EVV Home Health Soft Launch
The soft launch pay and report period for the implementation of electronic visit verification (EVV) for Home Health began April 1, 2023, and will run through June 30, 2023. During this period home health claims will pay without a verified visit containing all required EVV data.
NC Medicaid is closely monitoring provider readiness and adoption. Regular reports of submitted visits, both verified and incomplete, are being tracked to ensure compliance with this expectation. Staff is reaching out through phone calls and emails to provide technical assistance and guidance to home health providers that are not using the system successfully. Reports show some data mismatches for electronic visits between the Payer, Program and Service codes.
Home Health EVV Codes
It is important providers carefully select the correct information and submit all the required information for each visit. Effective July 1, 2023, the visit record must match the claim submitted to NCTracks for it to pay.
Home Health Taxonomies
Home health taxonomies subject to EVV are found in NC Medicaid bulletin Electronic Visit Verification Home Health Services Taxonomy and Bill Type Information.
Electronic Visit Verification does not apply to Independent Practitioner Providers of therapies billing professional claims. See NC Medicaid bulletin NC Medicaid Home Health Electronic Visit Verification: Exclusion of Independent Practitioner Providers.
Agencies providing services under the 253Z00000X taxonomy do not fall in the home health program. This taxonomy is for In Home Supportive Care for services such as personal care services.
Note: Some services under this taxonomy are also part of the Community Alternatives Program (CAP). CAP services are only available in NC Medicaid Direct and are not appropriate for beneficiaries enrolled in health plans.
Payer Codes
Providers should select the correct EVV Payer code for the individual receiving home health services.
- DHBPHP This code is for individuals enrolled with a Standard Plan.
- DHBTP This code is for individuals enrolled with a Tailored Plan.*
- DHBFFS This code is for individuals enrolled in NC Medicaid Direct.
- DHBLME** This code is for individuals enrolled in NC Medicaid Direct but receiving 1915(c) Innovations Waiver and 1915(i) Community Living and Support services through LME/MCOs.
* Tailored Plan is not effective until Oct. 1, 2023.
** This payer code is not applicable to Home Health Services
Program Codes
Providers should select the correct program code for the individual receiving home health services.
Program Codes in Home Health Services
- HHAID This code is for individuals receiving aide services under the home health program
- HHSNV This code is for individuals receiving skilled nursing visit services under the home health program
- HHTHER This code is for individuals receiving therapy services under the home health program
Program Codes not in Home Health Services
The following codes are not an appropriate selection for individuals receiving home health and should not be combined with the revenue codes listed in the home health service code section.
- PCS This code is for State Plan personal care services
- CAPC This code is for Community Alternatives Program for Children services
- CAPCD This code is for Community Alternatives Program Consumer Directed services
- CAPDA This code is for Community Alternatives Program for Disabled Adults services
Service Codes
The following codes are only appropriate for home health services and should not be used for EVV visits for personal care services, Community Alternatives Programs, or 1915(c) Innovations Waiver and 1915(i) Community Living and Support services provided under the LME/MCOs.
Therapies
- RC420 Physical therapy
- RC424 Physical therapy evaluation
- RC430 Occupational therapy
- RC434 Occupational therapy evaluation
- RC440 Speech-language pathology services
- RC444 Speech-language pathology services evaluation
Skilled Nursing Visits
- RC550 Skilled nursing: Initial assessment/re-assessment
- RC551 Skilled nursing: Treatment, teaching/training, observation/evaluation
- RC559 Skilled nursing: For a dually eligible beneficiary when the visit does not meet Medicare criteria
- RC580 Skilled nursing: Venipuncture
- RC581 Skilled nursing: Pre-filling insulin syringes/Medi-Planners
Home Health Aide
- RC570 Home Health Aide
If inaccurate information is entered in the Sandata EVV system, the appropriate way to correct the error is to omit the visit and reenter the correct information. It is not appropriate to clear the exceptions and cause the visit to go into verified status.
For more information on how to correctly manage visit data in the Sandata system, please refer to trainings located on the Sandata website to access Visit Capture and Visit Maintenance videos. The trainings can also be accessed at the Sandata on Demand library at sandata.com, navigate to Resources and then to Sandata on Demand.