Reminder: Electronic Visit Verification Implementation - Claim Adjudication Based on EVV Data Began June 1, 2021

NC Medicaid ended the pay and report period for Electronic Visit Verification (EVV) claims on May 31, 2021. Claims submitted for dates of Service June 1, 2021 and after will be required to validate EVV data prior to claims adjudication. There are two edits for EVV that will be applied if the claim submitted does not have the required EVV data. Once applied, these edits will pend for an identified number of days to allow for the issue to be resolved prior to denial of the claim. 


For claim lines with a Date of Service on or after 6/01/2021, the edit will pend for seven days then cut back units to the sum of the verified units.

Providers utilizing Sandata, the State’s EVV solution, should ensure that all visits are verified in the EVV portal prior to submitting claims. A visit with the status of verified, means there are no exceptions. Clearing or resolving all exceptions on an incomplete visit updates the visit status to ‘verified.’ Providers utilizing an alternate EVV (Alt EVV) solution may confirm verified visits with their vendor and may also view visits in the Sandata Aggregator.

For more information about EVV, please visit the NC Medicaid EVV webpage. Click the link here for more information on this Medicaid bulletin.

For questions please contact: