This bulletin applies to NC Medicaid Managed Care.
Managed Care EVV Requirements
The 21st Century Cures Act requires the use of an Electronic Visit Verification (EVV) system for home health care services (HHCS). EVV uses technology to record the times, dates and specific services provided, which helps ensure beneficiaries receive the services they are authorized to receive.
Starting Oct. 1, 2025, NC Medicaid will implement the hard launch phase of EVV for HHCS for dates of service rendered under both the Standard Plans and Tailored Plans. Claims for these services, with dates of service on or after Oct. 1, 2025, that do not include the required EVV data will be denied.
NC Medicaid Direct Home Health Care Services subject to EVV has been in Hard Launch since Oct. 1, 2023.
Home Health Care Services Subject to EVV
Services under Home Health Clinical Coverage policy that require EVV include:
- Home health aide
- Physical therapy
- Speech therapy
- Occupational therapy
- Skilled nursing visits
Managed Care Direct Billing Option
In response to provider requests, all managed care health plans have notified the Department of their intent 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. This enhanced functionality is expected to be implemented for Standard Plans and Tailored plans by July 1, 2025. Providers who prefer to allow the EVV system to continue to generate the claims can choose to do so.
Providers should notify the health plans which billing methodology they prefer to use to bill HHCS claims and direct any questions about billing options to the health plan.
Provider Data Capture Expectations During Soft Launch
The soft launch “pay and report” period will end on Sept. 30, 2025.
During the soft launch period:
- Providers must capture EVV visit information and acclimate to the health plans’ EVV vendor processes.
- Claims will not pend based on failed EVV validation.
- If a claim fails validation, a report will be generated noting the validation issue and the provider will be allowed to receive payment.
All providers are strongly encouraged to take immediate steps to prepare for the upcoming Home Health hard launch. Capturing visit data is the first and essential step in the HHCS claims adjudication process—regardless of your claims processing or billing method.
The current soft launch period is designed to give providers, their internal systems, and their chosen EVV Data Capture Vendors the opportunity to configure, test, and validate their processes. This phase is critical to ensure seamless and accurate visit data submission.
Providers must ensure that any contracted third-party EVV Data Capture Vendors are:
- Properly registered with HHAeXchange or CareBridge
- Successfully submitting visit data on the provider’s behalf
Failure to adequately prepare prior to the end of soft launch on Sept. 30, 2025, may result in delayed system configuration due to a high volume of post-launch support requests. This can lead to claim denials due to missing or invalid EVV data.
To ensure your visit data is correctly routed to the Sandata system from the HHAeXchange or CareBridge systems, please complete the North Carolina DHHS Alternate EVV New Provider Registration Form if you have not already done so.
Timely preparation is essential to avoid disruptions in claims processing. Take action now to ensure compliance and payment continuity.
Provider Expectations after Hard Launch
- All home health providers are expected to be fully compliant with EVV requirements for every visit.
- EVV data must be validated prior to claims adjudication, and
- Claims without the required EVV criteria will be denied.
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
1-855-400-4429
CareBridge
Customer Support
ncevv@carebridgehealth.com
1-855-782-5976
Third-Party EVV Solutions Integrated with CareBridge
evvintegrationsupport@carebridgehealth.com
1-844-920-0989
NC Medicaid Managed Care Provider Ombudsman
Medicaid.ProviderOmbudsman@dhhs.nc.gov
1-866-304-7062