Electronic Visit Verification Implementation: Claim Adjudication Based on EVV Data Begins June 1, 2021

Friday, April 30, 2021

NC Medicaid will end the pay and report period for Electronic Visit Verification (EVV) claims on May 31, 2021. Claims submitted for dates of Service June 1, 2021 and after will be required to validate EVV data prior to claims adjudication. There are two edits for EVV that will be applied if the claim submitted does not have the required EVV data. Once applied, these edits will pend for an identified number of days to allow for the issue to be resolved prior to denial of the claim. 

Edit

Description

Criteria

02077

ELECTRONIC VISIT VERIFICATION (EVV) NOT ON FILE FOR DOS

For claim lines with a Date of Service on or after 6/01/2021, 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 6/01/2021, the edit will pend for seven days then cut back units to the sum of the verified units.

Providers utilizing Sandata, the State’s EVV solution, should ensure that all visits are verified in the EVV portal prior to submitting claims. A visit with the status of verified, means there are no exceptions. Clearing or resolving all exceptions on an incomplete visit updates the visit status to ‘verified.’ Providers utilizing an alternate EVV (Alt EVV) solution may confirm verified visits with their vendor and may also view visits in the Sandata Aggregator.

Additional information to support providers with EVV implementation and claim adjudication with EVV starting on June 1, 2021, will be shared in an upcoming Medicaid bulletin article. 

For more information about EVV, please visit the NC Medicaid EVV webpage.

CONTACT

Medicaid.EVV@dhhs.nc.gov