, manually entered visits do not meet CMS requirements for an EVV visit and should be a rare occurrence.

North Carolina’s goal is that providers routinely use electronic means to capture visits and manage their processes so the percentage of manually entered visits is fewer than 15 percent.

There are four methods used to capture EVV Data Elements; the device types are:

  • Smart device using mobile app (MVV) (preferred method)
  • Fixed Visit Verification device (FVV) FOBs, which is also recommended
  • Telephony, (TVV)
  • Manual (not preferred, rare)

NC Medicaid EVV Monitoring Plan

As part of its EVV monitoring plan, NC Medicaid reviews provider’s level of compliance with EVV and their use of manual entry. NC Medicaid has identified some providers who are continuing to manually enter visits that does not align with the intended usage of EVV data capture.

To initiate this effort, all providers that have 100% manual entries will be required to implement a plan to reduce manual visit capture and use a smart device using mobile app (MVV), fixed visit verification device (FVV) or telephony (TVV) for visit capture a minimum of 85% of the time. Providers will be contacted and requested they attest that the use of manual entry will occur only when unavoidable and the organization’s procedures, practices and training requirements support NC EVV
characteristics.

All providers are encouraged to assess and analyze their operating procedures and make necessary changes to come into compliance. This includes a review of your organization’s procedures and
practices, training requirements and other EVV related activities.

For minimum requirements for providers subject to EVV, please use the links below to access NC Medicaid Clinical Coverage Policies:

NC EVV Hot Topics Training Sessions

Have questions about Electronic Visit Verification (EVVTM)? Now is your chance to ask away!

Sandata is excited to announce the launch of General Topic Sessions for the North Carolina Home Health Implementation.

Throughout June and July, Sandata will be hosting weekly sessions centered on different topics to help providers become more familiar with the EVV system. Learners can bring related questions to share via chat or voice during the Q and A part of the session. Additionally, these sessions will include a review of training resources for the NC provider community available on Sandata On-Demand.

Hot Topics Session Registration

Please visit the Sandata Training Center to register for any of the training sessions listed below.

June Webinars

  • System Overview – June 5, 11 a.m. – 12 p.m. (EST)
  • Client/Employee/Authorization – June 14, 10 – 11 a.m. (EST)
  • Scheduling – June 23, 2 – 3 p.m. (EST)
  • Visit Capture – June 26, 11 a.m. – 12 p.m. (EST)

July Webinars

  • Visit Maintenance – July 7, 10 – 11 a.m. (EST) and July 28, 11 a.m. –12 p.m. (EST)
  • Group Visit (Agency) – July 10, 2 – 2:45 p.m. (EST)
  • Group Visit (Caregiver) – July 19, 10 – 10:30 a.m. (EST)

Beneficiary Information Card

The EVV Beneficiary Information Card (Rack Card) is being distributed to Home Health Care beneficiaries subject to EVV receiving Home Health Care services. This Card notifies the beneficiary of the EVV requirement, which services are impacted, and how EVV will directly impact them. It also provides contact information should beneficiaries have follow-up questions. 

NC Medicaid Alternate Electronic Visit Verification (EVV) New Provider Registration Form

The registration form is intended for new Home Health Care Services (HHCS) providers as well as Personal Care Services (PCS) providers who intend to use an Alternate EVV vendor to submit visit data. HHAeXchange and Carebridge can also use the registration form to register providers using an alternate EVV system with Sandata so the visit information flows properly to the aggregator.

If your agency will be using multiple NPI Numbers, your agency will need to enroll separately for each unique NPI Number.

* Please complete all fields on both pages accurately. Any incorrect information will delay the arrival of your agency credentials. The registration link can be found here 

Contact

Medicaid.EVV@dhhs.nc.gov

Tab/Accordion Items

What Does EVV Mean for You?

Electronic Visit Verification (EVV) is a technology that allows caregivers to gather information by recording the time, dates and specific services they provide to you in your home. Caregivers (nurses or aides) will enter this information, using their own electronic device, within your home on the date of care. Some states, including North Carolina, are required to use EVV for certain home and community-based services, including PCS, CAP/C, and CAP/DA. EVV helps make sure  you receive the services you need, in the approved location, on the correct dates and for the full length of time allowed.

Does My Caregiver Need to Use EVV?

If a caregiver or personal care attendant visits your home to provide personal care assistance with your bathing, dressing, eating, mobility, toileting and transfer, known as activities of daily living (ADLs), they will need to use EVV. Beginning Jan. 1, 2021, paid caregivers for PCS, CAP/C, CAP/DA, Innovations and TBI waivers must use EVV to document details of the care they provide in your home. You do not need to do anything about this change in reporting. Your provider agency must go by the EVV requirements in order to receive payment for personal care types of service, including: 

  • PCS 
  • CAP In-home aide services
  • CAP/C Pediatric nurse aide services
  • CAP/C and CAP/DA respite services
  • Personal assistance care services through consumer direction services 

If you are receiving Home Health Services (HHS), the EVV requirement will not affect you until January 2023. Check the HHS page for updates. 

