Electronic Visit Verification

NC Medicaid has moved the implementation of Electronic Visit Verification for specific Innovations, (b)(3) and traumatic brain injury services to August 31, 2021 in order to allow additional provider integration and engagement with HHAeXchange. Review the June 28, 2021 NC DHHS communication. 

What is Electronic Visit Verification? 

Electronic Visit Verification is a system that uses technology to record and confirm information about the delivery of services. This system uses time, date and location information from a cell phone, a home phone (land line), or an electronic fob to verify that Medicaid services and programs authorized by Partners are received by our members. EVV uses technology to record the times, dates and specific services that are given. This process makes sure that people who should receive services, in fact, receive them. 

Section 12006 of the 21st Century Cures Act requires that the North Carolina Department of Health and Human Services (NC 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. 

Updates 

August 2021: HHAeXchange has announced an update for providers. 

Background Information: Several of the North Carolina LME/MCOs have grouped service codes within one authorization for members to avoid sending multiple authorizations for members being serviced in the home versus in the community. 

What is expected from Providers: Do not schedule or confirm a visit with the “ALL” service code. When scheduling or confirming a visit, providers must select the appropriate service code and modifier combination that represents services being provided prior to billing. 

• Note: Any visit scheduled with a service code that is not covered by the authorization will display as PINK on the member’s calendar. Since the service code on the visits will not match the service code on the authorization, these visits will always be PINK. This does NOT stop you from billing, as authorizations are not required for billing. 

NC DHHS Electronic Visit Verification Guidance Document >
Revised June 23, 2021 

Services Impacted by Electronic Visit Verification (updated July 9, 2021) 

Specific to Community Living & Supports (CLS), there are two types of service delivery which are exempt from EVV: 

• CLS provided by a live-in caregiver (whether Relative as Direct Support Employee or another live-in caregiver). 
• CLS provided in Community-Only (does not begin or end at member’s home). 

NC DHHS has established new codes for these two types of service delivery which will allow the provider to submit billing directly to Partners (rather than through HHAeXchange). Those codes (inclusive of codes available to special populations) are listed in the table below. The new codes may be billed without an authorization for a temporary period. Please be aware that the RADSE and Community-Only codes will not show as counting against the member’s authorized units when expended. Therefore, providers will need to keep close records on units used so they do not exceed the authorization for Community Living and Support or 84 hours per week. Units are subject to post-payment review. 

Providers will submit all other Community Living and Support billing through HHAExchange using the existing CLS codes.