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.
| Ohio Department of Medicaid: EVV Claims Adjudication Phases | ||||||
|---|---|---|---|---|---|---|
| Phase 1 March 1, 2025 | Phase 2 June 1, 2025 | Phase 3 June 1, 2025 | Phase 4 August 1, 2025 | Phase 5 October 1, 2025 | Phase 6 January 1, 2026 | Phase 7 March 1, 2026 |
| Billed to ODM FFS | Billed to Next Gen MCEs | Billed to DODD | Billed to ODM or ODA | Billed to MyCare | ||
| Home Health Services | Private Duty Nursing, Nurse Assessment and Consult | Home Health Services | Private Duty Nursing Nurse Assessment and Consult | IO, Level 1, Self Waiver Program Services | Ohio Home Care, Passport Waiver Services | Home Health PDN, Nurse Assessment and Consult, Waiver Services |
| *Based on claim line date of service | ||||||
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.
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.
Phase six, which includes Ohio Home Care and Passport waiver services claims billed to ODM or ODA, will officially go into effect January 1, 2026. 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.
Other payers will be phased in beginning on March 1, 2026, with full implementation expected by the end of the first quarter of 2026. Services and execution dates are listed in the chart.
Services Requiring EVV validation:
| Ohio MyCare and Medicaid PASSPORT Waiver Services Requiring EVV Validation | |||
|---|---|---|---|
| HCPCS | Description | Modifier(s | POS |
| T1019 | Personal Care Aid | All | 12 |
| T2025 | Choices Home Care Attendant | UB/U1 only (as of 07/01/24) *UA is no longer used by CareSource | 12 |
| T1002 | Waiver Nursing (RN) | All | 12 |
| T1003 | Waiver Nursing (LPN) | All | 12 |
| S5125 | Home Care Attendant | All | 12 |
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.