The North Carolina Department of Health and Human Services (NCDHHS) will implement an Electronic Visit Verification (EVV) system for Home Health Care Services (HHS) starting Jan. 1, 2023. This complies with the requirements of Section 12006 of the 21st Century Cures Act (the Cures Act).
Soft Launch: Jan. 1, 2023 through March 31, 2023
NCDHHS will implement a soft launch of its EVV HHS system from Jan. 1 through March 31, 2023. During this soft launch period:
- Home Health Care providers will submit EVV information
- The EVV HHS system will operate as Pay and Report
- Claims will not pend based on failed validation. If a claim fails validation, the EVV HHS system will generate a report of the validation issue and allow the provider to receive payment.
Hard Launch: April 1, 2023
- A hard launch will begin April 1, 2023. On this date:
- All Home Health Care providers are expected to be fully compliant with EVV requirements
- EVV data must be validated prior to claims adjudication
| Contract | Soft Launch Start | Hard Launch Start |
|---|---|---|
| NC Medicaid Direct | 1/1/2023 | 4/1/2023 |
| Standard Plans (Home Health) | 1/1/2023 | 4/1/2023 |
| Tailored Plans (Home Health) | 1/1/2023 | 4/1/2023 |
| Tailored Plans (PCS) | 12/1/2022 | 4/1/2023 |
Services covered through the State Plan and the 3-A Home Health Clinical Coverage Policy that will be subject to the EVV requirement:
- Aide Services
- Physical Therapy
- Occupational Therapy
- Skilled Nursing Visits
EVV will verify:
- Date of service
- Beneficiary receiving services
- Location of service
- Individual providing service
- Type of service rendered
- Time the service begins and ends
Revenue Codes and Services for Claims Subject to EVV
|
Home Health Care Claims Subject to EVV: |
|
|---|---|
|
Revenue Code |
Service |
|
THERAPIES |
|
|
420 |
Physicial therapy |
|
424 |
Physical therapy evaluation |
|
430 |
Occupational therapy |
|
434 |
Occupational therapy evaluation |
|
440 |
Speech-language pathology services |
|
444 |
Speech-language pathology services evaluation |
|
SKILLED NURSING VISITS |
|
|
550 |
Skilled nursing: Initial assessment/re-assessment (initial assessment of a new patient or 60 calendar-day re-assessment) |
|
551 |
Skilled nursing: Treatment, teaching/training, observation/evaluation |
|
559 |
Skilled nursing: For a dually eligible beneficiary when the visit does not meet Medicare criteria (for example, beneficiary is not homebound) |
|
580 |
Skilled nursing: Venipuncture |
|
581 |
Skilled nursing: Pre-filling insulin syringes/Medi-Planners |
|
HOME HEALTH AIDE |
|
|
570 |
Home Health Aide |
|
Personal Care Services Claims Subject to EVV: Tailored Plans |
|
|---|---|
|
Revenue Code |
Service |
|
99509 (modifier HA) |
State Plan PCS under Twenty-One |
|
99509 (modifier HB) |
State Plan PCS Adults |
|
S5125 |
TP TBI Personal Care |
|
T1015 |
TP TBI In Home Intensive |
|
T1019 (modifier U4) |
TP Personal Care/Individual Support |
|
T2013 |
TP TBI Life Skills Training - Individual and Group |
|
T2013 (modifiers TF, HQ, U4) |
TP 1915 (i) Community Living and Supports - Group |
|
T2013 (modifiers TF, U4) |
TP 1915 (i) Community Living and Supports |
|
T2013 (modifiers TF, HQ) |
TP (IN) Community Living and Supports-Group |
|
T2013 (modifier TF) |
TP (IN) Community Living and Supports |
|
T2033 (modifier U1) |
TP (IN) Supported Living - Periodic |
Third Party Alternate EVV Specifications
Third Party Alternate EVV specifications have been posted to the EVV webpage on the NC Medicaid website under Provider Resources and Service Codes > Third Party Alternate EVV > HH Alternate EVV.
Home Health providers are encouraged to frequently monitor the EVV webpage for Home Health Services EVV announcements, bulletins, FAQs, stakeholder meetings and other communications.
Questions
Send questions to medicaid.evv@dhhs.nc.gov.