Electronic Visit Verification

What is EVV?

Section 12006 of the 21st Century Cures Act requires that the North Carolina Department of Health and Human Services (NCDHHS) begins using an Electronic Visit Verification (EVV) system for Personal Care Services (PCS) by Jan. 1, 2021, and for Home Health Care Services (HHS) by January, 2023.

EVV uses technology to record the times, dates and specific services that are given. These help make sure that people who should receive services, in fact, receive them.

What's New?

Home Health EVV Announcements and Important Reminders - Dec. 20, 2022

Tab/Accordion Item

What Does EVV Mean for You?

Electronic Visit Verification (EVV) is a technology that allows caregivers to gather information by recording the time, dates, and specific services they provide to you in your home. Caregivers (nurses or aides) will enter this information, using their own electronic device, within your home on the date of care. Some states, including North Carolina, are required to use EVV for certain home- and community-based services, including PCS, CAP/C, and CAP/DA. EVV helps us to make sure that you receive the services you need, in the approved location, on the correct dates and for the full length of time allowed.

Does My Caregiver Need to Use EVV?

If a caregiver or personal care attendant visits your home to provide personal care assistance with your bathing, dressing, eating, mobility, toileting and transfer, known as activities of daily living (ADLs), they will need to use EVV. Beginning Jan. 1, 2021, paid caregivers for PCS, CAP/C, CAP/DA, Innovations and TBI waivers must use EVV to document details of the care they provide in your home. You will not need to do anything about this change in reporting. Your provider agency must go by the EVV requirements in order to receive payment for personal care types of service, including: 

  • PCS 
  • CAP In-home aide services
  • CAP/C Pediatric nurse aide services
  • CAP/C and CAP/DA respite services
  • Personal assistance care services through consumer direction services 

If you are receiving Home Health Services (HHS), the EVV requirement will not affect you until January 2023. Check the HHS page for updates. 

If you are receiving nursing services through Private Duty Nursing (PDN) or CAP/C nurse respite, EVV is not required.

How will this change affect you, the beneficiary?

Our commitment to you is that this change should be almost seamless. NC Medicaid is doing everything we can to ensure this new law supports you, the beneficiary. Your care is our top priority. EVV causes no significant disruption of services to beneficiaries.

  • Beneficiaries will be able to keep current providers and caregivers, provided they comply with the EVV requirement.
  • An EVV system does NOT change the services provided or the provider selection, limit the individual’s choice of caregiver or change the way care is delivered.
  • EVV will be a valuable tool in managing the accuracy and reporting of all in-home services.

It is important to know that EVV does not:

  • Impact your care.
  • Change how often you receive care.
  • Change where you receive care.
  • Change the type of care you receive.

If you or a loved one receive care through one of the NC Medicaid waivers listed below and you receive in-home care, you will be required to participate in the EVV system. 

How does EVV work? 

Each time your paid caregiver visits your home to help you with your activities of daily living (ADLs), an electronic device (which your caregiver is assigned) will verify at least the following things:  

  • The date the service was provided 
  • The location the service was provided 
  • The time the service begins and ends
  • That the type of approved service was provided 
  • The correct person (you) received the service
  • Your hired caregiver was the one who provided the service 

EVV may be captured through your telephone, an app on your caregiver’s device or a fixed verification device that will remain in your home. 
If your caregiver does not have an electronic device, the caregiver may ask to use your house phone (a landline) to check in and out. 

If you require assistance before your worker checks in, that’s okay. The check-in step can be completed once assistance has been provided, if needed.

Beneficiary Information Card 

The EVV Beneficiary Information Card (Rack Card) is being distributed to PCS beneficiaries subject to EVV in the State Plan PCS Program, the Community Alternatives Program for Children (CAP/C), and the Community Alternatives Program for Disabled Adults (CAP/DA). This Card notifies the beneficiary of the EVV requirement, which programs are impacted, and how EVV will directly impact them. It also provides contact information should beneficiaries have follow-up questions. Mailings began the week of Oct. 12, 2020.

