What is EVV and why do my claims fail because of it?
Electronic Visit Verification is the federally required electronic record of who delivered care, to whom, where and when. Claims fail when EVV data disagrees with the billed visit - a missed clock-in, a rounded time, or a visit recorded in one system but billed from another. The payer trusts the EVV record.
Why mismatches are so common
EVV problems are rarely fraud and almost always mechanical. A caregiver clocks in from the driveway instead of the doorstep. A visit runs eleven minutes long and the scheduling system rounds while the EVV system does not. A shift is edited in the AMS after the EVV record was created and the two never re-sync.
Each of these produces a claim that looks fine in your scheduling software and fails at the payer, because the payer is reconciling against the EVV aggregator rather than against your schedule.
Reconcile before submission, not after denial
The only reliable fix is a weekly reconciliation pass that compares scheduled hours, EVV-captured hours and authorized hours before the claim run - and holds the exceptions back for correction rather than submitting them and hoping.
People also ask
- Is EVV required for all Medicaid home care?
- EVV is federally mandated for Medicaid personal care and home health services under the 21st Century Cures Act. How it is implemented - which vendor, which aggregator - is decided by each state.
- What if a caregiver forgets to clock in?
- Most states allow a documented manual correction, but high correction rates draw audit attention. Reconcile exceptions weekly rather than at month end, while the caregiver still remembers the visit.
Last reviewed · Payer rules change and vary by state - confirm specifics against your payer.
Want this handled rather than explained?
Paradigm does this work for 4,000+ home care agencies. We are paid a percentage of what actually gets collected.
Related answers
How do I bill Medicaid for home care?
Enroll with your state Medicaid programme and contract with the managed care organisations that control authorizations in your area. Verify member eligibility, obtain prior authorization where required, capture EVV for every visit, and submit claims through a clearinghouse or the state portal. Rules vary substantially by state.
Why do home care claims get denied?
Most home care denials are created before submission, not during adjudication. The recurring causes are an expired or missing authorization, a mismatch between delivered and authorized hours, EVV data that disagrees with the billed visit, coverage that lapsed at redetermination, and wrong service codes or modifiers.