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 (DHHS) 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 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:
- 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. North Carolina DHHS 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 North Carolina Medicaid waivers listed below and you receive in-home care, you will be required to participate in the EVV system.
- State Plan Personal Care Services
- Community Alternative Program for Children (CAP/C)
- Community Alternative Program for Disabled Adults (CAP/DA)
- Innovations – Home and Community Based Services
- Traumatic Brain Injury (TBI)
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.
North Carolina DHHS EVV Provider Agency Survey (Due Nov. 30, 2020) – State Plan PCS and Community Alternatives Program (CAP) Providers
NC DHHS awarded a contract to Sandata Technologies, LLC on Sept. 24, 2020 and will begin using their services for Electronic Visit Verification (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 EVV Addendum
- NC DHB Alt EVV Addendum – FFS
- NC DHB Alt EVV Addendum – LME-MCO
- NC DHB Alt EVV Addendum – PHP
- Requirement Specification for Receipt of Alternate Electronic Visit Verification Systems Data (altEVV)Part of the Open EVV Series of Interfaces
Paid Live-In Caregiver
Webinar held Nov. 12, 2020
The following service codes will be required for EVV implementation effective Jan. 1, 2021.
State Plan PCS –
|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
- 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.
|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
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.
Training information for NCDHHS Electronic Visit Verification (EVV) Program
- NC Training Announcement
- EVV Provider Agency Training – Video Library
- Detailed Training Registration Process
- NCDHHS Sandata EVV Training Supplemental Materials Guide (Nov. 24, 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
Friday, May 21, 2021
March 9, 2021
Dec. 17, 2020
- EVV Stakeholder Presentation, Dec. 17, 2020
- Alt EVV Update, Dec. 17, 2020
- EVV Breakout Session 1, Dec. 17, 2020
- Stakeholder Breakout Session, Dec. 17, 2020
Oct. 22, 2020
- Electronic Visit Verification Payment Issues Identified - July 22, 2021
- Electronic Visit Verification Updates - June 28, 2021
- Electronic Visit Verification Implementation Update: Beginning of EVV Claim Adjudication, Alt EVV and Other Topics - June 9, 2021
- Paid Live-In Caregiver Electronic Visit Verification Exemption for CAP/C and CAP/DA Waiver Beneficiaries - May 28, 2021
- Electronic Visit Verification Stakeholder Meeting - May 14, 2021
- Electronic Visit Verification Implementation: Claim Adjudication Based on EVV Data Begins June 1, 2021 - April 30, 2021
- Electronic Visit Verification Implementation Update: Alternate EVV Solution Deadline for Compliance - April 16, 2021
- Electronic Visit Verification Implementation: Extension of Pay and Report Period - March 29, 2021
- Electronic Visit Verification for CAP/C and CAP/DA Waiver Beneficiaries - March 23, 2021
- Electronic Visit Verification Implementation for Innovations and TBI Waivers Administered by LME-MCOs - March 17, 2021
- Electronic Visit Verification Update: Alternate EVV Solution Deadline for Compliance - March 4, 2021
- Electronic Visit Verification Update: Implementation Flexibilities - Feb. 3, 2021
- Electronic Visit Verification Update: Implementation Flexibilities End Jan. 31, 2021 - Jan. 21, 2021
- Personal Care Services Policy 3L Posted for Public Comment - Jan. 19, 2021
- Electronic Visit Verification – Implementation Update - Dec. 31, 2020
- Electronic Visit Verification Training Reminder - Dec.17, 2020
- Electronic Visit Verification Stakeholder Meeting - Dec. 16, 2020
- Electronic Visit Verification and In-Home Caregivers - Dec. 16, 2020
- Provider Selection of Electronic Visit Verification Vendor Required for Jan. 1, 2021 Implementation -Dec. 11, 2020
- Electronic Visit Verification Billing and LME/MCO Update - Dec. 11, 2020
- Required Electronic Visit Verification Survey Deadline Extended - Dec. 3, 2020
- Span Dating Ends Jan. 1, 2021 for Providers Subject to Electronic Visit Verification - Dec. 1, 2020
- DHHS Awards Contract for Electronic Visit Verification - Oct. 2, 2020
Section 12006 of the 21st Century Cures Act requires that the North Carolina Department of Health and Human Services (DHHS) 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
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.
Alt EVV Update, Dec. 17, 2020
EVV Presentation, Aug. 7, 2020
HHAeXchange provider portal, including recorded trainings, any upcoming webinars