Electronic Visit Verification

The 21st Century Cures Act directs state Medicaid programs to require providers of personal care services and home health services to use an electronic visit verification (EVV) system to document services rendered. Federal law requires that providers use the EVV system to document the following information:

• Date of service
• Location of service
• Individual providing service
• Type of service
• Individual receiving service
• Time the service begins and ends

With Phase One of the EVV claims processing changes fast approaching, the Ohio Department of Medicaid (ODM) is announcing dates of the following six phases of the claims adjudication process.

Provider types and list of the specific services that fall into each phase below can be found here.

What is EVV?

EVV uses technology to electronically record when a caregiver begins and ends an in-home service with a Medicaid waiver participant. These systems require a device, such as a smartphone, GPS-enabled tablet, or landline, to collect the caregivers’ start and end times.

What services are subject to EVV validation for Ohio Medicaid?

The first phase, which includes home health services claims billed to ODM, will officially go into effect on March 1, 2025. At the time of this change, claims that require EVV must have a matching EVV visit record. Claims that do not match will be denied.

For claims with a date of service on or after June 1, 2025, claims submitted for Home Health Services that do not have a valid, matching EVV visit record on file with Sandata, will be denied:

For claims with a date of service on or after August 1, 2025, claims submitted for Private Duty Nursing, Nurse Assessment and Consult Services that do not have a valid, matching EVV visit record on file with Sandata, will be denied:

With full implementation expected by the end of the first quarter of 2026. Services and execution dates are listed in the chart.

Are there any exemptions to these services requiring EVV validation?

• Yes, per ODM, when the above codes are billed in the below scenarios, the claims are not subject to EVV validation:
  • Telehealth: Home Health and Private Duty Nursing services provided through telehealth and billed with the Place of Service Code – 02.
  • Live-in Caregiver: A direct care worker who lives in the same household as individual receiving services.
    • Direct care workers can request an exemption by submitting the Electronic Visit Verification Exemption Request.
    • This form can be located on the ODM EVV website.

What is the process for getting my claim adjusted, if it’s denied?

• If you receive notification of a claim denial, you should follow the steps below based on the reason for denial please read more here.

Questions?

ODM is working with Sandata, our EVV vendor, to make sure providers are ready for this change. Look for more communication about training sessions and resources from ODM as the phases progress. Refer to the ODM EVV webpage for additional details.

Quick Reference Materials

• Navigate Electronic Visit Verification FAQs
• Navigate Electronic Visit Verification Flier
• Navigate Electronic Visit Verification Overview Provider Training