NCDHHS EVV Provider Agency Survey (Due Nov. 30, 2020) – State Plan PCS and Community Alternatives Program (CAP) Providers
 

NCDHHS awarded a contract to Sandata Technologies, LLC on Sept. 24, 2020, and began using their services for EVV statewide on Jan. 1, 2021. EVV is a method used to verify visit activity for services delivered as part of home and community-based service programs. EVV offers a measure of accountability to help ensure that individuals who are authorized to receive services in fact receive them.

In compliance with Section 12006 of the 21St Century Cures Act (the Cures Act), P.L. 114-255 was added to Section 1903(l) of the Social Security Act (SSA). Section 1903(l) requires the use of an EVV system for Personal Care Services (PCS) and Home Health Services (HHS) that require an in-home visit by a provider for states participating in the Medicaid program. Programs subject to the EVV requirement include State Plan Personal Care (PCS) [In-Home], Community Alternatives Program for Children (CAP/C), Community Alternatives Program for Adults (CAP/DA), self-directed personal attendant care services, Innovations Waiver, TBI Waiver and the 1115 Managed Care Demonstration Waiver. 

NC Medicaid will continue to communicate with providers regarding the onboarding of Sandata, including dates and times of provider and beneficiary training. Medicaid will conduct stakeholder engagement discussions throughout the month of November to provide the details of the implementation plan for each of the affected program groups. Our process will ensure that Medicaid Long-Term Services and Supports (LTSS) continue without disruption to our providers or beneficiaries.
 

Fixed Visit Verification (FVV)

Third Party Alternate EVV 

    Alternate Vendor Specifications (Home Health, Personal Care Services and Waivers)

    Paid Live-in Caregiver

    Webinar held Nov. 12, 2020

    Service Codes

    The following service codes will be required for EVV implementation effective Jan. 1, 2021.

    State Plan PCS – 
    HCPCS 99509 

      Modifiers
    Any beneficiary under 21 years regardless of setting HA
    In-home care agencies, beneficiary 21 years or older HB

    Community Alternatives Programs  

    CAPDA S5125   Attendant Care Service 15m
    CAPDA S5125 UN Attend Care Cong 15m
    CAPDA S5150   In-Home Respite 15m
    CAPC S5125   CAPC In-Home Aide 
    CAPC S5150   In-Home Respite 15m
    CAPC T1019   PNA Asst 15m
    CAPC T1004   PNA In-Home Respite 15m
    CAPC S9122 TF In-Home Respite Cong 15m
    CAPC S9122 TG PNA Respite Cong 15m
    CAPC T2027   Personal Care Assist 15m
    CAPC T2027 TF Personal Care Asst Cong
    CAPCD S5135   Personal Care Assist
    CAPCD S5135 UN Personal Care Assist Cong 15m
    CAPCD S5125 UN Attend Care Cong 15m
    CAPCD S5125   Attendant Care Service 15m
    CAPCD S5150   In-Home Respite 15m

     

    Behavioral Health Services 

    Innovations Waiver 

    • Community Living and Supports and Supported Living (b)(3) Services: 

      • Personal Care/Individual Supports
      • Transitional Living Skills
      • In-Home Skill Building
      • Community Living and Supports 
      • Supported Living–Periodic            
    • Traumatic Brain Injury Waiver:
      • Life Skills Training
      • In-Home Intensive and Personal Care

    To ensure compliance with the 21st Century Cures Act for Electronic Visit Verification (EVV), two explanation of benefit (EOB) edits were created to pend, cut back or deny claims submitted to NCTracks subject to the EVV mandate that do not have EVV data. The EOBs EVV edits are 02077 and 02079. 

     

    Edit Description Criteria
    02077 ELECTRONIC VISIT VERIFICATION (EVV) NOT ON FILE FOR DOS  For claim lines with a Date of Service on or after 6/1/2021, the edit will pend for 14 days then deny.
    02079 SUBMITTED UNITS EXCEED VERIFIED VISIT UNITS FOR THIS DOS For claim lines with a Date of Service on or after 6/1/2021, the edit will pend for seven days then cut back units to the sum of the verified units.

      
    Error code 784 is created in the NCTracks provider portal when there is no EVV data (Edit 02077) on a claim or when there are more units (Edit 02079) submitted than captured in the EVV systems (Sandata, Alt EVV or Sandata Aggregator).  

