Electronic Visit Verification Updates - March 13, 2023

Home Health Care Services: Soft Launch April 1, 2023 through June 30, 2023; Provider Selection of Electronic Visit Verification Vendor

Note: This bulletin has been updated to adjust the first bullet under "Services covered through the State Plan and the 3-A Home Health Clinical Coverage Policy that will be subject to the EVV requirement"

Home Health Care Services Soft Launch April 1, 2023, through June 30, 2023

Starting April 1, 2023, the North Carolina Department of Health and Human Services (NCDHHS) will implement a soft launch of the Electronic Visit Verification (EVV) system for Home Health Care Services (HHCS) rendered under both the Standard Plans and NC Medicaid Direct.
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

Services covered through the State Plan and the 3-A Home Health Clinical Coverage Policy that will be subject to the EVV requirement:

  • Home Health Aide
  • Physical Therapy
  • Speech Therapy
  • Occupational Therapy
  • Skilled Nursing Visits

During this soft launch period beginning April 1, 2023:

  • Home Health Care providers will submit EVV information
  • The EVV program will operate as “Pay and Report”
  • Claims will not pend based on failed validation. If a claim fails validation, a report will be generated noting the validation issue and the provider will be allowed to receive payment.

A hard launch will begin July 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
  • Claims without the required EVV criteria will deny

Revenue Codes and Services for Claims Subject to EVV:

Revenue Code

Service

 

THERAPIES

420

Physical 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, the beneficiary is not homebound)

580

Skilled nursing: venipuncture

581

Skilled nursing: Pre-filling insulin syringes/Medi-Planners

 

HOME HEALTH AIDE

570

Home Health Aide

 

Home Health Care Services Provider Selection of Electronic Visit Verification Vendor 

Home Health Care Service providers rendering Home Health Care Services (HHCS) subject to electronic visit verification (EVV) are required to utilize an EVV to capture HHCS visits. This requirement includes providers who render HHCS under both NC Medicaid Managed Care and NC Medicaid Direct.

Each Medicaid payer type has a free EVV solution a provider can use. For providers rendering services to beneficiaries under:

  • NC Medicaid Direct, Sandata is the free solution. 
  • Standard Plans (except for Healthy Blue) HHAeXchange is the free solution. 
  • Healthy Blue, CareBridge is the free solution.

Home Health EVV soft launch is scheduled for April 1, 2023, for both Standard Plans and NC Medicaid Direct. 

  • Providers rendering HHCS subject to EVV under NC Medicaid Direct must be registered with Sandata to use their free EVV solution or select an alternate EVV solution.  
  • The selected alternate EVV solution vendor must be registered with Sandata and complete the required Sandata EVV training and testing.  

NC Medicaid requested that all providers select an alternate EVV vendor by Nov. 1, 2022; however, there are providers who have yet to make a selection. It is imperative that provider agencies delivering HHCS subject to EVV under NC Medicaid Direct and planning to use Sandata, the State’s free EVV solution, register with Sandata immediately.  

NC Medicaid Direct

Those provider agencies delivering HHCS subject to EVV under NC Medicaid Direct that will not be using the State’s EVV solution should contact their alternate EVV solution vendor as soon as possible to ensure the vendor is registered and has completed all required Sandata EVV training and testing no later than March 20, 2023.

  • Any provider agency planning to deliver HHCS subject to EVV under NC Medicaid Direct that has not registered with Sandata or that has not selected an alternate EVV solution by March 20, 2023, will be required to enroll with Sandata for the initial April 1, 2023, Home Health EVV soft launch. 
  • After the April 1, 2023, launch, a change to an Alternate EVV solution can be made. 
  • HHCS providers are to ensure there is no disruption in visit capture during the transition to an alternative EVV solution.  

Standard Plans

Home Health Care Service providers rendering HHCS under a Standard Plan should contact either HHAeXchange or CareBridge as applicable to obtain information about registering to use their free EVV solution or for registration and testing information for their selected alternate EVV solution vendor. Contact information is below.

Sandata

HHAeXchange
Customer Support:  
www.hhaexchange.com/contact
855-400-4429

CareBridge

NC Medicaid

Medicaid.evv@dhhs.nc.gov

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