This bulletin applies to NC Medicaid Managed Care.
The 21st Century Cures Act requires NC Medicaid to implement an Electronic Visit Verification (EVV) system for all Medicaid-funded Home Health Care Services (HHCS). EVV records the following seven elements:
- Type of service performed
- Individual receiving the service
- Date of service
- Location of service
- Individual providing the service
- Time the service begins
- Time the service ends
This system helps ensure individuals who should receive services actually receive them.
To comply with this mandate and address administrative oversight in capturing required EVV data points for HHCS, HHCS rates increased by 10% above the previous fee schedule rate, effective Feb. 1, 2023.
Standard Plan EVV Status
Standard Plans returned to EVV Home Health soft launch on Feb. 15, 2024, due to challenges with EVV systems related to pre-billing edits/holds. The soft launch will continue until the department determines a hard launch date.
Tailored Plan EVV Status
Tailored Plans began the EVV Home Health soft launch on July 1, 2024, with Tailored Plan launch. The soft launch will continue until a hard launch date is determined by the Department.
Provider Data Capture Expectations During Soft Launch
During the ongoing soft launch period, providers are expected to capture EVV visit information and acclimate to the health plans’ EVV vendor processes. Soft launch is intended to allow providers, their systems, and their EVV Data Capture Vendor to configure and test the process to ensure successful data capture. Providers are expected to ensure any contracted third-party EVV Data Capture Vendors are successfully submitting visits to HHAeXchange or CareBridge on the provider’s behalf. Visit capture is the first step in claims adjudication, regardless of the claims processing methodology.
Providers should capture visit data for all services subject to EVV. If EVV visits are not captured when a member is enrolled in managed care and the member retroactively returns to NC Medicaid Direct, NCTracks will not pay the Home Health claim for those service dates. NC Medicaid Direct remains in hard launch, requiring verified visit data for claims payment.
Managed Care Direct Billing Option
In response to provider requests, all managed care health plans have notified the Department of their intention to develop and deploy a direct billing option for Home Health providers. This option will allow providers to capture visit data separately from claims billing. The implementation of all direct billing solutions for Standard Plans and Tailored plans are expected to be in place by Summer 2025.
Provider Support
Home Health providers serving beneficiaries in a Standard Plan or Tailored Plan who need additional EVV assistance should contact their Health Plan or appropriate EVV vendor:
HHAeXchange
Customer Support
NCSupport@hhaexchange.com
855-400-4429
CareBridge
Customer Support
ncevv@carebridgehealth.com
855-782-5976
Third-Party EVV Solutions Integrated with CareBridge
evvintegrationsupport@carebridgehealth.com
844-920-0989
NC Medicaid Managed Care Provider Ombudsman —
Phone: 866-304-7062
Email: Medicaid.ProviderOmbudsman@dhhs.nc.gov