Electronic Visit Verification Billing and LME/MCO Update

Friday, December 11, 2020

NC Medicaid’s Electronic Visit Verification (EVV) system will launch on Jan. 1, 2021, for State Plan Personal Care Services, CAP/DA and CAP/C.

During the first 90 days following launch, we will operate EVV as “Pay and Report.” This means claims will not pend based on failed validation. NC Medicaid will give providers from Jan. 1, 2021, through close of business March 31, 2021, to adjust to EVV implementation. During this period, if a claim fails validation the system will generate a report of the validation issue and allow the provider to cure the issue. If the validation issue is not resolved and cured in 90 days, the payment may be subject to recoupment.

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 April 2, 2021.