If you are receiving nursing services through Private Duty Nursing (PDN) or CAP/C nurse respite, EVV is not required.

How will this change affect you, the beneficiary?

Our commitment is this change should be almost seamless. Medicaid is doing everything it can to ensure the new law supports you, the beneficiary. Your care is our top priority. EVV causes no significant disruption of services to beneficiaries.

  • Beneficiaries will be able to keep current providers and caregivers, provided they comply with the EVV requirement.
  • An EVV system does NOT change the services provided or the provider selection, limit the individual’s choice of caregiver or change the way care is delivered.
  • EVV will be a valuable tool in managing the accuracy and reporting of all in-home services.

It is important to know that EVV does not:

  • Impact your care.
  • Change how often you receive care.
  • Change where you receive care.
  • Change the type of care you receive.

If you or a loved one receive care through one of the NC Medicaid waivers listed below and you receive in-home care, you will be required to participate in the EVV system. 

How does EVV work? 

Each time your paid caregiver visits your home to help with your activities of daily living (ADLs), an electronic device (which your caregiver is assigned) will verify at least the following things:  

  • The date the service was provided 
  • The location the service was provided 
  • The time the service begins and ends
  • That the type of approved service was provided 
  • The correct person (you) received the service
  • Your hired caregiver was the one who provided the service 

EVV may be captured through your telephone, an app on your caregiver’s device or a fixed verification device that will remain in your home. 
If your caregiver does not have an electronic device, the caregiver may ask to use your house phone (a landline) to check in and out. 

If you require assistance before your worker checks in, that’s okay. The check-in step can be completed once assistance has been provided, if needed.

Beneficiary Information Card 

The EVV Beneficiary Information Card (Rack Card) is being distributed to PCS beneficiaries subject to EVV in the State Plan PCS Program, the Community Alternatives Program for Children (CAP/C), and the Community Alternatives Program for Disabled Adults (CAP/DA). This Card notifies the beneficiary of the EVV requirement, which programs are impacted, and how EVV will directly impact them. It also provides contact information should beneficiaries have follow-up questions. Mailings began the week of Oct. 12, 2020.

NCDHHS EVV Provider Agency Survey (Due Nov. 30, 2020) – State Plan PCS and Community Alternatives Program (CAP) Providers
 

NCDHHS awarded a contract to Sandata Technologies, LLC on Sept. 24, 2020, and began using their services for EVV statewide on Jan. 1, 2021. EVV is a method used to verify visit activity for services delivered as part of home and community-based service programs. EVV offers a measure of accountability to help ensure that individuals who are authorized to receive services in fact receive them.

In compliance with Section 12006 of the 21St Century Cures Act (the Cures Act), P.L. 114-255 was added to Section 1903(l) of the Social Security Act (SSA). Section 1903(l) requires the use of an EVV system for Personal Care Services (PCS) and Home Health Services (HHS) that require an in-home visit by a provider for states participating in the Medicaid program. Programs subject to the EVV requirement include State Plan Personal Care (PCS) [In-Home], Community Alternatives Program for Children (CAP/C), Community Alternatives Program for Adults (CAP/DA), self-directed personal attendant care services, Innovations Waiver, TBI Waiver and the 1115 Managed Care Demonstration Waiver. 

NC Medicaid will continue to communicate with providers regarding the onboarding of Sandata, including dates and times of provider and beneficiary training. Medicaid will conduct stakeholder engagement discussions throughout the month of November to provide the details of the implementation plan for each of the affected program groups. Our process will ensure that Medicaid Long-Term Services and Supports (LTSS) continue without disruption to our providers or beneficiaries.
 

Home Health Crosswalk Guidance for Managed Care Service Codes, Description of Services and Prior Authorizations

Standard Plan EVV HH Service Code Crosswalks are accessible to Home Health Providers by using the following links:

Billing Information

Fixed Visit Verification (FVV)

Third Party Alternate EVV 

Alternate Vendor Specifications (Home Health, Personal Care Services and Waivers)

Paid Live-in Caregiver

Webinar held Nov. 12, 2020

Service Codes

List of service codes required for EVV implementation, Sept. 1, 2023.

To ensure compliance with the 21st Century Cures Act for Electronic Visit Verification (EVV), two explanation of benefit (EOB) edits were created to pend, cut back or deny claims submitted to NCTracks subject to the EVV mandate that do not have EVV data. The EOBs EVV edits are 02077 and 02079. 

