Electronic Visit Verification Payment Issues Identified

Effective June 1, 2021, all personal care services (PCS) claims that were subject to the electronic visit verification (EVV) mandate must include visit data information before the claim can process to adjudication in NCTracks.

NC Medicaid is aware of three system issues that we have been troubleshooting with Sandata and NCTracks for a resolution. The issues have been identified and a fix is underway, but due to the complexity of the data collected from various interfaces, the timeline of the fix may change from the dates listed below. While NC Medicaid works to resolve these issues, providers may request a hardship advance to offset the business cost due to pended or denied claims. To request a hardship advance, send an email to Medicaid.hardships@dhhs.nc.gov. In the body of the email, include bullet points about your claim submission as it relates to EVV. 

The issues and resolutions are listed below:

1. Client not found - A system fix has been implemented for this issue as of July 20, 2021. To ensure clients show in the Sandata aggregator, ALT EVV vendors must resend clients and visits to the aggregator as described in the Alt EVV Addendum. There is no set timeframe to resend clients and visits to the aggregator, but until this is done, clients impacted by this issue will not show in the NCTracks system for adjudication.
2. Incomplete visit history data in NCTracks, although verified in the Aggregator - An Alt EVV system regeneration will be executed this week, and the visit files regeneration will be completed by July 23, 2021. Visit capture data will be transmitted to NCTracks on July 24, 2021. Claims that received EVV edit 02077 in June should resolve after July 26, 2021.
3. Visit history missing for date of service (DOS) of July 12, 2021 - An error file was identified that caused the visit history for July 12 not to show in the NCTracks system. A system fix was made to the error file and claims submitted for July 12 will adjudicate on July 23, 2021. 

Thank you for your patience and cooperation as we work through these system issues.

Contact:

medicaid.evv@dhhs.nc.gov