Electronic Visit Verification

Electronic Visit Verification (EVV) uses technology to record the times, dates and details of services provided to NC Medicaid beneficiaries in their home.

The Cures Act requires Personal Care Services (PCS) and Home Health Care Services (HHS) providers use an EVV system to record the services provided.

What does EVV track?

EVV tracks and monitors services received to ensure access to care for NC Medicaid beneficiaries. EVV uses technology to record the following information:

• Type of service performed
• Beneficiary receiving the service
• Date of service
• Service location
• Person providing the services
• Service start and end times

Information for Beneficiaries

What is Electronic Visit Verification (EVV)?

EVV is a technology caregivers (nurses or aides) use to collect information by recording the time, date and services provided to where you receive services.

Caregivers capture visit information, in an applicable electronic device, during the course of the visit.

Some states, including North Carolina, must use EVV for certain home and community-based services, such as Personal Care Services (PCS), Community Alternatives Program for Children (CAP/C), Home Health Care Services (HH) and Community Alternatives Program for Disabled Adults (CAP/DA). EVV makes sure you get 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 assistant visits your home to give personal care help with things like bathing, dressing, eating, mobility, toileting and transfer (known as activities of daily living), they need to use EVV to collect information on the services received in real time.

Paid caregivers for PCS, CAP/C, CAP/DA, Home Health, Innovations and TBI waivers must use EVV to record the details about the care they give in your home.  

If you get nursing services through Private Duty Nursing (PDN) or CAP/C nurse respite, EVV does not need to be used.

How Will This Affect Me?

EVV should not have an effect on your services.

• You can keep the providers and caregivers you have now, if they meet the EVV requirements.
• An EVV system does NOT change the services you get, limit the beneficiary’s choice of caregiver or change the way care is given.
• EVV is a useful tool to make sure the reporting of all in-home services is correct.

It is important to know that EVV does not change:

• Your care
• How often you get care
• Where you get care
• The type of care you get

If you or a loved one get care through a NC Medicaid waiver and you get in-home care, your caregiver must use the EVV tool.

• Personal Care Services
• Home Health Services
• Community Alternative Program for Children (CAP/C)
• Community Alternative Program for Disabled Adults (CAP/DA)
• Innovations – Home and Community-Based Services
• Traumatic Brain Injury (TBI)

How Does EVV Work?

Each time your paid caregiver visits your home to help with your activities of daily living they will use an electronic tool to make sure the following are correct:  

• The date the service was given.
• The location the service was given.
• The time the service began and ended.
• The type of approved service that was given.
• The correct person received the service.
• Your hired caregiver was the one who gave the service.

EVV may be captured electronically using telephony (phone registered to beneficiary record), mobile visit verification (application on caregivers’ mobile device), fixed visit verification, or manual entry only when necessary.  

Beneficiary Information Card

The EVV Beneficiary Information Card (Rack Card) is 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.

• EVV Home Health Services Rack Card
• EVV Home Health Services Rack Card - Spanish

TBI and Innovations Information for Beneficiaries

What does EVV mean if I am on the Innovations or TBI Waiver?

NC Medicaid is required to use EVV for some 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.

EVV Provider Information

Electronic Visit Verification (EVV) is a method to verify services delivered as part of home and community-based service programs. Programs subject to the EVV requirement include NC Medicaid in- home Personal Care (PCS), Home Health (HHCS), 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.  The purpose of EVV is to track and monitor timely service delivery and help to ensure access to care for Medicaid beneficiaries.

EVV Vendors

Sandata, the selected EVV Vendor for the NC Medicaid has two roles. Sandata hosts the free solution for beneficiaries enrolled in NC Medicaid Direct.  In addition, Sandata collects all captured visit data for NC Medicaid, regardless of the original source. Providers with beneficiaries enrolled in NC Medicaid Direct may select the EVV vendor of their choice but all visit data will be sent to Sandata to manage.

The free solution for Healthy Blue is CareBridge. Providers with members enrolled in Healthy Blue may select the EVV vendor of their choice but the visit data will be sent to CareBridge to manage.

The free solution for all other Standard Plans, LME/MCOs and Tailored Plans is HHAeXchange. Providers with members enrolled in these plans may select the EVV vendor of their choice but the visit data will be sent to HHAeXchange to manage.

Providers should us electronic means EVV to capture visits. On rare occasions when the caregiver is unable to use EVV, a manual entry is allowed. Although manual edits will not cause a claim to deny, they should be kept to 15% or less. Providers should capture EVV Data Elements electronically at least 85% of the time using electronic methods. NC Medicaid regularly monitors providers use of manual entry. 

The three device types are:

• Smart device using mobile app (MVV) (preferred method)
• Fixed Visit Verification device (FVV) FOBs, also recommended
• Telephony (TVV) (Phones that are registered to the beneficiary's account)

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.  

EVV Claim and Resolution Tips

In NCTracks, 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. 

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.  

Tips to Troubleshoot EVV-related Billing Issues

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. 

Rounding Rules 

Minimum Amount to Count as 1 unit  

• 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. 

Provider Information and Service Codes

EVV Service Codes List

Provider Meetings and Trainings

Visit this page frequently for newly-added learning opportunities. 

Training Information for NCDHHS Electronic Visit Verification (EVV) Program

• Sandata EVV Provider Agency Training – Video Library