    A claim with an Error code 784 will pend for the specified number of days waiting for the claim line to be fixed. 

    The Sandata Customer Care Center is not able to provide information about your pended claims for error code 784. Please call NCTracks at 800-688-6696 for 784 questions. 

    Min Amount to Count as 1 unit Amount to Round from 1 to 2 units 

    • 0-7 min = 0 units 
    • 8 - 22 min = 1 unit 
    • 23 - 37 min = 2 units 
    • 38 - 52 min = 3 units 
    • 53 - 67 min = 4 units 
    • 68 - 82 min = 5 unit 
    • 83 - 97 min = 6 units 
    • 98 - 112 min = 7 units 
    • etc…. 

    If you received an EOB for Edit 02077, your visit in your EVV system or the State’s aggregator might not be in a verified status, or there may not be a visit for the date of the claim. You may need to fix or add your visit to your EVV solution. 

    If you received an EOB for Edit 02079, you might not have submitted enough units per the approved care plan for PCS or plan of care for the CAP/C or CAP/DA. If you think the units were submitted correctly, your claim will process within seven days. If the units are not correct, you may need to update your visit or claim to match the other. 

    Claims submitted with a place of service code 99 (paid live-in caregiver) with a date of service code from June 1-July 10, 2021, will receive the EVV edit 02077. GDIT is in the process of updating its systems to recognize the POS code for paid live-in caregivers. On and after July 11, 2021, all claims with a POS code 99 will bypass the EVV edits. Claims submitted between June 1-July 11, 2021 will be reprocessed to bypass the EVV edits.  

     

    Visit this page frequently for newly-added learning opportunities.

    Home Health EVV Announcements and Important Reminders - Dec. 20, 2022

    All NC Medicaid Home Health Sandata training webinars have been rescheduled:

    Wednesday, Dec. 14, 2022 
    Thursday, Dec. 15, 2022 
    Friday, Dec. 16, 2022

    Home Health Services Alternate Electronic Visit Verification Live Instructor-Led Training Webinars

    Sandata Solutions engineering team will be hosting live instructor-led Home Health Services Alternate Electronic Visit Verification (EVV) training webinars for vendors and providers on the following dates:

    • October 25-27, 2022
    • November 1-3, 2022

    Courses cover each module of the NC EVV system, Sandata. Participants will register for the desired webinar courses and attend from a remote location, using their own computer with internet access. Participants can listen to the webinars either by calling in by phone or through computer audio. 

    Specific training classes, dates, times and registration for live instructor-led webinar training can be found on the Sandata North Carolina Provider Training webpage

    Training information for NCDHHS Electronic Visit Verification (EVV) Program 

    Previous Stakeholder Meetings

    Tuesday, August 23, 2022

    Monday, April 25, 2022

    Monday, Feb. 28, 2022

    Wednesday, Aug. 25, 2021

    EVV Stakeholder Meeting and Technical Support Webinar

    Friday, May 21, 2021

    March 9, 2021

    Dec. 17, 2020

    Oct. 22, 2020

    State Plan PCS Virtual Regional Trainings

    Electronic Visit Verification Implementation – Training will provide policy updates to Clinical Coverage Policy 3L to include EVV requirements. Additionally, we will walk through the QiRePort system changes to the PCS Service Plan process. 

    EVV Regional Training, Nov. 17-19, 2020

     

     

     

     

    We want to hear your feedback. Send an email or join our email list.

     

    Contact Us

    NC Medicaid EVV
    Phone: 919-855-4360
    Medicaid.EVV@dhhs.nc.gov
     

    Provider Health Plans (PHPs) 

    medicaid.ncdhhs.gov/transformation/health-plans

    LME/MCOs 

    ncdhhs.gov/providers/lme-mco-directory 

    NC Medicaid Direct

    Sandata Customer Support Team: 
    855-940-4915 or NCCustomerCare@Sandata.com 

    Sandata Alternate EVV Support: 
    844-289-4246 or NCAltEVV@Sandata.com  

    NC Medicaid EVV Policy Questions: 
    919-855-4360 or Medicaid.EVV@dhhs.nc.gov

     

    Section 12006 of the 21st Century Cures Act requires that the North Carolina Department of Health and Human Services (NCDHHS) begins using an Electronic Visit Verification (EVV) system for Personal Care Services (PCS) by Jan. 1, 2021, and for Home Health Care Services (HHS) by January 2023.

