This bulletin applies to NC Medicaid Managed Care.
Managed Care EVV Requirements
The 21st Century Cures Act requires the use of an 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, without the required EVV data will be denied.
Note: NC Medicaid Direct implemented the EVV Hard Launch for HHCS on Oct. 1, 2023.
Managed Care Direct Billing Option
In response to providers’ feedback, all managed care health plans have implemented a direct billing option for Home Health providers with a 251E00000X taxonomy. Providers may choose to:
- Submit Home Health claims directly to the health plan; or
- Use HHAx and CareBridge’s claims invoice billing process.
Regardless of the billing method, capturing visit data is the first essential step in the HHCS claims adjudication process. Providers should notify health plans which billing methodology they prefer and direct any questions about billing options to the health plan within the next 10 days, if they have not already done so.
Provider Data Capture Expectations During Soft Launch
The soft launch “pay and report” period will end on Sept. 30, 2025.
All providers are strongly encouraged to take immediate steps to prepare for the upcoming Home Health hard launch. It is recommended providers allow a minimum of 10 business days for the integration process. Failure to adequately prepare prior to the end of soft launch 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.
Steps for providers who have not fully integrated with an EVV Vendor and configured their systems:
- Select Preferred EVV Data Capture Vendor
Providers may choose to work with one of the free vendor solutions or to contract with an EVV data capture vendor they prefer as shown below:- Managed Care or Medicaid Direct Free Solution (HHAeXchange, CareBridge or Sandata)
- Third-Party Alternate EVV Vendor
- Providers must ensure that any contracted third-party alternate EVV data capture vendor is integrated with HHAeXchange and/or CareBridge to ensure appropriate transfer of visit data to the health plan.
- Information and registration forms to register with the health plans EVV vendor are found at the links below:
- Ensure the third-party alternate EVV vendor is submitting visit data to each health plan’s EVV Vendor on the provider’s behalf.
- Register your Agency with the State’s EVV Aggregator
- To ensure your captured EVV visit data is correctly routed to the State’s Sandata system from the HHAeXchange or CareBridge systems, please complete the NCDHHS Alternate EVV New Provider Registration Form.
Steps for providers integrated with a Third-Party Alternate EVV Vendor, but not yet capturing EVV visit data to ensure readiness for hard launch.
- Begin sending EVV Data
- Revenue and service codes on the claim must match what is submitted with the EVV visit data or the claim will deny due to “no matching data”. The codes included in the visit and claim must also match the authorized services.
- Health plan revenue and service code crosswalks are available on each plan’s EVV webpage.
- Review Rejection logs in the Third-Party Alternate EVV Vendor’s system
- Follow the contracted third-party alternate EVV data capture vendors process for instructions to access this information
- HHAeXchange:
- Response file is sent to third-party alternate EVV data capture vendors via SFTP
- The visit import rejections can be viewed in HHAX Portal: EDI Tool
- CareBridge:
- Response Reporting is sent to third-party alternate EVV Data Capture Vendors
- Visit information can be viewed in CareBridge Read-Only Provider Portal
- HHAeXchange:
- Follow the contracted third-party alternate EVV data capture vendors process for instructions to access this information
- Make appropriate corrections to rejected visits in the third-party Vendors system.
Provider Expectations after Hard Launch
Timely preparation is essential to avoid disruptions in claims processing. Act now to ensure compliance and payment continuity.
- 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.
Experiencing difficulties or have questions?
Help is available. Standard and Tailored Plans are reaching out to Home Health providers not accurately capturing or submitting EVV visit data. The health plans want to ensure a successful launch and are scheduling office hours and one-on-one meetings to educate and answer questions.
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
1-855-400-4429
CareBridge Customer Support
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