Medicaid Electronic Visit Verification (EVV) Reminder

Date: 11/23/21

Pursuant to Section 1903 of the Social Security Act (42 U.S.C. 1396b), the 21st Century Cures Act, in order to prevent a reduction in the Federal Medical Assistance Percentage (FMAP), AHCCCS was mandated to implement Electronic Visit Verification (EVV) for non-skilled in-home services (attendant care, personal care, homemaker, habilitation, respite) and for in-home skilled nursing services (home health). As a result, AHCCCS required EVV for personal care and home health services beginning January 1, 2021. If your agency is registered with AHCCCS as one of the provider types listed in the tables below and you deliver any of the services listed in any of the locations listed in the tables, you are subject to EVV and required to participate in order to continue to be paid when the soft edit timeframe ends. In mid-January, 2021, we confirmed that Sandata, the AHCCCS EVV Vendor, was rejecting service confirmations we submitted on your behalf due to its inability to accommodate modifiers. As a result, AHCCCS began working on a change to address the issue and in the interim, we suspended further submissions of service confirmations.

Starting 11/15/21, we resumed submitting EVV service confirmations to Sandata.

If you submitted a service confirmation to us for a date of service after 11/15/21 prior to 11/15/21, we ask that you please resubmit it.

Provider Type and Services

Provider DescriptionProvider Type
Attendant Care AgencyPT 40
Behavioral Outpatient ClinicPT 77
Community Service AgencyPT A3
Fiscal IntermediaryPT f1
Habilitation Provider PT 39
HomeHealth AgencyPT 23
Integrated ClinicPT IC
Non-Medicare Certified HomeHealth AgencyPT 95
Private NursePT 46

Services and Service Codes

ServiceHCPCS Service Codes
Attendant CareS5125
Companion CareS5135
HabilitationT2017
HomeHealth Services (aide, therapy, and part-time/intermittent nursing services)
NursingG0299 and G0300
Home Health AideT1021
Physical TherapyG0151 and S9131
Occupational TherapyG0152 amd S9129
Respiratory TherapyS5181
Speech TherapyG0153 and S9128
Private Duty Nursing
(continuous nursing services)
S9123 and S9124
HomemakerS5130
Personal CareT1019
RespiteS5150 and S5151
Skills Training and DevelopmentH2014

Places of Service and POS Codes

Place of Service DescriptionPOS Code
Home12
Assisted Living Facility13
Other99

As a reminder…

  • If you are subject to EVV, you need to complete training with Sandata, the AHCCCS EVV Vendor, or an *alternate vendor. The training must be completed by the identified EVV Administrator or Key Contact. This must occur immediately so please register, complete the required training and receive your welcome kit to begin the EVV process.
  • If your EVV Administrator or EVV key contact has changed, it’s IMPORTANT to report the change to Sandata by calling 855-928-1140.  Please make sure your current EVV Administrator key contact on file is correct.
  • For more information regarding the required Sandata training, visit this the Sandata websiteExternal Link.
  • The authorization process won’t change. For those services subject to EVV for which we require prior authorization, we will continue to review and respond to your requests as we do today. Authorizations will be automatically uploaded to Sandata for you to view. PLEASE NOTE: Prior to billing for services that require prior authorization, you must enter the visit information into Sandata or another *alternative vendor system.
  • For services which we do NOT require prior authorization, you will need to enter the visit information into the AHCCCS Service Confirmation PortalExternal Link.

EVV Claims Denials

  • We are currently allowed to apply soft claim edits, meaning we use specific codes on the Explanation of Payment to notify you the service is subject to EVV. We are not yet certain when AHCCCS will require the health plans to begin to actually deny claims, but feel it is coming soon. We will provide you as much notice as we can. We also encourage you to sign up for the AHCCCS Constant Contact email notification list to receive updates on recent developments for the EVV initiative.
  • If you are subject to EVV and do not participate after the soft claim edit period has expired, you can’t be paid for the services you deliver, so your participation is CRITICAL.
  • We’ve established two EVV denial codes that we are using during the soft claim edit period.
    • EX8i - DENIAL WOULD BE APPLIED IF NOT VERIFIED THROUGH EVV VISIT VERIFICATION
    • EX8h - NO EVV VISIT MATCH FOR MEDICAID ID

AHCCCS has developed a number of FAQs to assist you with the EVV process. Please visit the page for more information on the EVV process and requirements: https://www.azahcccs.gov/AHCCCS/Initiatives/EVV/.External Link

Additional Information

If you have questions regarding the information contained in this update, please feel free to contact our Provider Customer Service Center at 866-796-0542 or contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.