    EVV uses technology to record the times, dates and specific services that are given. These help make sure that people who should receive services, in fact, receive them. 

    What does EVV mean for the Innovations and TBI waivers? 

    Provider Info and Service Codes

    Is EVV required if a provider doesn't participate in PCS services, but participates in the NC Innovations Waiver or TBI Waiver?

    Yes, EVV is required for the following services in the Innovations and TBI Waivers:

    Innovations Waiver Services Subject to EVV

    • Community Living and Support  (In-Home Services Only) - Group–T2013 TF HQ
    • Community Living and Support (In-Home Services Only) –  Individual T2013 TF
    • Supported Living – Periodic (In-Home Services Only) – T2033 

    TBI Waiver Services Subject to EVV

    • Personal Care  (In-Home Services Only) – S5125
    • In-Home Intensive (In-Home Services Only) – T1015
    • Life Skills Training  (In-Home Services Only) – T2013

    (b)(3) Services Subject to EVV

    • Personal Care/ Individual Support (In-Home Services Only) – T1019 U4
    • Transitional Living Skills (In-Home Services Only)  – H2022 U4
    • In-Home Skill Building (In-Home Services Only)  – T2013 U4
    • Community Living and Support  (In-Home Services Only) - Group– T2013 TF HQ U4
    • Community Living and Support (In-Home Services Only) – T2013 TF U4
    • Supported Living – Periodic (In-Home Services Only)   – T2033 U1
       

    Beneficiary Info

    What does EVV mean for me if I am covered by the Innovations or TBI waiver? 

    Electronic Visit Verification (EVV) is a technology that allows caregivers to gather information by recording the time, dates and specific services caregivers provide to you in your home. Direct care staff will enter this information, using their own electronic device, within your home on the date of care. Some states, including North Carolina, are required to use EVV for certain home- and community-based services, including the NC Innovations and TBI Waivers. EVV helps us to make sure that you receive the services you need, in the approved location, on the correct dates and for the full length of time allowed.
     

    FAQ for Innovations and TBI Waivers

    Q. Will retainer services be included in EVV?

    A. Specific to the Innovations and TBI Waivers, retainer plans of care are excluded from the EVV mandate because an in-home visit is not made when a retainer agreement is in place.
    Waiver beneficiaries who are living with a paid caregiver, regardless of the type of service being provided (provider or Self-Directed), are excluded from the EVV mandate.

    Q. Will family-serving-family consumers including RaDSE be exempt from EVV requirements?

    A. Family members who provide services and who live in the same home as the beneficiary, including Relative as Direct Support Employee (RaDSE), are exempt from EVV requirements under these waivers.

    If a beneficiary has additional staff who are not live-In caregivers, those staff are subject to EVV.

    Q. Can providers of Innovations or TBI Waiver services submit EVV data directly to Sandata if they have their own EVV solution?

    A. Innovations providers will work with their respective LME-MCO and the LME-MCO vendor, HHAeXchange for EVV implementation.

    Q: Who do providers contact regarding EVV for the Innovations Waiver, Traumatic Brain Injury Waiver Services and (b)(3) services subject to EVV?

    A: Providers may contact their LME-MCO for EVV implementation. To ensure EVV implementation aligns with current billing processes for the Innovations and TBI waiver programs, as well as for (b)(3) services administered by LME-MCOs, EVV implementation of those programs is planned for June 30, 2021. An LME-MCO directory and information on the HHAeXchange are available for your use. 
     

    Provider Trainings

    Alt EVV Update, Dec. 17, 2020 

    EVV Presentation, Aug. 7, 2020

    HHAeXchange provider portal, including recorded trainings, any upcoming webinars 
     

    Links and Contacts

    NC Medicaid Innovations Waiver

    NCDHHS Traumatic Brain Injury
     

    This page was last modified on 12/20/2022