 

Edit Description Criteria
02077 ELECTRONIC VISIT VERIFICATION (EVV) NOT ON FILE FOR DOS  For claim lines with a Date of Service on or after 6/1/2021, the edit will pend for 14 days then deny.
02079 SUBMITTED UNITS EXCEED VERIFIED VISIT UNITS FOR THIS DOS For claim lines with a Date of Service on or after 6/1/2021, the edit will pend for seven days then cut back units to the sum of the verified units.

  
Error code 784 is created in the NCTracks provider portal when there is no EVV data (Edit 02077) on a claim or when there are more units (Edit 02079) submitted than captured in the EVV systems (Sandata, Alt EVV or Sandata Aggregator).  

A claim with an Error code 784 will pend for the specified number of days waiting for the claim line to be fixed. 

The Sandata Customer Care Center is not able to provide information about your pended claims for error code 784. Please call NCTracks at 800-688-6696 for 784 questions. 

Min Amount to Count as 1 unit Amount to Round from 1 to 2 units 

  • 0-7 min = 0 units 
  • 8 - 22 min = 1 unit 
  • 23 - 37 min = 2 units 
  • 38 - 52 min = 3 units 
  • 53 - 67 min = 4 units 
  • 68 - 82 min = 5 unit 
  • 83 - 97 min = 6 units 
  • 98 - 112 min = 7 units 
  • etc…. 

If you received an EOB for Edit 02077, your visit in your EVV system or the State’s aggregator might not be in a verified status, or there may not be a visit for the date of the claim. You may need to fix or add your visit to your EVV solution. 

If you received an EOB for Edit 02079, you might not have submitted enough units per the approved care plan for PCS or plan of care for the CAP/C or CAP/DA. If you think the units were submitted correctly, your claim will process within seven days. If the units are not correct, you may need to update your visit or claim to match the other. 

Claims submitted with a place of service code 99 (paid live-in caregiver) with a date of service code from June 1-July 10, 2021, will receive the EVV edit 02077. GDIT is in the process of updating its systems to recognize the POS code for paid live-in caregivers. On and after July 11, 2021, all claims with a POS code 99 will bypass the EVV edits. Claims submitted between June 1-July 11, 2021 will be reprocessed to bypass the EVV edits.  

 

Visit this page frequently for newly-added learning opportunities.

EVV Home Health Care Services Stakeholder Meeting - Feb. 28, 2023

Home Health EVV Announcements and Important Reminders - Dec. 20, 2022

All NC Medicaid Home Health Sandata training webinars have been rescheduled:

Wednesday, Dec. 14, 2022 
Thursday, Dec. 15, 2022 
Friday, Dec. 16, 2022

Home Health Services Alternate Electronic Visit Verification Live Instructor-Led Training Webinars

Sandata Solutions engineering team will be hosting live instructor-led Home Health Services Alternate Electronic Visit Verification (EVV) training webinars for vendors and providers on the following dates:

  • October 25-27, 2022
  • November 1-3, 2022

Courses cover each module of the NC EVV system, Sandata. Participants will register for the desired webinar courses and attend from a remote location, using their own computer with internet access. Participants can listen to the webinars either by calling in by phone or through computer audio. 

Specific training classes, dates, times and registration for live instructor-led webinar training can be found on the Sandata North Carolina Provider Training webpage. 

Training information for NCDHHS Electronic Visit Verification (EVV) Program 

Previous Stakeholder Meetings

Wednesday, Sept. 13, 2023

Friday, Sept. 8, 2023

Thursday, Sept. 7, 2023

Thursday, May 25, 2023

Tuesday, March 28, 2023

Tuesday, Feb. 28, 2023

Tuesday, Jan. 31, 2023

Tuesday, Aug. 23, 2022

Monday, April 25, 2022

Monday, Feb. 28, 2022

Wednesday, Aug. 25, 2021

EVV Stakeholder Meeting and Technical Support Webinar

Friday, May 21, 2021

March 9, 2021

Dec. 17, 2020

Oct. 22, 2020

State Plan PCS Virtual Regional Trainings

Electronic Visit Verification Implementation – Training will provide policy updates to Clinical Coverage Policy 3L to include EVV requirements. Additionally, we will walk through the QiRePort system changes to the PCS Service Plan process. 

EVV Regional Training, Nov. 17-19, 2020

 

 

 

 

We want to hear your feedback. Send an email or join our email list.

 

Contact Us

NC Medicaid EVV
Phone: 919-855-4360
Medicaid.EVV@dhhs.nc.gov
 

Managed Care Home Health Electronic Visit Verification Escalation

If you have not received a satisfactory response to a concern submitted previously to your EVV vendor, you may escalate your issue for the Standard Plans by contacting specific support teams using the following information:

Health Plans  

medicaid.ncdhhs.gov/transformation/health-plans

LME/MCOs 

ncdhhs.gov/providers/lme-mco-directory 

NC Medicaid Direct

Sandata Customer Support Team: 
855-940-4915 or NCCustomerCare@Sandata.com 

Sandata Alternate EVV Support: 
844-289-4246 or NCAltEVV@Sandata.com  

NC Medicaid EVV Policy Questions: 
919-855-4360 or Medicaid.EVV@dhhs.nc.gov

 

Section 12006 of the 21st Century Cures Act requires that the North Carolina Department of Health and Human Services (NCDHHS) begins using an Electronic Visit Verification (EVV) system for Personal Care Services (PCS) by Jan. 1, 2021, and for Home Health Care Services (HHS) by January 2023.

EVV uses technology to record the times, dates and specific services that are given. These help make sure that people who should receive services, in fact, receive them. 

What does EVV mean for the Innovations and TBI waivers? 

Provider Info and Service Codes

Is EVV required if a provider doesn't participate in PCS services, but participates in the NC Innovations Waiver or TBI Waiver?

Yes, EVV is required for the following services in the Innovations and TBI Waivers:

Innovations Waiver Services Subject to EVV

  • Community Living and Support  (In-Home Services Only) - Group–T2013 TF HQ
  • Community Living and Support (In-Home Services Only) –  Individual T2013 TF
  • Supported Living – Periodic (In-Home Services Only) – T2033 

TBI Waiver Services Subject to EVV

  • Personal Care  (In-Home Services Only) – S5125
  • In-Home Intensive (In-Home Services Only) – T1015
  • Life Skills Training  (In-Home Services Only) – T2013

(b)(3) Services Subject to EVV

  • Personal Care/ Individual Support (In-Home Services Only) – T1019 U4
  • Transitional Living Skills (In-Home Services Only)  – H2022 U4
  • In-Home Skill Building (In-Home Services Only)  – T2013 U4
  • Community Living and Support  (In-Home Services Only) - Group– T2013 TF HQ U4
  • Community Living and Support (In-Home Services Only) – T2013 TF U4
  • Supported Living – Periodic (In-Home Services Only)   – T2033 U1
     

Beneficiary Info

What does EVV mean for me if I am covered by the Innovations or TBI waiver? 

Electronic Visit Verification (EVV) is a technology that allows caregivers to gather information by recording the time, dates and specific services caregivers provide to you in your home. Direct care staff will enter this information, using their own electronic device, within your home on the date of care. Some states, including North Carolina, are required to use EVV for certain home- and community-based services, including the NC Innovations and TBI Waivers. EVV helps us to make sure that you receive the services you need, in the approved location, on the correct dates and for the full length of time allowed.
 

FAQ for Innovations and TBI Waivers

Q. Will retainer services be included in EVV?

A. Specific to the Innovations and TBI Waivers, retainer plans of care are excluded from the EVV mandate because an in-home visit is not made when a retainer agreement is in place.
Waiver beneficiaries who are living with a paid caregiver, regardless of the type of service being provided (provider or Self-Directed), are excluded from the EVV mandate.

Q. Will family-serving-family consumers including RaDSE be exempt from EVV requirements?

A. Family members who provide services and who live in the same home as the beneficiary, including Relative as Direct Support Employee (RaDSE), are exempt from EVV requirements under these waivers.

If a beneficiary has additional staff who are not live-In caregivers, those staff are subject to EVV.

Q. Can providers of Innovations or TBI Waiver services submit EVV data directly to Sandata if they have their own EVV solution?

A. Innovations providers will work with their respective LME-MCO and the LME-MCO vendor, HHAeXchange for EVV implementation.

Q: Who do providers contact regarding EVV for the Innovations Waiver, Traumatic Brain Injury Waiver Services and (b)(3) services subject to EVV?

A: Providers may contact their LME-MCO for EVV implementation. To ensure EVV implementation aligns with current billing processes for the Innovations and TBI waiver programs, as well as for (b)(3) services administered by LME-MCOs, EVV implementation of those programs is planned for June 30, 2021. An LME-MCO directory and information on the HHAeXchange are available for your use. 
 

Provider Trainings

Alt EVV Update, Dec. 17, 2020 

EVV Presentation, Aug. 7, 2020

HHAeXchange provider portal, including recorded trainings, any upcoming webinars 
 

Links and Contacts

NC Medicaid Innovations Waiver

NCDHHS Traumatic Brain Injury
 

This page was last modified on 03/28/2024